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Next the doctor examines you by checking your posture, how you walk, and where your pain is located.
Your skin sensation, muscle strength, and reflexes are also tested because it is difficult to distinguish pain coming from the sacroiliac joint from pain coming from other spine conditions.
If there is any question whether you might have an infection or some type of arthritis affecting multiple joints, laboratory tests may be ordered. A special type of MRI scan called neurography is being used more frequently to look at nerves. The most accurate way to tell if the piriformis muscle is the cause of pain is with a diagnostic injection into the muscle.
If you still have pain after trying these treatments, your doctor may suggest injections.The main use of injections is to see if your pain is from piriformis syndrome. Botulism injection therapy (also known as Botox® injections) can be used to actually paralyze the piriformis muscle.
These procedures are usually done on an outpatient basis, meaning that you will be able to go home the same day as the surgery.
The surgeon begins by making a small incision, usually about three inches long, in the buttock.
If more room is needed to release the pressure on the nerve, a portion of the piriformis muscle may be removed.
Ultrasound is another treatment choice that can be set for deep heating in the buttock area.
Hands-on treatments such as deep massage and specialized forms of soft-tissue mobilization may be used initially.
As your symptoms ease, your therapist will gradually advance your program to include posture training, muscle strengthening, and general conditioning. During therapy after surgery, your therapist may use treatments such as heat or ice, electrical stimulation, massage, and ultrasound to help calm pain and muscle spasm.
As the therapy sessions come to an end, your therapist helps you get back to the activities you enjoy. Neither the service provider nor the domain owner maintain any relationship with the advertisers.
The most common cause for sciatica is irritation of the spinal nerves in or near the lumbar spine. It connects to the sacrum, the triangular shaped bone that sits between the pelvic bones at the base of the spine.
It's still a mystery why the piriformis muscle sometimes starts to irritate the sciatic nerve.
Eventually the muscle heals, but some of the muscle fibers inside the piriformis muscle are replaced by scar tissue. Your doctor will ask questions about your symptoms and how the pain is affecting your daily activities. You may need to have blood drawn and give a urine sample to send to the laboratory for special tests.

X-rays can give your doctor an idea about how much wear and tear has developed in the sacroiliac joint. A magnetic resonance imaging (MRI) scan can be used to look at the lumbar spine and pelvis in much more detail and rule out other conditions in the area conditions. This uses a regular MRI scanner, but the computer settings are set to look for areas of irritation along a nerve. The muscle is deep inside the buttock, so the injection requires X-ray guidance with a fluoroscope, a CT scanner, or an open MRI machine. In some cases, doctors simply monitor their patients' condition to see if symptoms improve. After evaluating your condition, the therapist uses treatments to ease spasm and pain in the piriformis muscle. An injection of local anesthetic such as lidocaine can be injected into the muscle to temporarily relax it. This usually doesn't cause problems with strength because there are several much stronger muscles that help turn the leg outward.
Plan to attend physical therapy sessions two to three times each week for six to eight weeks. Your therapist may also position your hip and leg in a way that helps to relax nerve signals to the piriformis. In case of trademark issues please contact the domain owner directly (contact information can be found in whois). Many doctors think that the condition begins when the piriformis muscle goes into spasm and tightens against the sciatic nerve, squeezing the nerve against the bone of the pelvis.
The pain can radiate down the leg all the way to the foot and may be confused for a herniated disc in the lumbar spine. When they do sit down, they tend to sit with the sore side buttock tilted up rather than sitting flat in the chair. Your doctor will also want to know what positions or activities make your symptoms worse or better. X- rays of the lumbar spine and hips are also helpful to rule out problems in these areas that may look and act like sacroiliac joint problems.
The MRI scan uses magnetic waves rather than X-rays and shows a very detailed picture of the soft tissues of the body. This may change the way doctors use the MRI to diagnose nerve problems such as piriformis syndrome, thoracic outlet syndrome, and carpal tunnel syndrome. Once the needle is placed in the muscle, an anesthetic can be injected into the muscle to paralyze the piriformis muscle. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to treat the pain and inflammation caused by the irritation on the nerve.
Exercises, particularly stretching exercises, are given to try and relieve irritation on the sciatic nerve.
The first is to cut the piriformis tendon where it attaches on the greater trochanter (the bump on the side of your hip).

This gives the surgeon a way to see deep into the buttock and locate the piriformis muscle.
The deep heating effect of ultrasound is ideal for preparing the piriformis muscle for hands- on forms of treatment and for getting the muscle to stretch out. Your therapist will position you in ways that help you get a good stretch on the piriformis muscle.
You may need guidance on which activities are safe or how to change the way they go about their activities. This is because the sciatic nerve runs under (and sometimes through) the piriformis muscle on its way out of the pelvis. You will be asked about any injuries in the past and about any other medical problems you might have such as any arthritis that runs in the family. The tracers collect in areas where the bone tissue is reacting strongly to some type of stress to the skeleton, such as arthritis and infection of the sacroiliac joint. If the pain goes away after the injection, your doctor can be reasonably sure that the pain you are feel is from piriformis syndrome. Acetaminophen (for example Tylenol®) can be used to treat the pain but will not control the inflammation.
In the meantime, however, it is hoped that a stretching program can be used to fix the problem. The other method is to cut through the piriformis muscle to take pressure off the sciatic nerve. When the piriformis muscle and tendon can be seen, the surgeon then cuts (releases) the tendon where it connects to the greater trochanter.
Along with the stretches you'll do in the clinic, you'll be shown several ways to stretch the muscle on your own. Piriformis syndrome can be painful, but it is seldom dangerous and rarely leads to the need for surgery. The other end of the piriformis muscle connects by a tendon to the greater trochanter, the bump of bone on the top side of your hip.
The piriformis muscle can squeeze and irritate the sciatic nerve in this area, leading to the symptoms of sciatica. Cortisone, for example, may be mixed with the anesthetic medication to reduce the inflammation on the sciatic nerve.
In other words, when the injection wears off, the muscle may have been stretched enough so that the symptoms do not return. Most people with this condition can reduce the pain and manage the problem with simple methods, such as physical therapy. Cortisone is a potent anti-inflammatory medication that is commonly used both in pill form and in injections to treat inflammation.

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