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  • Chapter 35 - Use of Botulinum Neurotoxin in the Treatment of Piriformis Syndrome

  • Edited by Daniel Truong, University of California, Riverside, Dirk Dressler, Hannover Medical School, Mark Hallett, National Institutes of Health (NIH), Christopher Zachary, University of California, Irvine, Mayank Pathak, Truong Neuroscience Institute
  • Book:
    Manual of Botulinum Toxin Therapy
    Published online:
    02 November 2023
    Print publication:
    23 November 2023, pp 290-298

  • Summary

    Piriformis syndrome is entrapment of the sciatic nerve by the piriformis muscle, causing sciatica. One estimate puts the incidence of sciatica of non-disc origin as equal to or greater than that of herniated disc. Symptoms of piriformis syndrome include buttock pain and tenderness and sciatica, with pain radiating distally. This chapter reviews the three main pathogenetic factors in the development of piriformis syndrome: anatomical variations, nerve compression and nerve adhesion. The approach to patient examination, and diagnosis using electrophysiogical methods (H-reflex), the FAIR test, electromyography and neural scanning using MRI are discussed.

    Injections of botulinum neurotoxin (BoNT) are a successful and largely innocuous treatment for piriformis syndrome. The application of BoN) types A and B is detailed, and injection techniques are illustrated with anatomical diagrams and dosing recommendations. The importance of injection guidance techniques, focusing on electromyography, is stressed.