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Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin a and physical therapy
Author(s) -
Fishman Loren M.,
Wilkins Allen N.,
Rosner Bernard
Publication year - 2017
Publication title -
muscle and nerve
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.025
H-Index - 145
eISSN - 1097-4598
pISSN - 0148-639X
DOI - 10.1002/mus.25504
Subject(s) - medicine , placebo , anesthesia , sciatic nerve , piriformis syndrome , adverse effect , botulinum toxin , visual analogue scale , reflex , surgery , alternative medicine , pathology
Piriformis syndrome is entrapment of the sciatic nerve by the piriformis muscle. Methods In this article we describe a 56‐person randomized, double‐blind, controlled study involving physical therapy and incobotulinum toxin A or placebo. Inclusion criteria were 3‐SD delay of posterior tibial (PT) or fibular (FN) H‐reflexes on f lexion, a dduction, and i nternal r otation (FAIR) testing, and normal paraspinal electromyographic findings. Outcome measures included adverse side effects, visual analog scale (VAS) findings, and H‐reflex delay on the FAIR test. Results Mean intervention VAS score decreased significantly more compared with placebo at 2, 4, 6, 8, 10, and 12 weeks post‐injection ( P < 0.0001). FAIR test scores for PT, but not FN, decreased significantly more compared with placebo at 2, 4, 6, and 8 weeks post‐injection (PT: P = 0.038, 0.003, 0.003, and 0.046). Adverse effects were minimal. VAS slope and PT FAIR test results varied significantly ( P < 0.0001). Conclusion Incobotulinum toxin A chemodenervation may be useful for treating piriformis syndrome as identified by the FAIR test. Muscle Nerve 56 : 258–263, 2017