HIP ISSN 1120-7000
Hip Int 2015; 25 (2): 172-175 DOI: 10.5301/hipint.5000219
ORIGINAL ARTICLE
Piriformis syndrome: treatment of a rare cause of posterior hip pain with fluoroscopic-guided injection Akif Albayrak, Rasit Ozcafer, Mehmet B. Balioglu, Deniz Kargin, Yunus Atici, Mehmet N. Ermis M.S. Baltalimani Bone Disease and Research Hospital, Istanbul - Turkey
ABSTRACT Introduction: Piriformis syndrome involves the irritation of the piriformis muscle due to various reasons that are primarily related to anatomical variation or sciatic nerve compression due to contraction caused by overuse. In this study, we aimed to define an injection method that is easy to apply, safe, simple and repeatable. Materials and Methods: We administered percutaneous lidocaine and depomedrol injections into the hips of 28 patients (14 men and 14 women) under fluoroscopic control. Bipolar injections of the piriformis muscle were performed at the medial pole, the intersection of the sciatic notch and the sacroiliac joint, and at the lateral pole of the femoral insertion region. Each injection was 5 cc, and the contrast agent was observed after the dyeing process. Results: Clinical examinations were performed before and 6 weeks after the injections. The average of Harris Hip Score increased from a pre-injection score of 44.5 to a post-injection score of 68.5, and the Visual Analog Scale scores decreased from 8.3 to 4.2 (p0.05). † Comparison of male and female. * Parziale et al.
In this study, our aim was to demonstrate that the bipolar injection of local anaesthetic and depomedrol is an effective treatment for PS and that orthopaedic surgeons can treat this condition simply via the use of fluoroscopy alone.
Materials and Methods In total 33 PS patients who were treated between August 2012 and September 2013 in our clinic were included in this case series study. We excluded 5 patients due to lack of follow-up. The diagnosis was made based on the presence of the pertinent symptoms and the absence of signs of any other diseases on x-ray and MRI. Anti-inflammatory drug treatment and stretching exercises were applied for a duration of 2 weeks to all patients. For the 28 patients whose complaints persisted (14 M, 14 F, average age 46.1, ages between 19 and 71), percutaneous lidocaine and depomedrol injections were applied to the hip under the control of fluoroscopy. The mean follow-up period was 6 weeks. The injections were applied bipolarly to the piriformis muscle. Clinical examinations were performed before and 6 weeks after the injections, and the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) results were documented. Injection technique The patient was placed on a radiolucent operation table in the prone position, and his/her gluteal region was sterilised via the local application of povidone-iodine. In the technique that we applied, AP fluoroscopy images were used to determine the injection location. Initially, the
© 2015 Wichtig Publishing
AP image was focused on the upper end of the femur, and major insertion edge of the piriformis muscle on the trochanter was injected with contrast agent using a 22-gauge 10-cm black spinal needle. After observing the dye in the tendon and confirming that no blood was entering due to negative aspiration, a 25% bupivacaine and depomedrol mixture in a volume of 5 ml was injected (Fig. 1). Following these steps, the fluoroscope was set to display the inferior end of the sacroiliac joint. After targeting the medial end of the muscle, contrast agent was injected 1.5-2 cm inferior to the sciatic notch in the lateral side of the sacrum. Finally, after observing the piriformis myogram on an x-ray and confirming that no blood was entering due to negative aspiration, a 25% bupivacaine and depomedrol mixture in a volume of 5 ml was injected (Fig. 2). After confirming post-injection relaxation of the region that was in pain prior to the injection via physical examination, the process was concluded. The mean number of x-ray shots per patient was 8 (range 6-10 x-ray shots) and included 4 shots of each end of the muscle. To ensure that no sciatic nerve irritation occurred, the patients were questioned regarding the occurrence of any sensations of electrical shocks or numbness spreading to the leg.
