Ultrasound Guided Piriformis Injection with Confirmation of Needle Placement Through Electromyography

Abstract

Dear Editor: Piriformis syndrome is a controversial topic that consists of a constellation of symptoms that may mimic spondylosis, radiculopathy, sacroiliac joint pain, and facet arthropathy [1]. One of the modalities of piriformis syndrome treatment is direct injection of medication into the piriformis muscle belly [2]. Previous authors have reported various methods in performing piriformis injections: fluoroscopically, motor stimulation, and most recently, ultrasound (US) guidance [3–5]. We describe a case presentation and, to our knowledge, the first report of combined use of US with electromyography (EMG) confirmation of muscle placement for piriformis muscle injection. A 60-year-old male presented to our clinic with lower back, left hip, and left buttock pain for 6 years. The pain was sharp in quality and radiated toward the left lateral buttock and hip. The pain was rated 6/10 at initial presentation and was aggravated by prolonged sitting, squatting, and bending over. Pain was improved with rest. On examination, the patient demonstrated mild tenderness along the left lumbar spine and paraspinal muscles, as well as tenderness to palpation in the left lateral buttock area. Straight leg raise test was positive in the left lower extremity. Motor examination revealed full …