Injection of the piriformis muscle by fluoroscopic and electromyographic guidance.
BACKGROUND
There is not a universally accepted single technique for injection of the piriformis muscle that has validated exact placement of the needle tip within the piriformis muscle.


OBJECTIVE
We sought a methodology that would precisely document needle placement within the piriformis muscle that is reliable, relatively uncomplicated, and reproducible.


METHODS
Patients with piriformis syndrome underwent injections of the piriformis muscle under fluoroscopic and electromyographic guidance. This technique used electrophysiological confirmation of needle placement within the piriformis muscle and image-guided identification of the piriformis muscle with radiopaque contrast media under fluoroscopy.


RESULTS
Using this methodology, injections on 17 occasions in 11 patients resulted in needle placement within the piriformis muscle.
Fishman
S M
SM
MGH Pain Center, Department of Anesthesia and Critical Care, Massachusetts General Hospital, Boston 02114, USA.
Caneris
O A
OA
Bandman
T B
TB
Audette
J F
JF
Borsook
D
D
D000077:Acetabulum / Q000000981:diagnostic imaging; D000200:Action Potentials / Q000502:physiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002081:Buttocks / Q000000981:diagnostic imaging / Q000294:innervation; D003287:Contrast Media; D004576:Electromyography; D005260:Female; D005269:Femur / Q000000981:diagnostic imaging; D005471:Fluoroscopy; D006801:Humans; D007273:Injections, Intramuscular; D007479:Iopamidol; D008297:Male; D008875:Middle Aged; D009046:Motor Neurons / Q000502:physiology; D018482:Muscle, Skeletal / Q000000981:diagnostic imaging / Q000294:innervation / Q000503:physiopathology; D009339:Needles; D009407:Nerve Block / Q000379:methods*; D059408:Pain Management; D015641:Radiography, Interventional; D015642:Radiology, Interventional; D012446:Sacroiliac Joint / Q000000981:diagnostic imaging; D012447:Sacrum / Q000000981:diagnostic imaging; D012585:Sciatica / Q000628:therapy
D003287:Contrast Media; D007479:Iopamidol