Guided Injections of the Posterior Hip

  • Leon R. ToyeEmail author


This book chapter details various image-guided techniques used to inject potential sources of posterior extra-articular hip and pelvic pain. A discussion of relevant anatomy is first reviewed, with detailed color anatomic illustrations. Multiple radiographic images are included, demonstrating patient positioning, approach, and needle positioning. Pudendal nerve perineural injections are discussed in two separate locations: first near the ischial spinous process and second at the pudendal (Alcock’s) canal. Next, piriformis muscle injection techniques are explained with both fluoroscopic and CT guidance. Lastly, sacroiliac joint injections under CT guidance are reviewed. Injectate medicines, postinjection care, and possible complications are also discussed.


Image-guided injections CT (computed tomography) Fluoroscopy Posterior hip Pudendal nerve Obturator internus Piriformis Sacroiliac 



Special thanks to Michael Stadnick, MD (Radsource – Brentwood, Tennessee, USA) for creating the medical illustrations (Fig. 6.1a–c) for this chapter, used with permission.


  1. 1.
    Gajraj NM. Botulinum toxin a injection of the obturator internus muscle for chronic perineal pain. J Pain. 2005;6(5):333–7.CrossRefPubMedGoogle Scholar
  2. 2.
    Hough DM, Wittenberg KH, Pawlina W, Maus TP, King BF, Vrtiska TJ, et al. Chronic perineal pain caused by pudendal nerve entrapment: anatomy and CT-guided perineural injection technique. Am J Roentgenol. 2003;181:561–7.CrossRefGoogle Scholar
  3. 3.
    Mamlouk MD, van Sonnenberg E, Dehkharghani S. CT-guided nerve block for pudendal neuralgia: diagnostic and therapeutic implications. AJR Am J Roentgenol [Internet]. 2014;203(1):196–200. Scholar
  4. 4.
    Richard HM III, Marvel RP. CT guided pudendal nerve block. Open J Radiol. 2013;3(1):41–4.CrossRefGoogle Scholar
  5. 5.
    Robert R, Prat-Pradal D, Labat JJ, Bensignor M, Raoul S, Rebai R, et al. Anatomic basis of chronic perineal pain: role of the pudendal nerve. Surg Radiol Anat [Internet]. 1998;20(2):93–8. Scholar
  6. 6.
    Filler AG. Diagnosis and treatment of pudendal nerve entrapment syndrome subtypes: imaging, injections, and minimal access surgery. Neurosurg Focus [Internet]. 2009;26(2):E9. Scholar
  7. 7.
    Thoumas D, Leroi a M, Mauillon J, Muller JM, Benozio M, Denis P, et al. Pudendal neuralgia: CT-guided pudendal nerve block technique. Abdom Imaging. 1999;24:309–12.CrossRefPubMedGoogle Scholar
  8. 8.
    Benzon HT, Katz JA, Benzon HA, Iqbal MS. Piriformis syndrome: anatomic considerations, a new injection technique, and a review of the literature. Anesthesiology [Internet]. 2003;98(6):1442–8.\npapers2://publication/uuid/CD240315-78CD-4F56-96FC-D8D7E9A34BB8.CrossRefGoogle Scholar
  9. 9.
    Faubel C. Piriformis muscle injection with fluoroscopy [Internet]. 2013. p. 3–5.
  10. 10.
    Chen CPC, Shen C-Y, Lew HL. Ultrasound-guided injection of the piriformis muscle. Am J Phys Med Rehabil [Internet]. 2011;90(10):871–2.\npapers2://publication/doi/10.1097/PHM.0b013e31822de72c.CrossRefGoogle Scholar
  11. 11.
    Smith J, Hurdle MF, Locketz AJ, Wisniewski SJ. Ultrasound-guided piriformis injection: technique description and verification. Arch Phys Med Rehabil. 2006;87:1664–7.CrossRefPubMedGoogle Scholar
  12. 12.
    Ozisik P, Toru M, Denk C, Taskiran O, Gundogmus B. Ct-guided piriformis muscle injection for the treatment of piriformis syndrome. Turk Neurosurg [Internet]. 2013;3:471–7. Scholar
  13. 13.
    Filler AG, Haynes J, Jordan SE, Prager J, Villablanca JP, Farahani K, et al. Sciatica of nondisc origin and piriformis syndrome: diagnosis by magnetic resonance neurography and interventional magnetic resonance imaging with outcome study of resulting treatment. J Neurosurg Spine. 2005;2(2):99–115.CrossRefPubMedGoogle Scholar
  14. 14.
    Artner J, Cakir B, Reichel H, Lattig F. Radiation dose reduction in CT-guided sacroiliac joint injections to levels of pulsed fluoroscopy: a comparative study with technical considerations. J Pain Res. 2012;5:265–9.CrossRefPubMedPubMedCentralGoogle Scholar
  15. 15.
    Silbergleit R, Mehta B, Sanders WP, Talati SJ. Imaging-guided injection techniques with fluoroscopy and CT for spinal pain management. Radiographics. 2001;21(4):927–39. discussion 940–2.CrossRefPubMedGoogle Scholar
  16. 16.
    Klauser A, De Zordo T, Feuchtner G, Sögner P, Schirmer M, Gruber J, et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum [Internet]. 2008;59(11):1618–24. Scholar
  17. 17.
    D’Orazio F, Gregori LM, Gallucci M. Spine epidural and sacroiliac joints injections – when and how to perform. Eur J Radiol [Internet]. 2014;84(5):777–82. Scholar
  18. 18.
    Fritz J, Henes JC, Thomas C, Clasen S, Fenchel M, Claussen CD, et al. Diagnostic and interventional MRI of the sacroiliac joints using a 1.5-T open-bore magnet: a one-stop-shopping approach. AJR Am J Roentgenol [Internet]. 2008;191(6):1717–24. Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2019

Authors and Affiliations

  1. 1.RadsourceBrentwoodUSA

Personalised recommendations