Cutting the piriformis

[frigator]

Completed my 2yr checkup with Dr Gross yesterday and metal ions are normal. I have had a tough recovery, starting having sitting pain at 5 months and now cant sit without pain. Have been to John Hopkins three times for testing and doctor visits and they have been unable to help.

From his examination yesterday he feels the piriformis muscle is impinging on the sciatic nerve when I sit on it and offered to cut the muscle. He explained when the muscle is cut and reattached it is shortened and sometimes spasms over the nerve. He said he has never done a piriformis cut as a separate procedure but cuts the piriformis all the time doing the hip resurfacing. Was wondering if anyone has had their piriformis cut or removed and what the outcome was. I am really needing to do something so I can once again sit but wonder if this is the right move?

[jimbone]

Frigator-

Sorry to hear of this difficulty.  It was actually a condition I was very concerned with myself prior to surgery and for a period after.  I knew prior how tight my periformis was and how it affected my sciatic nerve.  I considered it might be periformis syndrome where the nerve runs through the muscle and causes problems as a result.  My surgeon didn't think an MRI was needed prior to surgery and it turned out ok although it was one of the last muscles to respond to PT and stretching it eventually did.  I will still get an occasional twinge  in the buttock and ROM is still developing but I was fortunately spared sciatic problems.  Also PT felt it was the gluteus minimus that was the culprit which is where I would also suggest you consider looking at.  Are you/have you done PT?  Has there been a positive diagnosis it is a periformis issue?  Is there any way an increase in stretching/exercise might resolve it?  If you do need to do the surgical route, I would investigate "periformis syndrome" and surgical outcomes and then find someone that has done that surgery successfully many times.  Best of luck.

[frigator]

Thanks for the reply Jimbone. I of course started out with the simple bed excercise that Dr Gross prescribes. I was on the slow protocol so wasnt able to do full weight bearing for a number of weeks. I then swam every other day for the whole summer 2018 and then Dr Gross sent me to core PT at 7 months.. The PT made it worse and the stretching makes it worse. I also did Pelvic Floor PT this year for a number of months including some dry needling. That also made it worse. I finally just stopped doing anything except walking since march, 2019. That seemed to calm the nerves down some but still have had a terrible time with this no sitting and lost almost 40llbs. I am now eating a a lot trying to gain it back as I was already thin.

I am tempted to just let Dr Gross do the surgery? He spent almost an hour with me last week trying to find a way to help and that was his recommendation, cut the muscle. I am so burned out over this ordeal. Do I follow the recommendation of my surgeon? I have been reading this board for a few years and have never heard of Dr Gross doing a post surgical procedure like this.    We did a Mars Mri 10 months ago that was normal...they didnt comment on the piriformis.

I had a hard time doing the piriformis stretch as I have a high cup. Bringing the knee up past 90- 100 deg makes the femoral neck strike the cup. So Dr Gross told me to avoid the stretch and and do the band work for the short rotaters  I did those bands a number of months laying down as I could not sit, but once again it made it worse. So I dont know. I am trying to get a second opinion.

[frigator]

Update..... I talked to the nerve surgeon from Johns Hopkins on the phone this morning, Dr Rosson,  and he says Dr Gross's diagnosis is probably correct. Best thing to do is try a mri guided botox injection into the piriformis muscle and if the pain is reduced.. that is confirmation. Also 2 to 3 injections of botox over time may cure the problem.  So he went ahead and entered an order for me to have the mri guided Botox injection. Sounds like that is best way to go...try something conservative before another surgery? Any experience with injections such as this??

[frigator]

Had the BOTOX injections into the piriformis muscle at Johns Hopkins on Dec 20, 2019. Was painful but amazing as they put me in and out of the MRI machine to get the needle placed into the thin piriformis muscle. So they injected it about 4 times in different places and it was sore for two weeks. Doesnt look like it helped much. I dont really feel much improvement.

Yesterday, out of the blue, received a call from Dr Gross wondering why I hadn't scheduled the operation with him to cut the piriformis. I had last seen him for my 2yr checkup 3 months ago.  I told him about the botox and he revealed to me that he thinks he may have made the piriformis too tight while reattaching.  So is offering to remove it.

But the piriformis seems high on the butt cheek and all my pain is down low. Dr Gross is strongly recommending that I get the piriformis cut and removed. I was surprised to get his call but am thankful he remembers me and is concerned with my recovery. So really dont know what to do. Normally if you get no releif from the botox that means you dont have piriformis syndrome according to the Hopkins doc.  But my surgeon thinks otherwise

[jimbone]

Hey,

I had some concerns with this myself as I told you.  If the botox injections indicate no periformis syndrome, have you explored further PT and possible glute medius or minimus restrictions?  This seemed to be my condition and the muscles and functions are very close together.   OTTH- talking with Gross in regards to the success of a perifomis surgery with his other patients would be worth a chat as well as consulting with the other top guys.  Have you contacted Dr. Pritchett?  His knowledge of anatomy is pretty encyclopedic- it's a call I'd make.  Best of luck.

[Ljpviper]

I have a similar issue and also a Dr.Gross patient. I experienced pain in the glute out of no where 10 months after surgery. I went to see him twice and he dismissed me and said he he could find nothing wrong.

I have tried PT, cortizone injections, etc. I still have pain daily when I sit. I had my metal levels checked recently and cobalt was .5 and chromium was .7 very low as I am 4 years out of surgery. It's no wonder I could never get over the hurdle of having a pain free hip. I would feel good for a few days but the pain would always come back. I was very diligent about my hip excersises.

I sent an email to Dr. Gross's office yesterday. Let's see what he says.

[BKB41]

frigator,

Do you have any updates on your progress? Did you end up getting the piriformis muscle cut??