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Questions Regarding a Comparison of Techniques for Piriformis Muscle Injection

To the Editor: My colleagues and I read with great interest the paper on comparison of the efficacy of 2 imaging techniques for injection into piriformis muscle by Fowler et al. We have some questions regarding the methodology and statistical analysis techniques used in this study. First, we are unclear about the site of the ultrasound (US)-guided injection from the authors’ description of their technique. The long axis of the piriformis muscle is cephalad to the ischial spine, and we use this landmark routinely during scanning to avoid placement of the probe caudal to the belly of the piriformis. It is easy to confuse the piriformis with the other external rotators of the hip (superior and inferior gemelli and obturator externus) if the US probe is positioned too caudally. In the