Jay Smith, MD, Mark-Friedrich Hurdle, MD, Adam J

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Presentation transcript:

Ultrasound-Guided Piriformis Injection: Technique Description and Verification Jay Smith, MD, Mark-Friedrich Hurdle, MD, Adam J. Locketz, MD, Stephen J. Wisniewski, MD Archives of Physical Medicine and Rehabilitation Volume 87, Issue 12, Pages 1664-1667 (December 2006) DOI: 10.1016/j.apmr.2006.08.337 Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 1 (A) Longitudinal view of the piriformis muscle using a 6-to-1–MHz curvilinear transducer. The piriformis (PIR) muscle–tendon is visualized as a thin, hyperechoic band passing medial (left) to lateral (right) toward the greater trochanter (GT). The piriformis travels deep to the gluteus maximus (GMAX) as it passes out of the superior greater sciatic foramen, formed anteriorly by the ilium. In this picture, the lateral sacrum would lie just off-screen to the left. (B) Transducer position relative to skeletal landmarks to obtain ultrasound picture shown in figure 1A. Abbreviation: RT PIR LG, right piriformis, longitudinal view (parallel to the long axis of the muscle). Archives of Physical Medicine and Rehabilitation 2006 87, 1664-1667DOI: (10.1016/j.apmr.2006.08.337) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 2 Transverse view of the sciatic nerve at the level of the quadratus femoris. The transducer is placed in an anatomic transverse plane at the level of the distal–lateral aspect of the ischial tuberosity. Here, the conspicuity of the hyperechoic sciatic nerve is increased as it passes between the hypoechoic quadratus femoris (deep) and gluteus maximus (superficial). The nerve can then be traced cranially to visualize its passage deep to the piriformis. Abbreviations: LAT, lateral; MED, medial; QF, quadratus femoris; RT QF LG, right side, quadratus femoris, longitudinal view (parallel to the long axis of the muscle); SCN, sciatic nerve. Archives of Physical Medicine and Rehabilitation 2006 87, 1664-1667DOI: (10.1016/j.apmr.2006.08.337) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 3 (A) Longitudinal US view of the piriformis during needle placement using a medial-to-lateral approach parallel to the long axis of the transducer. The proximal end of the needle has been digitally enhanced to highlight needle trajectory. (B) Postinjection tenogram at the level of the greater sciatic foramen. Anechoic injectate (FLUID) within the piriformis tendon sheath lies superficial and deep to the hyperechoic tendon. Abbreviations: RT PIR LG, right side, piriformis, longitudinal view; TIP, needle tip. Archives of Physical Medicine and Rehabilitation 2006 87, 1664-1667DOI: (10.1016/j.apmr.2006.08.337) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions

Fig 4 Piriformis tenogram/myogram obtained after needle placement using US guidance and contrast injection under real-time fluoroscopy. Contrast flow pattern documents accurate injection. Archives of Physical Medicine and Rehabilitation 2006 87, 1664-1667DOI: (10.1016/j.apmr.2006.08.337) Copyright © 2006 American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and Rehabilitation Terms and Conditions