Results The average of HHS increased from a pre-injection value of 44.5 to a post-injection value of 68.5, and the VAS scores decreased from a pre-injection value of 8.3 to a post-injection value of 4.2 (p
Hip Int 2015; 25 (2): 172-175 DOI: 10.5301/hipint.5000219
ORIGINAL ARTICLE
Piriformis syndrome: treatment of a rare cause of posterior hip pain with fluoroscopic-guided injection Akif Albayrak, Rasit Ozcafer, Mehmet B. Balioglu, Deniz Kargin, Yunus Atici, Mehmet N. Ermis M.S. Baltalimani Bone Disease and Research Hospital, Istanbul - Turkey
ABSTRACT Introduction: Piriformis syndrome involves the irritation of the piriformis muscle due to various reasons that are primarily related to anatomical variation or sciatic nerve compression due to contraction caused by overuse. In this study, we aimed to define an injection method that is easy to apply, safe, simple and repeatable. Materials and Methods: We administered percutaneous lidocaine and depomedrol injections into the hips of 28 patients (14 men and 14 women) under fluoroscopic control. Bipolar injections of the piriformis muscle were performed at the medial pole, the intersection of the sciatic notch and the sacroiliac joint, and at the lateral pole of the femoral insertion region. Each injection was 5 cc, and the contrast agent was observed after the dyeing process. Results: Clinical examinations were performed before and 6 weeks after the injections. The average of Harris Hip Score increased from a pre-injection score of 44.5 to a post-injection score of 68.5, and the Visual Analog Scale scores decreased from 8.3 to 4.2 (p0.05). † Comparison of male and female. * Parziale et al.
In this study, our aim was to demonstrate that the bipolar injection of local anaesthetic and depomedrol is an effective treatment for PS and that orthopaedic surgeons can treat this condition simply via the use of fluoroscopy alone.
Materials and Methods In total 33 PS patients who were treated between August 2012 and September 2013 in our clinic were included in this case series study. We excluded 5 patients due to lack of follow-up. The diagnosis was made based on the presence of the pertinent symptoms and the absence of signs of any other diseases on x-ray and MRI. Anti-inflammatory drug treatment and stretching exercises were applied for a duration of 2 weeks to all patients. For the 28 patients whose complaints persisted (14 M, 14 F, average age 46.1, ages between 19 and 71), percutaneous lidocaine and depomedrol injections were applied to the hip under the control of fluoroscopy. The mean follow-up period was 6 weeks. The injections were applied bipolarly to the piriformis muscle. Clinical examinations were performed before and 6 weeks after the injections, and the Harris Hip Score (HHS) and Visual Analogue Scale (VAS) results were documented. Injection technique The patient was placed on a radiolucent operation table in the prone position, and his/her gluteal region was sterilised via the local application of povidone-iodine. In the technique that we applied, AP fluoroscopy images were used to determine the injection location. Initially, the
© 2015 Wichtig Publishing
AP image was focused on the upper end of the femur, and major insertion edge of the piriformis muscle on the trochanter was injected with contrast agent using a 22-gauge 10-cm black spinal needle. After observing the dye in the tendon and confirming that no blood was entering due to negative aspiration, a 25% bupivacaine and depomedrol mixture in a volume of 5 ml was injected (Fig. 1). Following these steps, the fluoroscope was set to display the inferior end of the sacroiliac joint. After targeting the medial end of the muscle, contrast agent was injected 1.5-2 cm inferior to the sciatic notch in the lateral side of the sacrum. Finally, after observing the piriformis myogram on an x-ray and confirming that no blood was entering due to negative aspiration, a 25% bupivacaine and depomedrol mixture in a volume of 5 ml was injected (Fig. 2). After confirming post-injection relaxation of the region that was in pain prior to the injection via physical examination, the process was concluded. The mean number of x-ray shots per patient was 8 (range 6-10 x-ray shots) and included 4 shots of each end of the muscle. To ensure that no sciatic nerve irritation occurred, the patients were questioned regarding the occurrence of any sensations of electrical shocks or numbness spreading to the leg.
Results The average of HHS increased from a pre-injection value of 44.5 to a post-injection value of 68.5, and the VAS scores decreased from a pre-injection value of 8.3 to a post-injection value of 4.2 (p
