Could dry needling change the kinematics of gait in individuals with piriformis muscle syndromes? Secondary analysis of a randomized controlled trial.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a condition that can lead to symptoms including gluteal pain, local tenderness, and limitation of hip joint motion in daily activities, and it may have a major impact on some daily functions such as gait. We proposed that dry needling (DN) can improve the gait of individuals with PMS. METHODS: Thirty-two individuals with PMS were assigned equally and randomly to the treatment group or the wait-list control group. Subjects in the treatment group received three sessions of DN of the piriformis muscle. All participants in both groups were educated to correct their lifestyles. The outcome measures were the gait-related parameters (walking speed, peak hip flexion, peak hip extension, time to peak internal and external hip rotation, and knee sagittal range of motion), which were evaluated at baseline and after treatment. To compare different outcomes, analysis of covariance (ANCOVA) was used, with baseline as the covariance and groups as a factor. RESULT: After DN sessions, peak hip extension during gait showed a statistically significant difference [adjusted MD 1.9 (3.7-0.08), p < 0.05, d = 0.56 (0.1-1.28)] in favor of the DN group. Peak hip flexion, on the other hand, exhibited a marginal statistically significant difference [adjusted MD -3.2 (-6.51 to 0.01), p = 0.053, d = 0.44 (1.16 to -0.02)] compared to the control group. CONCLUSION: The findings suggest that participants in DN showed significantly greater peak extension angle of the hip during walking in individuals with PMS than in the control group.

Comparing radial extracorporeal shockwave therapy and corticosteroid injection in the treatment of piriformis syndrome: A randomized clinical trial.

OBJECTIVE: This study was designed to compare the effects of shockwave therapy and corticosteroid injection in the treatment of piriformis syndrome. METHODS AND MATERIALS: In this randomized clinical trial, thirty-five patients with piriformis syndrome were randomly divided into two groups of 18 in the shockwave group and 17 in the corticosteroid group. The Shockwave group underwent three sessions of shockwave therapy per week (2000 pulses per session with 5Hz frequency and pressure equal to 4 Bar) and the corticosteroid group underwent an injection of 40 mg methylprednisolone with 1 mL of 1% lidocaine under ultrasound guidance. All patients were assessed by SF-36 questionnaire and visual analogue scale (VAS). The SF-36 questionnaire was used to evaluate the quality of life before and 4 weeks after the intervention. VAS scale was used to evaluate pain before the intervention, and 1, 4, 8, and 12 weeks after the intervention. RESULTS: The baseline characteristics of the two groups were not significantly different. At the end of the study, both groups had a significant improvement in pain and quality of life compared to before the intervention. However, according to the VAS, in the shockwave group improvement was seen in the first follow-up while not seen in the corticosteroid group (P-value <0.001 and P-value 1.00, respectively). According to the SF-36 questionnaire, the overall score in both groups had a significant improvement (P-value <0.05). CONCLUSIONS: It seems that shockwave therapy and corticosteroid injection are both effective in the treatment of piriformis syndrome. There was no significant difference between the two groups in the quarterly follow-up. Because shockwave therapy is a relatively non-invasive treatment with fewer side effects, it can be useful to improve pain and the quality of life of patients with piriformis syndrome.

Errate: Effectiveness of Hydro-Dissection of the Piriformis Muscle Plus Low-Dose Local Anesthetic Injection for Piriformis Syndrome: A Report of 2 Cases.

The authors have discovered an error in their figures and have provided replacement figures which have been corrected. Specifically, the positions of "Lateral" and "Medial" were reversed, and the positions of "Ischium" and "Sacrum" were reversed. Additionally, the solid lines at the boundaries of each muscle and bone have been removed, and only the nerves have been marked with dotted lines, which is a common notation in ultrasound images. The authors would also like to add the following Acknowledgment: The authors are grateful to Tadashi Kobayashi and Yoshihiko Shiraishi for advising us on the accurate anatomy of ultrasound images. Reference: Mihiro Kaga, Takeshi Ueda. Effectiveness of Hydro-Dissection of the Piriformis Muscle Plus Low-Dose Local Anesthetic Injection for Piriformis Syndrome: A Report of 2 Cases. Am J Case Rep, 2022; 23: e935346. DOI: 10.12659/AJCR.935346.

