EMG in piriformis syndrome diagnosis: Reliability of peroneal H-reflex according to results obtained after surgery, Botox injection and medical treatment

Use of botulinum neurotoxin in the treatment of piriformis syndrome: A systematic review

“…5,10,13,16 However, two studies reported improvement in pain using descriptive terms or percentages; Najdi et al evaluated pain improvement with 7 patients having transient pain relief from botulinum toxin lasting one week to one month while Fishman 2002 reported 65% of the patients who received botulinum toxin having 50% or more pain improvement compared to 32% of patients in the triamcinolone and lidocaine group. 2,15 Only one study by Childers reported less than 3-point change of VAS from baseline for activities, intensity, spasm and distress. 14 For the randomized trials comparing botulinum toxins with other injectable medications, all the three studies demonstrated piriformis injection with botulinum toxin reduced pain to a greater extent than normal saline.…”

“…The number of botulinum toxin injection per patient was also heterogenous within studies and between studies. 2,16 In most of the seven studies, only one injection was administered to each patient. Nevertheless, the study by AleAl-Shaikh et al described up to 4 injections per patient while the study by Fishman 2004 had seven patients who received two injections.…”

“…Piriformis syndrome is a neuromuscular disorder that is presumed to involve the compression of the sciatic nerve at the level of the piriformis muscle. 1,2 In piriformis syndrome, pain is produced by the prolonged or excessive contraction of the piriformis muscle and a sciatic-like pain is commonly described. 2,3 There are many possible etiologies of piriformis syndrome including gluteal trauma, myofascial trigger points and anatomical anomalies.…”

“…1,2 In piriformis syndrome, pain is produced by the prolonged or excessive contraction of the piriformis muscle and a sciatic-like pain is commonly described. 2,3 There are many possible etiologies of piriformis syndrome including gluteal trauma, myofascial trigger points and anatomical anomalies. 4 Clinically piriformis syndrome poses both diagnosis and treatment challenges due to lack of clinical signs which are pathognomonic.…”

Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case

“…PS is classically diagnosed by detecting changes in amplitude and latency of the H-reflex, which are accentuated if compared in a neutral and stressful (flexion, adduction, and internal rotation) position of the hip. 19 Unfortunately, these changes are also present in CES and therefore cannot be used to differentiate these two pathologies. The optimal method of differentiating PS from CES was suggested by Di Lazzaro et al, who performed double determination of the central motor conduction time (CMCT), first as the difference between response latencies of cortical and paravertebral magnetic stimulation [CMCT(m)] and second as the difference between the latency of cortical motor evoked potential and the total peripheral conduction time calculated via F-wave latency [CMCT(f)].…”