Piriformis steroid injection cpt code

I have been suffering with piriformus syndrome for the last year and the pain is excruciating. I have had several (over 8) injections of steroid, lidocaine and one of toradol. All of these injections have been done either under xtay in the hospital or under ultrasound in my Dr.’s office. Thay have not given much relief so i inquired about botox about 8 months ago. So i was referred to another Dr. In the same practice. I met with him 4 weeks ago and he thought i might get some relief with the botox. I was scheduled today and went in this morning. This Dr. Was going to have me lay on the table and give me a botox injection in my piriformus muscle. I asked how he was going to find it. He said by pushing to see where it hurt and then inject into the pirifomus till i told him where i feel the muscle jump. I told him i cannot tell by pushing on it. It doesnt hurt like that. Well he assures me that it takes skill to do these injections and he knows where the pirifomus muscle is. He left the room to mix my botox shot and i got even more nervous thinking to myself this is wrong. How is he going to be sure he’s injecting the right place and with botox of all things! When he came back i was almost in tears. I said im not so sure about doing this without ultrasound. I felt like an idiot and i was wasting his time. I apologized and said i would be more comfortable under ultrasound. He said he doesnt do ultrasound. So i decided to wait for the injection even though im in terrible pain. He said he would put my mixed needle in the fridge for next week so my other Dr. Can do it under ultrasound. My other Dr. Doesnt do botox injections so i dont know what will happen. This Dr. I saw today said that my original dr. Will give me a trigger point injection and i said ok but with the botox right? He said it doesnt matter whats in the needle. I said well ive been waiting for this botox for 8 months and of course it matters whats in the needle! Ive tried all the steroid and lidocaine etc and i want the botox to help ease my pain. He made me feel stupid. I know im not a dr but i believe that i made the right decision to not just let this man stick a needle full of botox in my butt without a 100% guarantee that it is in fact going in my piriformus muscle. I have no ides what he wrote in my file but he said that he agreed i shouldnt get the shot. Now i dont know if i insulted his intelligence by actions and words. So i have 2 questions for you #1 Do you think i made the right decision? And #2 will this mixed botox needle be ok in the fridge for a week till i can have the injection under ultrasound? Please respond to me. I am desperate and in pain and now im afraid that this Dr. Put some thing in my file that im paranoid or anxiety ridden. I was nervous today. I always am. I dont like needles. But i felt very torn today because i want that shot!

I too am in the same stage as you - I am off to see two hip surgeons on the 7th and 8th Dec to take their advice (8th is a second opinion and he is a research surgeon). I dont think this steroid is going to last at all, and my surgeon did say they don't always work if that gives you any comfort, and I too share your worries and am glued to all of these discussions!  I know with my own scan the MRI didn't show the osteoarthritis but my Xray did (and this is common apparently) - I have some tasty osteocytes . spurs etc - have you had this done? I had friends winding me up about the steroid not working as much as I had hoped but draw comfort from my scan (and my 1st surgeon's comments) if that is of help.

SOURCES:
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NHS Choices: Ankylosing spondylitis
NHS Tameside: Sacroiliac joint injections
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Hartung W, Ross CJ, Straub R et al. Ultrasound-guided sacroiliac joint injection in patients with established sacroiliitis: precise IA injection verified by MRI scanning does not predict clinical outcome. Rheumatology (Oxford) 2010;49(8):1479-82.
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Cotterill, J. (1888). "Stiffness of the great toe in adolescents." Br Med J 1: 1158.
Davies-Colley, M. (1887). "Contraction of the metatarsophalangeal joint of the great toe." Br Med J 1: 728.
Drago, J. J., L. Oloff, et al. (1984). "A comprehensive review of hallux limitus." J Foot Surg 23(3): 213-220.
Dutra, T. (2004) "Inside Insights on Orthotic Modification For Sports" Podiatry Today 17(10) October 2004 .
Hanft, J. R., E. T. Mason, et al. (1993). "A new radiographic classification for hallux limitus." J Foot Ankle Surg 32(4): 397-404.
Kravitz, S. R., LaPorta, G. A., Lawton, J. (1994). "Progressive staging classification of hallux limitus and hallux rigidus." Lower Extremity 1(1): 55-66.
Laird, P. O. (1972). "Functional hallux limitus." Illinois Podiatrists 9(4).
Lovejoy, C. O., B. Latimer, et al. (2009). "Combining prehension and propulsion: the foot of Ardipithecus ramidus." Science 326(5949): 72e71-78.
Pribut, S. (2010) "Challenging Running Injuries". Podiatry Management. January, 2010 (in press)
Roukis, T. S., P. M. Jacobs, et al. (2002). "A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus." J Foot Ankle Surg 41(2): 76-95.
Vanore, J. V., J. C. Christensen, et al. (2003). "Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: Hallux rigidus." J Foot Ankle Surg 42(3): 124-136.

Piriformis steroid injection cpt code

piriformis steroid injection cpt code

Cotterill, J. (1888). "Stiffness of the great toe in adolescents." Br Med J 1: 1158.
Davies-Colley, M. (1887). "Contraction of the metatarsophalangeal joint of the great toe." Br Med J 1: 728.
Drago, J. J., L. Oloff, et al. (1984). "A comprehensive review of hallux limitus." J Foot Surg 23(3): 213-220.
Dutra, T. (2004) "Inside Insights on Orthotic Modification For Sports" Podiatry Today 17(10) October 2004 .
Hanft, J. R., E. T. Mason, et al. (1993). "A new radiographic classification for hallux limitus." J Foot Ankle Surg 32(4): 397-404.
Kravitz, S. R., LaPorta, G. A., Lawton, J. (1994). "Progressive staging classification of hallux limitus and hallux rigidus." Lower Extremity 1(1): 55-66.
Laird, P. O. (1972). "Functional hallux limitus." Illinois Podiatrists 9(4).
Lovejoy, C. O., B. Latimer, et al. (2009). "Combining prehension and propulsion: the foot of Ardipithecus ramidus." Science 326(5949): 72e71-78.
Pribut, S. (2010) "Challenging Running Injuries". Podiatry Management. January, 2010 (in press)
Roukis, T. S., P. M. Jacobs, et al. (2002). "A prospective comparison of clinical, radiographic, and intraoperative features of hallux rigidus." J Foot Ankle Surg 41(2): 76-95.
Vanore, J. V., J. C. Christensen, et al. (2003). "Diagnosis and treatment of first metatarsophalangeal joint disorders. Section 2: Hallux rigidus." J Foot Ankle Surg 42(3): 124-136.

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