Effectiveness of Hydro-Dissection of the Piriformis Muscle Plus Low-Dose Local Anesthetic Injection for Piriformis Syndrome: A Report of 2 Cases.

BACKGROUND Piriformis syndrome causes severe buttock and low back pain and numbness of the lower limbs, leading to difficulty in walking. The lack of unified diagnostic criteria for piriformis syndrome until 2018 made it difficult to diagnose; therefore, it is often underestimated, and some patients do not receive appropriate treatment. Treatment methods include local anesthetic injection, steroid injection, and local botulinum toxin injection. However, the most effective drug for the treatment of severe piriformis syndrome has not been established. This report aimed to propose a new and more effective treatment for piriformis syndrome with a minimal risk of adverse effects. CASE REPORT We performed ultrasound-guided hydro-dissection of the superficial and deep surfaces of the piriformis muscle under local anesthesia (a mixture of 18 mL of saline and 2 mL of 1% lidocaine) in 2 flexion, adduction, and internal rotation test-positive patients with tenderness of the piriformis muscle. In both patients, symptoms improved quickly after injection. One required hospital treatment but gradually returned to previous activities of daily living (ADL) status 5 days after admission and was then discharged. The other patient received 2 injections weekly to improve ADL status with continued lifestyle guidance. CONCLUSIONS Hydro-dissection by ultrasound-guided injection of a very low concentration of local anesthetic is effective and has lower risk of adverse effects, thus making it more convenient for the treatment of piriformis syndrome than conventional treatments, such as local anesthetics, steroids, and botulinum toxin injection.

Little needle-scalpel for piriformis syndrome: A protocol for systematic review and meta-analysis.

BACKGROUND: Piriformis syndrome (PS) is a condition in which the sciatic nerve is compressed when passing through the inferior mouth of the piriformis muscle, mainly caused by pain in one hip and leg. In severe cases, patients may experience severe buttock and lower limb pain, discomfort, difficulty walking, and claudication. It is estimated that the annual incidence of low back pain and sciatica is about 40 million cases, and the annual incidence of piriformis syndrome is about 2.4 million cases. The aim of this systematic review is to assess the effectiveness and safety of Little needle-scalpel therapy for Piriformis syndrome. METHODS: Two reviewers will electronically search the following databases: the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; China National Knowledge Infrastructure (CNKI); Chinese Biomedical Literature Database (CBM); Chinese Scientific Journal Database (VIP database); and Wan-Fang Database from the inception, without restriction of publication status and languages. Additional searching including researches in progress, the reference lists, and the citation lists of identified publications. Study selection, data extraction, and assessment of study quality will be performed independently by 2 reviewers. If it is appropriate for a meta-analysis, RevMan 5.4 statistical software will be used; otherwise, a descriptive analysis will be conducted. Data will be synthesized by either the fixed-effects or random-effects model according to a heterogeneity test. The results will be presented as risk ratio (RR) with 95% confidence intervals (CIs) for dichotomous data and weight mean difference (WMD) or standard mean difference (SMD) 95% CIs for continuous data. RESULTS: This study will provide a comprehensive review of the available evidence for the treatment of Little needle-scalpel with piriformis syndrome. CONCLUSIONS: The conclusions of our study will provide an evidence to judge whether Little needle-scalpel is an effective and safe intervention for patients with piriformis syndrome. ETHICS AND DISSEMINATION: This systematic review will be disseminated in a peer-reviewed journal or presented at relevant conferences. It is not necessary for a formal ethical approval because the data are not individualized. TRIAL REGISTRATION NUMBER: INPLASY2020110092.

A new treatment modality in piriformis syndrome: Ultrasound guided dry needling treatment.

