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.

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.

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.

[Observation on therapeutic effect of round-sharp needle of new nine-needle and elongated needle for piriformis syndrome with triple puncture method].

OBJECTIVE: To compare the efficacy differences between round-sharp needle of new nine-needle and elongated needle for piriformis syndrome, and explore its action mechanism. METHODS: Eighty cases were randomly divided into a round-sharp needle of new nine-needle group (round-sharp needle group) and an elongated needle treatment group (elongated needle group), 40 cases in each group. The round-sharp needle group was treated with round-sharp needle (0.60 mm x 125 mm) at three points in piriformis with triple puncture method, while the elongated needle group was treated with elongated needle of ordinary specifications (0.32 mm x 125 mm) at three points in piriformis with triple puncture method. Besides, the two groups were also treated with routine acupuncture at Weizhong (BL 40) and Yanglingquan (GB 34), 3 times every week, 2 weeks as one course of treatment. After one course of treatment, the clinical effect was evaluated and the pain threshold values were measured before and after treatment in the two groups. RESULTS: The total effective rate in the round-sharp needle group was 92.5% (37/40), which was superior to 77.5% (31/40) in the elongated needle group (P < 0.05). Compared before treatment, the pain threshold values after treatment in two groups were improved significantly (both P < 0.01). The increment of pain threshold value in the round-sharp needle group was higher than that in the elongated needle group (P < 0.01). CONCLUSION: Round-sharp needle of new nine-needle is effective in treatment of piriformis syndrome and is better than ordinary elongated needle, which is related to that it can effectively increase pain threshold value of the local tissue.

Piriformis muscle syndrome: diagnostic criteria and treatment of a monocentric series of 250 patients.

OBJECTIVES: Piriformis Muscle Syndrome (PMS) is caused by sciatic nerve compression in the infrapiriformis canal. However, the pathology is poorly understood and difficult to diagnose. This study aimed to devise a clinical assessment score for PMS diagnosis and to develop a treatment strategy. MATERIAL AND METHODS: Two hundred and fifty patients versus 30 control patients with disco-radicular conflict, plus 30 healthy control subjects were enrolled. A range of tests was used to produce a diagnostic score for PMS and an optimum treatment strategy was proposed. RESULTS: A 12-point clinical scoring system was devised and a diagnosis of PMS was considered 'probable' when greater or equal to 8. Sensitivity and specificity of the score were 96.4% and 100%, respectively, while the positive predictive value was 100% and negative predictive value was 86.9%. Combined medication and rehabilitation treatments had a cure rate of 51.2%. Hundred and twenty-two patients (48.8%) were unresponsive to treatment and received OnabotulinumtoxinA. Visual Analogue Scale (VAS) results were 'Very good/Good' in 77%, 'Average' in 7.4% and 'Poor' in 15.6%. Fifteen of 19 patients unresponsive to treatment underwent surgery with 'Very good/Good' results in 12 cases. CONCLUSIONS: The proposed evaluation score may facilitate PMS diagnosis and treatment standardisation. Rehabilitation has a major role associated in half of the cases with botulinum toxin injections.

[Piriformis syndrome]. / Syndrome du muscle piriforme.

Sciatic pain is often misleading and establishing the link with a local muscular cause can be difficult and lead to errors, especially when faced with a young sportsman, with typical discogenic pain. Simple, specific and reproducible tests enable a better identification and treatment of a muscular cause or canal syndrome. Physiotherapy, or local infiltrations are generally very efficient, and sufficient. Surgery may be considered only in a very limited number of cases, lack of response to the first line treatment and then only if it is the absolute diagnosis, diagnosis which must remain a diagnosis of exception, more so of exclusion.