Botulinum Toxin Type A Use in Piriformis Muscle Syndrome

Abstract

VAS data suggest that intramuscular piriformis injection with 100 units of botulinum toxin type A can reduce pain to a greater extent than similar injections with vehicle alone.

Treatment of an Individual With Piriformis Syndrome Focusing on Hip Muscle Strengthening and Movement Reeducation: A Case Report

“…Previous clinical reports addressing piriformis syndrome have focused on multiple, concurrent treatment interventions and have emphasized stretching, 1,11,15,16,19,26,27,30 soft tissue mobilization, 1,5,11,15,16,19,30 electrophysical agents, 1,5,11,16,19 and medication and injections. 1,3,5,8,11,15,16,26,27,30 The overriding premise behind such interventions is that a shortened piriformis is responsible for creating compression on the sciatic nerve. 5,9,11,15,27,29,33 Although 2 previous authors addressed hip abductor weakness and 1 author noted that hip abductor strengthening "seemed to hasten recovery," 1,17 these authors offered no mechanism as to why strengthening would be effective.…”

“…1,3,5,8,11,15,16,26,27,30 The overriding premise behind such interventions is that a shortened piriformis is responsible for creating compression on the sciatic nerve. 5,9,11,15,27,29,33 Although 2 previous authors addressed hip abductor weakness and 1 author noted that hip abductor strengthening "seemed to hasten recovery," 1,17 these authors offered no mechanism as to why strengthening would be effective. After a review of the published literature, no studies were found that mentioned our proposed mechanism of injury or treatment approach.…”

“…[ case report ] syndrome is reported in the literature to include injections, 1,3,5,8,11,15,16,26,27,30 prescription of nonsteroidal anti-inflammatory drugs and muscle relaxants, 1,5,8,11,15,16,26,27 surgical release, 1,5,8,11,14,16 and referral to physical therapy. 1,5,11,15,20,27,30 The most commonly reported physical therapy interventions include ultrasound, 1,5,11,16,19 soft tissue mobilization, 1,5,11,15,16,19,30 piriformis stretching, 1,11,15,16,19,26,27,…”

“…1,5,11,15,20,27,30 The most commonly reported physical therapy interventions include ultrasound, 1,5,11,16,19 soft tissue mobilization, 1,5,11,15,16,19,30 piriformis stretching, 1,11,15,16,19,26,27,30 hot packs or cold spray, 5,11,15,16,19 and various lumbar spine treatments. 1,5,8,10,13,26,30 As noted above, a common assumption guiding physical therapy intervention for piriformis syndrome is that the piriformis is shortened or in spasm, creating compression of the sciatic nerve.…”

Brief review: Piriformis syndrome: etiology, diagnosis, and management

“…Botulinum toxin injections in PS 14,21,29,35,48,84,87,90,[102][103][104] Botulinum toxin type A is one of seven immunologically distinct serotypes (A-G) of neurotoxin produced by Clostridium botulinum. Botulinum toxin type A can be administered with fluoroscopic, electromyelographic, CT, or MRI guidance.…”