Piriformis syndrome is a painful entrapment neuropathy caused by compression of the sciatic nerve under piriformis muscle for structural or acquired reasons. Myofascial pain syndrome is the most common cause. There are physical therapy modalities, stretching exercises, injection therapies and medical treatment approaches.In this case, we planned to demonstrate a different perspective to the treatment of piriformis syndrome with the ultrasound-guided dry needling treatment.

[Effect of elongated-needle by Hui-puncture method on piriformis syndrome].

OBJECTIVE: To observe the clinical effect of elongated needle by Hui-puncture method in the treatment of piriformis syndrome. METHODS: A total of 100 piriformis syndrome patients were randomly divided into routine acupuncture group (n＝50) and elongated needle by Hui-puncture method (Hui-puncture) group (n＝50). For patients of the routine acupuncture group, Huantiao (GB30), Juliao (GB29), Zhibian (BL54), Weizhong (BL40), Yanglingquan (GB34), Juegu (GB39) and Ashi-point on the affected side of the body were punctured with filiform needles for 30 min. And for those of the Hui-puncture group, elongated needles were respectively inserted into GB30 and Ashi-point. The treatment was conducted once every other day for 10 times. The visual analog scale (VAS) pain score and the severity scores of symptoms (hip pain, lower limb pain, walking ability, straight leg elevation test, piriformis muscle tension test, piriformis muscle tenderness, 0-15 points) were measured before and after the treatment. The therapeutic effect was assessed by Criteria for Diagnosis and Assessment of Therapeutic Effect of Syndromes or Illnesses of Traditional Chinese Medicine (1994). RESULTS: After the treatment, the scores of symptoms and VAS scores of both routine acupuncture and Hui-puncture groups were significantly decreased in comparison with their own pre-treatment (P<0.05), and the scores of the two indexes of the Hui-puncture group were evidently lower than those of the routine acupuncture group (P<0.05). Of the two 50 cases in the routine acupuncture and Hui-puncture groups, 39 and 47 were effective, with the effective rate being 78.00% and 94.00%, respectively. The comprehensive therapeutic effect of the Hui-puncture group was significantly superior to that of the routine acupuncture group (P<0.05). CONCLUSION: Elongated-needle by Hui-puncture method has significant effect in treating piriformis syndrome patients and is worthy of promotion.

Effect of piriformis injection on neuropathic pain.

OBJECTIVES: The aim of this study was to investigate the effect of a piriformis injection on neuropathic pain in patients with piriformis syndrome. METHODS: Thirty patients with unilateral hip and/or leg pain, a positive FAIR test (increased H-reflex latency with Flexion, Adduction and Internal Rotation), and a trigger point at the piriformis muscle were enrolled in this prospective study. All of the patients exhibited neuropathic pain scored according to the Douleur Neuropathique 4 (DN4) of ≥4 for at least 6 months. All of the patients received 4 mL of lidocaine 2%+1 mL of betamethazone to the piriformis muscle under the guidance of ultrasound. The Numeric Rating Scale (NRS), DN4, and the painDETECT (PD) questionnaire were used for outcome assessment. RESULTS: A statistically significant improvement was seen in all scores (p<0.001) when both first week and first month results were compared with the baseline values. Comparison of the first week results with those of the first month revealed a statistically significant improvement in only the NRS and PD scores (p<0.001). The greatest improvement in all scores was seen in the first week after the injection. A mild increase was seen in all scores at the first month compared to the first week. CONCLUSION: A piriformis injection was found to be effective for both somatic and neuropathic pain in piriformis syndrome patients. Long-term follow-up is needed in order to consider this option alongside other treatment alternatives, like botulinum toxin and myofascial release.

Ultrasound-guided dry needling decreases pain in patients with piriformis syndrome.

