ABSTRACT
INTRODUCTION: Piriformis syndrome (PS) is a rare focal soft tissue rheumatic disease. Due to heavy rural work, we questioned whether PS was more prevalent in the rainy monsoon than in other seasons. In this pilot research, we studied the pattern of PS, the frequency of PS over the seasons, and whether there were typical preceding events. Methods: In this time-series descriptive study, PS cases diagnosed in a community-based clinic between January 2018 and December 2019 were enrolled. PS was diagnosed by clinical features and a 50% immediate pain relief from ultrasonogram-guided lidocaine (2%) injection in the piriformis muscle (PM). PS mimics were excluded. RESULTS: A total of 38 PS cases (11 males) were enrolled consecutively. In 2018, during dry winter (November-February), pre-monsoon (March-May), and rainy monsoon (June-October), nine, seven, and one PS cases were diagnosed, respectively; in 2019, the numbers were three, eight, and seven, respectively. Thus, over two years, 12 PS patients were diagnosed in dry winter, 15 in pre-monsoon, and eight in rainy monsoon. There was no correlation with the type of preceding events. There were no differences in the pattern of PS between the seasons. CONCLUSIONS: In this pilot study, over two years more new PS cases were observed in the pre-monsoon and dry winter than in the rainy season; this was not supporting our research question. There was no association with specific preceding events.
ABSTRACT
BACKGROUND: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. METHODS: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. RESULTS: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. CONCLUSIONS: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.
