Work-related piriformis syndrome treatment often involves doctors monitoring the patients' condition to see if symptoms improve. At this stage many injured workers are off work with a doctor's excuse or off work restrictions and are receiving worker's comp benefits called TTD benefits. When the insurance adjustor denies benefits, McCormick Law Office attorneys can advise on the best course of action to take for the best results under Wisconsin's worker's compensation law. Anti-inflammatory medications, such as ibuprofen and naproxen, are commonly used to treat the pain and inflammation caused by the irritation on the nerve. Acetaminophen or Tylenol can be used to treat the pain but will not control the inflammation. Physical therapy may be ordered to ease spasm and pain in the piriformis muscle. Exercises, particularly stretching exercises, are given to try and relieve irritation on the sciatic nerve.
If pain remains after these treatments, the doctor may suggest injections. In addition to diagnostic purposes, an injection of local anesthetic such as lidocaine can be injected into the muscle to temporarily relax it. This loosens up the muscle and reduces the irritation on the sciatic nerve. Other medications have also been injected into the piriformis muscle. Cortisone, for example, may be mixed with the anesthetic medication to reduce the inflammation on the sciatic nerve.
Botox injections can be used to actually paralyze the piriformis muscle. This makes the muscle relax, which helps take pressure off the sciatic nerve. The effect of the Botox injection isn't permanent; it generally only lasts a few months. In the meantime, however, it is hoped that a stretching program can be used to fix the problem. In other words, when the injection wears off, the muscle may have been stretched enough so that the symptoms do not return.
Surgery may be considered as a last resort for piriformis syndrome. One procedure involves cutting the piriformis tendon where it attaches on the greater trochanter or hip. The other method is to cut through the piriformis muscle to take pressure off the sciatic nerve. These procedures are usually done on an outpatient basis either under general anesthesia or a local.
The surgeon begins by making a small incision, usually about three inches long, in the buttock. The fibers of the gluteus maximus, the largest buttock muscle, are split. When the piriformis muscle and tendon can be seen, the surgeon then cuts (releases) the tendon where it connects to the greater trochanter. If more room is needed to release the pressure on the nerve, a portion of the piriformis muscle may be removed. This usually doesn't cause problems with strength because there are several much stronger muscles that help turn the leg outward.