INTRODUCTION: Piriformis muscle syndrome (PMS) is a disorder that can lead to symptoms of buttock pain and limited hip-joint mobility, and may have an impact on quality of life. METHODS: Thirty-two patients with PMS were randomized to the treatment group, which included three sessions of ultrasound-guided dry needling (DN) of the piriformis muscle (n = 16), or a waitlist control group (n = 16). The primary outcome was pain intensity measured on the visual analog scale recorded at baseline and then at 72 hours and 1 week after treatment. RESULTS: At 1-week follow-up, pain intensity was significantly less in the DN group than in the waitlist control group (-2.16 [-1.01 to -3.32], P = .007) by an amount consistent with clinically meaningful improvement. DISCUSSION: The findings suggest that DN resulted in clinically meaningful short-term improvement in pain intensity of patients with PMS.

Evaluation of neural therapy effect in patients with piriformis syndrome.

BACKGROUND: The aim of this study was to explore the effect of neural therapy on pain and functionality in patients with low back pain due to piriformis syndrome. It also aimed to find out any possible links between the clinical changes and demographic features. METHOD: One hundred and two patients were randomly divided into two groups (neural therapy and control). All patients were given stretching exercises for the piriformis muscle. The patients in the neural therapy group additionally received 6 sessions of neural therapy. The visual analog scale (VAS) and Oswestry Disability Index (ODI) were noted before and after the treatment in both groups. RESULTS: The VAS and ODI improved in both groups. However, improvement of the VAS and ODI scores were more obvious in the neural therapy group. The changes of VAS and ODI values did not show any correlations with the demographic features. CONCLUSION: After the neural therapy, the patients with low back pain due to piriformis syndrome may have improvement in both pain and functioning.

Inyección ecoguiada del músculo piriforme. Un nuevo abordaje / Ultrasound-guided piriformis muscle injection. A new approach

El síndrome piriforme es una causa poco frecuente de dolor de espalda y miembros inferiores. Algunas de las opciones de tratamiento incluyen la inyección del músculo piriforme con anestésicos locales y corticoides. Se han descrito varias técnicas de inyección. Las técnicas ecoguiadas permiten la visualización directa del músculo y la inyección en tiempo real. Se presenta una serie de 5 pacientes cuya clínica es compatible con síndrome piriforme, que no han mejorado tras tratamiento farmacológico. Se optó por la inyección del músculo piriforme con anestésicos locales y corticoides mediante un nuevo abordaje ecoguiado más sencillo técnicamente, basado en la técnica estándar. En los 5 pacientes se apreció una mejoría del dolor medido por la escala verbal numérica tras la inyección. Solo en un caso se presentó como complicación una ciatalgia que mejoró espontáneamente en 10 días. En los demás pacientes no se observaron complicaciones tras la inyección. Se describe una variante de la técnica ecoguiada recomendada en la inyección del músculo piriforme, más sencilla de realizar, con un buen perfil de seguridad y con buenos resultados clínicos (AU)

Piriformis syndrome is an uncommon cause of buttock and leg pain. Some treatment options include the injection of piriformis muscle with local anesthetic and steroids. Various techniques for piriformis muscle injection have been described. Ultrasound allows direct visualization and real time injection of the piriformis muscle. We describe 5 consecutive patients, diagnosed of piriformis syndrome with no improvement after pharmacological treatment. Piriformis muscle injection with local anesthetics and steroids was performed using an ultrasound technique based on a standard technique. All 5 patients have improved their pain measured by numeric verbal scale. One patient had a sciatic after injection that improved in 10 days spontaneously. We describe an ultrasound-guided piriformis muscle injection that has the advantages of being effective, simple, and safe (AU)

Perisciatic Ultrasound-Guided Infiltration for Treatment of Deep Gluteal Syndrome: Description of Technique and Preliminary Results.

The objective of this study was to describe a perisciatic ultrasound-guided infiltration technique for treatment of deep gluteal syndrome and to report its preliminary clinical results. A mixture of saline (20 mL), a local anesthetic (4 mL), and a corticosteroid solution (1 mL) was infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles. Relative pain relief was achieved in 73.7% of the patients, with average preprocedural and postprocedural visual analog scale scores of 8.3 and 2.8, respectively. Fifty percent of patients reported recurrence of discomfort, and the average duration of the therapeutic effect in these patients was 5.3 weeks.

