Fluoroscopic Guided Piriformis Injection


Piriformis muscle syndrome can mimic pain like sciatica, or the large nerve pain that produces sharp shooting pain down the leg. Piriformis muscle syndrome pain starts in the lower back and/or buttocks, sometimes feeling as if it’s deep inside the buttock muscles. It may be too painful to sit on the affected buttock. The pain and/or tingling can radiate down the backs of the legs as well


The piriformis muscle runs behind the hip joint and aids in external hip rotation, or turning your leg outward. The catch here is that the piriformis crosses over the sciatic nerve. The piriformis muscle can become tight from, for example, too much sitting (a problem many working people can relate to). The muscle can also be strained by spasm or overuse. In piriformis syndrome, this tightness or spasm causes the muscle to compress and irritate the sciatic nerve. This brings on lower-back and buttock pain, sometimes severe. The diagnosis is tricky because piriformis syndrome can very easily be confused with sciatica.

The difference between these diagnoses is that traditional sciatica is generally caused by some spinal issue, like a compressed lumbar disc. Piriformis syndrome becomes the go-to diagnosis when sciatica is present with no discernible spinal cause. Runners, cyclists and rowers are the athletes most at risk for piriformis syndrome. Other people that are risk are anyone who over pronates the foot in their gait. It can also be seen after treatment for spinal stenosis and/or neurogenic claudication with the mild® procedure as the once leaning forward walking motion is replaced with a straighter, more upright gait, thereby staining the sciatic nerve with the piriformis muscle.

What to Expect

Treatment of the syndrome is easy and straight forward. It is done on an outpatient basis usually in the office using fluoroscopy (x-ray) or ultrasound guidance. Proper placement of a single needle to the depth of the piriformis muscle, located deep to the gluteus Maximus and Minimus muscles in the buttock area is why imaging guidance is needed. Once access to the buttock area is obtained, the skin is prepped and skin numbed with the needle placed by way of imaging confirmation. Contrast may be used to ensure proper placement. Injection of local anesthetic to help relief of the pain and spasm (trigger point) of the piriformis muscle with steroid for the inflammation is undertaken and the spread noted via imaging. A band aid is used for dressing and physical therapy, home stretching and exercises are given.


Many patients note immediate relief after this injection. Outcomes for this procedure are excellent and usually only one or two injections, along with home therapy and exercises are all that are needed for prolonged relief. The spasm and sciatica type pain may recur and if not relieved by conservative management the injection can be repeated. Many mild® procedure patients note that after this injection they can now fully understand the benefit from the mild® procedure and the gait changes that is has produced, enabling them to walk straighter, longer, and with less pain now that the piriformis muscle syndrome has been treated.