I've been diagnosed with piriformis syndrome. I understand there isn't a good way to know for sure if that's what I really have (no tests outside of my symptoms). I also know if physical therapy doesn't help that I might be able to have an injection. What does the injection do and what are the side effects?
The sciatic nerve travels underneath the piriformis muscle in the deep buttock area. In some people, the nerve passes through the muscle belly. Prolonged or repeated contractions of the piriformis muscle compresses or irritates the sciatic nerve enough to cause pain, numbness, and tingling in the buttock. The symptoms may travel down the leg along the pathway of the sciatic nerve. This condition is called piriformis syndrome.
Treatment for piriformis syndrome starts with analgesics (pain relievers) and physical therapy. The therapist helps the patient change posture that might be contributing to the problem. Stretching the piriformis muscle often helps, as well as mobilizing the sciatic nerve. The therapist guides the patient through these steps, but in some cases, the painful symptoms persist.
Doctors turn to injections of the piriformis next. Steroids, local anesthetics (numbing agents), and botulinum toxin (BOTOX) may be used. BOTOX is a paralyzing agent that works temporarily to help stop piriformis muscle contractions. Side effects may depend on the type of injection performed.
Steroids can weaken the soft tissues leading to a delay in healing and further injury later. BOTOX is often accompanied by dry mouth. That doesn't sound like much but it can be very distressing. Sometimes local anesthetics are combined with other medications such as clonidine for more effective pain reduction. Clonidine blocks pain messages from going up the spinal cord to the brain. It can be accompanied by dizziness and low blood pressure.
With any injection, there is a risk of nerve damage, hematoma (bleeding), and temporary loss of motor function if the motor nerve (along with the sensory nerve) is injected by mistake. But most of the time, they provide short-term relief from the painful symptoms. Repeat injections may be needed to get the maximum benefit. If no improvement (or minimal improvement) occurs after three injections, the treatment is discontinued.