Piriformis syndrome: comparison of the effectiveness of local anesthetic and corticosteroid injections: a double-blinded, randomized controlled study.

BACKGROUND: Piriformis syndrome (PS), which is characterized by pain radiating to the gluteal region and posterior leg, is accepted as one of the causes of sciatalgia. Although the importance of local piriformis muscle injections whenever PS is clinically suspected has been shown in many studies, there are not enough studies considering the clinical efficacy of these injections. OBJECTIVE: To investigate the differences between local anesthetic (LA) and LA + corticosteroid (CS) injections in the treatment of PS. STUDY DESIGN: A prospective, double-blinded, randomized controlled trial. SETTING: Physical medicine and rehabilitation department of a university hospital. METHODS: Fifty-seven patients having unilateral hip and/or leg pain with positive FAIR test and tenderness and/or trigger point at the piriformis muscle were evaluated. Out of 50 patients randomly assigned to 2 groups, 47 patients whose pain resolved at least 50% from the baseline after the injection were diagnosed as having PS. The first group (n = 22) received 5 mL of lidocaine 2% while the second group (n = 25) received 4 mL of lidocaine 2% + 1 mL of betametazone under the guidance of ultrasound. OUTCOME ASSESSMENT: Numeric Rating Scale (NRS) and Likert Analogue Scale (LAS). RESULTS: No statistically significant difference (P > 0.05) was detected between the groups in NRS score values at resting (P = 0.814), night (P = 0.830), and in motion (P = 0.145), and LAS values with long duration of sitting (P = 0.547), standing (P = 0.898), and lying (P = 0.326) with evaluations at baseline, first week, and first and third months after the injection. A statistically highly significant (P < 0.005) reduction of pain was evaluated through NRS scores at resting (P = 0.001), in motion (P = 0.001), and at night (P = 0.001) and LAS values with long duration of sitting (P = 0.001), standing (P = 0.001), and lying (P = 0.001) in both of the groups. LIMITATIONS: Presumed limitations of this study include having a relatively small sample. CONCLUSION: LA injections for the PS were found to be clinically effective. However, addition of CS to LA did not give an additional benefit. This gives us the idea that PS is mostly muscular in origin and responds well to both LA and LA+CS injections.

A randomized comparison of the efficacy of 2 techniques for piriformis muscle injection: ultrasound-guided versus nerve stimulator with fluoroscopic guidance.

BACKGROUND: Piriformis muscle injections are most often performed using fluoroscopic guidance; however, ultrasound (US) guidance has recently been described extensively in the literature. No direct comparisons between the 2 techniques have been performed. Our objective was to compare the efficacy and efficiency of fluoroscopic- and US-guided techniques. METHODS: A randomized, comparative trial was carried out to compare the 2 techniques. Twenty-eight patients with a diagnosis of piriformis syndrome, based on history and physical examination, who had failed conservative treatment were enrolled in the study. Patients were randomized to receive the injection either via US or fluoroscopy. Injections consisted of 10 mL of 1% lidocaine with 80 mg of triamcinalone. The primary outcome measure was numeric pain score, and secondary outcome measures included functional status as measured by the Multidimensional Pain Inventory, patient satisfaction as measured by the Patient Global Impression of Change scale, and procedure timing characteristics. Outcome data were measured preprocedure, immediately postprocedure, and 1 to 2 weeks and 3 months postprocedure. RESULTS: We found no statistically significant differences in numeric pain scores, patient satisfaction, procedure timing characteristics, or most functional outcomes when comparing the 2 techniques. Statistically significant differences between the 2 techniques were found with respect to the outcome measures of household chores and outdoor work. CONCLUSIONS: Ultrasound-guided piriformis injections provide similar outcomes to fluoroscopically guided injections without differences in imaging, needling, or overall procedural times.