title: Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study.
abstract: BACKGROUND
  Piriformis syndrome (PS), which is characterized by pain radiating to the gluteal region and posterior leg, is accepted as one of the causes of sciatalgia. Although the importance of local piriformis muscle injections whenever PS is clinically suspected has been shown in many studies, there are not enough studies considering the clinical efficacy of these injections.
  
  
  OBJECTIVE
  To investigate the differences between local anesthetic (LA) and LA + corticosteroid (CS) injections in the treatment of PS.
  
  
  METHODS
  A prospective, double-blinded, randomized controlled trial.
  
  
  METHODS
  Physical medicine and rehabilitation department of a university hospital.
  
  
  METHODS
  Fifty-seven patients having unilateral hip and/or leg pain with positive FAIR test and tenderness and/or trigger point at the piriformis muscle were evaluated. Out of 50 patients randomly assigned to 2 groups, 47 patients whose pain resolved at least 50% from the baseline after the injection were diagnosed as having PS. The first group (n = 22) received 5 mL of lidocaine 2% while the second group (n = 25) received 4 mL of lidocaine 2% + 1 mL of betametazone under the guidance of ultrasound.
  
  
  METHODS
  Numeric Rating Scale (NRS) and Likert Analogue Scale (LAS).
  
  
  RESULTS
  No statistically significant difference (P > 0.05) was detected between the groups in NRS score values at resting (P = 0.814), night (P = 0.830), and in motion (P = 0.145), and LAS values with long duration of sitting (P = 0.547), standing (P = 0.898), and lying (P = 0.326) with evaluations at baseline, first week, and first and third months after the injection. A statistically highly significant (P < 0.005) reduction of pain was evaluated through NRS scores at resting (P = 0.001), in motion (P = 0.001), and at night (P = 0.001) and LAS values with long duration of sitting (P = 0.001), standing (P = 0.001), and lying (P = 0.001) in both of the groups.
  
  
  CONCLUSIONS
  Presumed limitations of this study include having a relatively small sample.
  
  
  CONCLUSIONS
  LA injections for the PS were found to be clinically effective. However, addition of CS to LA did not give an additional benefit. This gives us the idea that PS is mostly muscular in origin and responds well to both LA and LA+CS injections.
authors: Department of Physical Medicine and Rehabilitation, Koc University Hospital, Istanbul, Turkey; Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey;3Medical Park Hospital Gebze, Kocaeli, Turkey; Medicana Hospital Haznedar, Istanbul, Turkey.
authors: Tugce O
authors: TO
authors: Misirlioglu
authors: Kenan
authors: K
authors: Akgun
authors: Deniz
authors: D
authors: Palamar
authors: Meryem G
authors: MG
authors: Erden
authors: Tuba
authors: T
authors: Erbilir
mesh_terms: D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D000328:Adult; D000779:Anesthetics, Local / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007268:Injections, Epidural; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000188:drug therapy; D055958:Piriformis Muscle Syndrome / Q000000981:diagnostic imaging* / Q000188:drug therapy*; D011446:Prospective Studies; D016896:Treatment Outcome; D014463:Ultrasonography
chemical_list: D000305:Adrenal Cortex Hormones; D000779:Anesthetics, Local