Need images of a piriformis myogram

[Ligament]

Hi All,

Do you have any good images of a piriformis myogram under fluoro you could share with me? thanks

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[lobelsteve]

Hi All,

Do you have any good images of a piriformis myogram under fluoro you could share with me? thanks

Shoot me an email, I'll dl off the DICOM.

 

[PMR 4 MSK]

I find EMG-guided injection to be much easier and useful.

 

[lobelsteve]

I find EMG-guided injection to be much easier and useful.

Cost vs success?

1. How to differentiate EMG of piriformis vs surrounding muscles. How can we know you are in the piriformis vs surrounding muscles contracting.

2. Re-imburesement for EMG guidance- is it paid for for 355 via 20552 or sciatic nerve block?

3. Anyone do EMG and fluoro guidance to verify? THat would be a cool and definitive way of sorting it out.

4. Does it matter? Note the recent shoulder injection study said if you get close, you are close enough to make a therapuetic difference (kinda stinks knowing anyone can get a shoulder done right).

 

[drusso]

Cost vs success?

1. How to differentiate EMG of piriformis vs surrounding muscles. How can we know you are in the piriformis vs surrounding muscles contracting.

2. Re-imburesement for EMG guidance- is it paid for for 355 via 20552 or sciatic nerve block?

3. Anyone do EMG and fluoro guidance to verify? THat would be a cool and definitive way of sorting it out.

4. Does it matter? Note the recent shoulder injection study said if you get close, you are close enough to make a therapuetic difference (kinda stinks knowing anyone can get a shoulder done right).

Steve,

Send me a copy of the shoulder injection if you get a chance.

--DR

 

[Mister Mxyzptlk]

I have posted some pix here:
http://www.angelfire.com/planet/painkillah/pain_pictures/

It also includes a technique for super-easy piriformis injection. It's the first two pictures. If I weren't so lazy I'd flip one of them so they matched up side to side, but as it is, one shows left and the other right.

 

[lobelsteve]

Steve,

Send me a copy of the shoulder injection if you get a chance.

--DR

Looking for it now- I just came across Gruson's paper 2008 that kind of refutes the close is good enough paper.

 

[MN1]

Looking for it now- I just came across Gruson's paper 2008 that kind of refutes the close is good enough paper.

There's a couple ultrasound papers showing better short-term outcomes with US guidance vs. "blind" with shoulder subacromial injections. Not aware of any long-term data.