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Injection therapy for pelvic soft tissue conditions: identification of the greater trochanter of the femur is a required step.

Article Excerpt
Soft tissue musculoskeletal conditions are common causes of pelvic and lower extremity pain. Injection therapy may provide relief in 2 of these conditions--piriformis syndrome and greater trochanteric pain syndrome (GTPS), or trochanteric bursitis--but a required step in the procedure for both conditions is identification of the greater trochanter of the femur. In this article, we describe the appropriate injection techniques.

Clinical syndromes

* Piriformis syndrome: The piriformis muscle lies deep in the gluteal region. It originates from the anterior sacral surface and then passes through the greater sciatic notch to insert on the greater trochanter of the femur, aiding in external rotation of the hip. Closely proximate to the piriformis is the sciatic nerve, although its relative position varies: its 2 major divisions (portions destined to be the tibial and common peroneal nerves) may both pass anterior and inferior to the muscle (in 85% of cases), split with either one (10% of cases) or both (fewer than 1% of cases) branches passing through the muscle, or split and encircle the muscle (2% to 3% of cases). (1) Contraction or compression of the piriformis muscle can lead to an entrapment neuropathy of the sciatic nerve (piriformis syndrome).

Patients with piriformis syndrome may note paralumbar, sacral, buttock, and leg pain. Pain may radiate down...

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