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BOTOX and Physical Therapy in the Treatment of Piriformis Syndrome

2002; Lippincott Williams & Wilkins; Volume: 81; Issue: 12 Linguagem: Inglês

10.1097/00002060-200212000-00009

1537-7385

Loren M. Fishman, Christopher B. Anderson, Bernard Rosner,

Peripheral Nerve Disorders

Fishman LM, Anderson C, Rosner B: BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil 2002;81:936–942. Objective This study evaluates the efficacy of botulinum toxin A injections used in conjunction with physical therapy for the treatment of piriformis syndrome. Design This a double-blind, placebo controlled clinical trial using electrophysiologic criteria for patient selection and a visual analog scale to assess treatment efficacy in relieving pain. Results As measured on the visual analog scale, patients injected with botulinum toxin A experienced more relief from pain than patients receiving lidocaine with steroid (P < 0.05) and more relief than patients receiving placebo (P = 0.001). Conclusions Injection with botulinum toxin A is an effective adjunct to physical therapy in the treatment of piriformis syndrome. H-reflex prolongation by flexion, adduction, and internal rotation (FAIR test) beyond 1.86 msec (3 SD) of the mean is a clinical indication of piriformis syndrome.