Post-TKR Piriformis Syndrome - Cortisone Shot?

I have piriformis syndrome and have had it since 2002.
I have had four left hip surgeries an actebulum fracture and broke the pubic ramis. I have had one right hip replacement. My neurologist did an emg and the muscle remains contracted. The neurologist uses 200 mgs of Botox into the muscles and it last three months or longer. It’s very painful and common with hip replacements. We can’t stretch it out because I have a block in my left hip surgically implanted that keeps me from moving my hips certain directions.

I have not had any hip replacements as of yet...do have some mild arthritis in my left but this is on my right piriformis. Hopefully it resolves after the shot and the countdown. Think I messed it up stretching it to much at least I'm hoping.

This past Monday (4 days ago) I had a cortisone shot in my bursa that went to my piriformis. While the piriformis does feel about 60% better now I have some groin pain and pain right below my right buttocks. Any thoughts? I can't imagine cortisone flair this far out from the shot. It's mostly worse during the evening and when I sleep as opposed to the day. He did tell me to take my countdown after 3-4 days if not better to help more. Anyone have this issue? I really dont' want to go back and get a shot right into the muscle because I feel that the pain has moved from where it was to a different location. I do have some pain behind my right leg behind my thigh. Thanks for any info you may have.

Hi, I have had both my hip busars removed. I think the pain you're feeling is from your hip. I have to have a hip replacement and my symptoms are just like yours.
Thigh pain front and back, groin pain front and back, yes? It's probably the hip itself. Good luck God bless

Hello @cindymattern, I combined your new discussion with your first discussion on your piriformis muscle issues and your cortisone shot.

I updated the title a bit to help other members join your discussion, "Post-TKR Piriformis Syndrome - Cortisone Shot?" - https://connect.mayoclinic.org/discussion/piriformis-syndrome-1.

I have many lower joint issues as well (fused ankle, end-stage arthritis in other ankle and a total knee replacement that is 18 years old in my right knee). I know that when one area of my lower body is hurting that I subconsciously compensate and by doing so I disturb other joints or muscles. For me, this causes a "jumping around" of my pain points. They seem to go from one area to the next and so on.

How is your mobility during the day now that you are 4 days removed from your cortisone shot? Are you able to move more during the day and is your pain maybe "catching up" to you at night? I notice my pain and swelling most when I finally settle in for the evening and the day catches up to me.

Hello,
While I am at week 8 with Left TKR, and have encountered a completely inflamed left hip (glutes, periformis, trochanter etc). This has likely arisen from intense left sided therapy.
However, in my past, and extremely active, the hip area has flaired
I strongly suggest scheduling PT. They will get to the heart of the tightness in no time. (Tho a cortisone could give temporary relief).
Be well.

Mobility is fine during the day. Doesn't bother walking at all but my Apple Watch says I'm at a fall risk in the next 12 months as my walking is unstable (sometimes getting up from a chair takes a minute). I sleep on my side and back which probably does not help. This just started for me a few weeks ago and never an issue before. Not sure if I twisted wrong or lifted too much (taking trash out). The pain in the right buttock seems some better but there are times it really hurts. Interestingly though my feet do not tingle anymore after the first shot. He did say he could do one right in the muscle but need a driver for that one. I'm seeing him this next Friday again. Hoping I can walk on the treadmill Monday as I have a stress test.

@christine5 is right…groin pain is often related to a hip joint issue, and the pain is referred.

But there could be many potential causes of the pain you’re describing. For example, I have front of hip pain that occurs often with low back/sacral pain. It often refers down my groin, and I have pain behind my right leg and thigh like you described—it’s more like muscle pain.

The diagnoses (yep, plural) we settled on are: hip osteoarthritis (causes by hip dysplasia)—that’s causing the front of hip and groin pain, coccydynia (tailbone) and pelvic floor tension myalgia—my pelvic floor muscles are overly tight, which is causing the pain behind mg right leg.

All the above can also cause bursitis.

Specifically, I have the most tightness in the obturator internus muscles that run from the front of the pelvis to the back, behind the leg—that’s what’s causing the pain.

Totally confusing, right? The pain didn’t get better because I had the wrong diagnosis at the beginning. Injecting one muscle with cortisone if a different root cause is prompting the pain sometimes won’t help. Or the injection can refer pain to another part of your body.

You might want to give it a few more days to see if it calms down?

I’m not sure what type of provider you’re seeing, but I got the most accurate answers from a physiatrist (physician in physical medicine and rehabilitation specialty) as opposed to an orthopedist because they look more at the big picture, and a pelvic PT—they have much more specialized training in pelvic floor, hip, and low back pain.

Thank you....I was told one time I had
sacroillitis and have issues with Nsaids. I think I did this lifting a heavy bag into the trash (50-70lbs?). Right now the pain I mostly in my right butt cheek but it can radiate behind the right thigh. It helps sitting on a roller and rolling it. 4th day into methylprednisone and isn't helping. The shot in my bursa close to the piriformis did help like 60% and it isn't shooting pain anymore but it does hurt at times when I move it just right. I'm seeing a sports medicine guy and I love how he uses a portable ultrasound machine to look at things. He may give me another shot this next week when I go back as it's not resolved completely.

Hi tired,

I'm a little surprised that your hip has acted up in response to the TKR rehab. I didn't experience this and did all the exercises, every day as recommended.

Is at another problem with your hip, like osteoarthritis? I say this because I have osteoarthritis, hence the TKRs. I'm certain my hip joints are bone on bone. I know my shoulder joints are bone on bone. But my hips don't bother me at all, and didn't act up when I was doing TKR rehab. And you're right, the extensive rehab on one leg for a TKR could aggravate a compromised hip.

Just a thought as to what else might be the cause. I applaud you for doing so well with the TKR rehab. Hopefully that is going well. And I hope your hip settles down. I think it will.

Joe