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Category: Volume 06 Issue 04 April 2018
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Title: A Study to Observe the Clinical Improvement after Intervention at Piriformis Point Using Steroid and Local Anaesthetics in Patients with Chronic Piriformis Syndrome with Radiation to Lower Limb

Authors: Dr Siddhartha Sinha Ray, Dr Kshetra Madhab Das, Prof. (Dr.) Nityananda Kar

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.207

Abstract

Piriformis syndrome is believed to result from compression of the sciatic nerve around the piriformis muscle. Symptoms may include pain and numbness in the buttocks and down the leg. Intervention done by injecting steroid and local anaesthetic agents at the piriformis point is considered as a part of the important nonsurgical management of piriformis syndrome. The aim of this study was to observe the clinical improvement after piriformis point intervention using steroid and local anaesthetics in patients with chronic piriformis syndrome with radiation to lower limb. Twenty eight patients, a part from getting treatment with Non Steroidal Anti Inflammatory Drugs (NSAIDs), muscle relaxants, pregabalin, static spinal exercise, piriformis stretching exercise and local heat, received intervention at piriformis point with steroid and local anaesthetic. Patients were assessed by piriformis point tenderness, radiation, Straight Leg Raising test (SLR) and activity scores before and two weeks after intervention. Resultant data of twenty four patients who have completed the study were analysed in Statistica version6 software with appropriate statistical tools like Kolmogorov-Smirnov goodness-of-fit test, paired t test, frequency distribution. Significant improvement is noted  in all outcome measurement tool scores. Though piriformis on both sides have shown improvement, significantly better improvement of piriformis tenderness of intervention side over opposite side clearly indicates towards the direct effect of intervention locally while not ruling out its indirect systemic effect on the opposite side as well.

Keywords: Piriformis Syndrome; Steroid and Local Anaesthetics, Piriformis point Intervention.

References

  1. Di Giovanna EL, Schiowitz S, Dowling DJ, eds. An Osteopathic Approach to Diagnosis and Treatment. 3rd ed. Philadelphia, Pa: Lippincott Williams &Wilkins; 2005.
  2. Centers for Disease Control and Prevention. Prevalence of disabilities and associated health conditions among adults—United States, 1999 [published correction appears in MMWR Morb Mortal Wkly Rep. 2001;50:149]. MMWRMorb Mortal Wkly Rep. 2001;50:120-125.
  3. Pace JB, Nagle D. Piriformis syndrome. West J Med. 1976;124:435-439.
  4. Papadopoulos EC, Khan SN. Piriformis syndrome and low back pain: a new classification and review of the literature. Orthop Clin North Am. 2004;35:65- 71.
  5. Hallin RP. Sciatic pain and the piriformis muscle. Postgrad Med. 1983;74:69- 72.
  6. Chaitow L. Soft Tissue Manipulation: A Practitioner’s Guide to the Diagnosis and Treatment of Soft-Tissue Dysfunction and Reflex Activity. 3rd ed.Rochester, Vt: Healing Arts Press; 1988.
  7. Benson ER, Schutzer SF. Posttraumatic piriformis syndrome: diagnosis and results of operative treatment. J Bone Joint Surg Am. 1999;81:941-949.
  8. Te Poorten BA. The piriformis muscle. J Am Osteopath Assoc. 1969;69:150- 160.
  9. Foster MR. Piriformis syndrome. Orthopedics. 2002;25:821-825.
  10. Retzlaff EW, Berry AH, Haight AS, Parente PA, Lichty HA, Turner DM, et al. The piriformis muscle syndrome. J Am Osteopath Assoc. 1974;73:799-807.
  11. Hughes SS, Goldstein MN, Hicks DG, Pellegrini VD. Extrapelvic compression of the sciatic nerve. An unusual cause of pain about the hip: report of five cases. J Bone Joint Surg Am. 1992;74:1553-1559.
  12. Honorio T. Benzon, M.D.,* Jeffrey A. Katz, M.D.,Hubert A. Benzon, B.A., Muhammad S. Iqbal, M.D.Piriformis Syndrome Anatomic Considerations, a New Injection Technique, and a Review of the Literature Anesthesiology 2003; 98:1442–8 © 2003
  13. Fishman SM, Caneris OA, Bandman TB, Audette JF, Borsook D: Injection of the piriformis muscle by fluoroscopic and electromyographic guidance. Reg Anesth Pain Med 1998; 23:554–9
  14. Pinar Akdemır Ozısık1, Mustafa Toru2, C. Cem Den k3, Ozden O. Taskıran4, Begum Gundog mus4 CT-Guided Piriformis Muscle Injection for the Treatment of Piriformis Syndrome Piriformis Sendromu Tedavisinde BT Eşliğinde Piriformis Enjeksiyonu Turk Neurosurg 2014, Vol: 24, No: 4, 471-477
  15. Hee Seok Jeong, Guen Young Lee, Eu Gene Lee, Eu Gene Joe, Joon Woo Lee, Heung Sik Kang Long-term assessment of clinical outcomes of ultrasound-guided steroid injections in patients with piriformis syndrome Ultrasonography 34(3), July 2015
  16. W. Evan Rivers, Juan Francisco Asenjo, Myofascial Injections in Practical Management of Pain (Fifth Edition), 2014

Corresponding Author

Dr. Kshetra Madhab Das

Associate Professor, Dept of P.M. & R,

NRS Medical College & Hospital, Kolkata, India

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