Piriformis Syndrome Injections

Piriformis syndrome is a relatively common and painful condition of the hip and buttocks. It is caused by an irritation of the sciatic nerve near the piriformis muscle, a narrow muscle located in the buttocks.

Sciatica, or pain along the sciatic nerve, refers to a set of symptoms that can have different causes. When the cause of the sciatic pain involves the piriformis muscle, it is called piriformis syndrome. The piriformis muscle and the sciatic nerve are close to each other as they pass through an opening in the pelvic bone and into the leg. A spasm or inflammation of the piriformis muscle can irritate the sciatic nerve and cause symptoms such as sharp pain that radiates from the lower back down the back of one leg, numbness, difficulty sitting down, and pain when the hip is rotated outward. 

If you are diagnosed with piriformis syndrome, your doctor may recommend an anti-inflammatory mecidine such as ibuprofin, a muscle relaxant, and physical therapy. If the pain persists, your doctor may refer you for a steroid injection, which will help reduce the pain and inflammation and enable progress with physical therapy. 

What to Expect From a Piriformis Syndrome Injection

Columbia's musculoskeletal radiologists use ultrasound to diagnose and treat piriformis syndrome. The real-time images allow us to precisely guide injections. Our experts perform hundreds of image-guided procedures each year, providing relief for piriformis syndrome and many other conditions.

How do I get ready for the procedure?

Your doctor will discuss which medications you may take on the days before, and on the day of, your procedure. Do not drink or eat anything for several hours before the procedure. Make sure you have someone to accompany you home after the procedure.

What will happen during the procedure?

When you arrive at our office, you will be escorted to the procedure room and asked to lie down on your stomach on the examination table. We will clean your back and buttock area and inject a numbing medicine into the area that will receive the injection.

We will then apply a small amount of warm gel to the area. The sonographer will glide the ultrasound transducer (wand) over your skin to capture images of the area. Using these images, the radiologist will direct a small needle into the affected area and inject a mixture of steroids and anesthetic into and around the piriformis muscle.

The needle will be removed and a sterile bandage will be applied. You will be monitored for at least 15 minutes after the injection. Some patients feel numbness in their legs for up to an hour, and we will make sure that you are able to walk before you go home. 

Are there any risks?

Piriformis syndrome injections are generally safe. In rare cases, an allergic reaction to the steroid medication may occur.

After the Procedure

You should avoid driving immediately after the procedure. You will be instructed to rest for the rest of the day. You can return to work and normal activities the next day.

You may feel immediate pain relief from the local anesthetic and then a return to your usual level of pain after a few hours when it wears off. Pain relief from the steroid may take several days.

It is normal to have a small amount of redness or swelling around the area of the injection, and you can apply an ice pack to the area for 20 minutes, two or three times a day.