title: Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin a and physical therapy.
abstract: Piriformis syndrome is entrapment of the sciatic nerve by the piriformis muscle.
  
  
  
  In this article we describe a 56-person randomized, double-blind, controlled study involving physical therapy and incobotulinum toxin A or placebo. Inclusion criteria were 3-SD delay of posterior tibial (PT) or fibular (FN) H-reflexes on flexion, adduction, and internal rotation (FAIR) testing, and normal paraspinal electromyographic findings. Outcome measures included adverse side effects, visual analog scale (VAS) findings, and H-reflex delay on the FAIR test.
  
  
  
  Mean intervention VAS score decreased significantly more compared with placebo at 2, 4, 6, 8, 10, and 12 weeks post-injection (P < 0.0001). FAIR test scores for PT, but not FN, decreased significantly more compared with placebo at 2, 4, 6, and 8 weeks post-injection (PT: P = 0.038, 0.003, 0.003, and 0.046). Adverse effects were minimal. VAS slope and PT FAIR test results varied significantly (P < 0.0001).
  
  
  
  Incobotulinum toxin A chemodenervation may be useful for treating piriformis syndrome as identified by the FAIR test. Muscle Nerve 56: 258-263, 2017.
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, 133 East 58th Street, New York, New York, 10022, USA.
authors.forename: Loren M
authors.initials: LM
authors.lastname: Fishman
authors.affiliation: Department of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons, 133 East 58th Street, New York, New York, 10022, USA.
authors.forename: Allen N
authors.initials: AN
authors.lastname: Wilkins
authors.affiliation: Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, USA.
authors.forename: Bernard
authors.initials: B
authors.lastname: Rosner
mesh_terms: D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D004568:Electrodiagnosis; D005260:Female; D005500:Follow-Up Studies; D006181:H-Reflex / Q000502:physiology; D006801:Humans; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D055958:Piriformis Muscle Syndrome / Q000188:drug therapy / Q000503:physiopathology / Q000534:rehabilitation; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D064232:Visual Analog Scale
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A; C545476:incobotulinumtoxinA
keywords: FAIR test; botulinum; clinical trial; electrodiagnosis; physical therapy; piriformis; sciatica