Management of a patient with myofascial pain syndrome (piriformis syndrome): clinical follow-up

The article considers a clinical case of treatment of one of the variants of myofascial pain syndrome – piriformis syndrome without signs of sciatic nerve neuropathy. The peculiarity of the case is the comorbidity of the opioid syndrome with diabetic sensorimotor polyneuropathy and osteoporosis, which required the appointment of complex therapy. The diagnosis was confirmed by additional research methods: spondylography, MRI of the lumbosacral spine, ultrasound of the piriformis muscle, electroneuromyography. A patient management tactic was chosen based on federal clinical guidelines for the treatment of patients with nonspecific back pain. Treatment included non-medicinal and medicinal methods. In order to relieve pain, dexketoprofen was prescribed 2 ml intramuscularly per 2 ml of 0.5% lidocaine solution – 1 time а day No. 2 – under navigation by ultrasound. Subsequently, the transfer was made to oral administration of 25 mg 3 times а day for 3 days. A step-by-step scheme of prescribing dexketoprofen: its introduction into the piriformis muscle with subsequent transfer to oral administration allowed to significantly reduce the severity of pain after 5 days of treatment. The complex effect on the spasmodic piriformis muscle with the help of a tableted muscle relaxant in combination with postisometric relaxation made it possible to quickly stop the pain syndrome and prevent its chronization. The administration of the preparation of thioctic acid pursued two goals: to improve the metabolism of the spasmodic muscle and restore the energy metabolism of peripheral nerves. As a result of the use of complex, pathogenetically based therapy, a positive effect was achieved.

Comparison of Gluteal Muscle Strengthening versus Conventional Isometrics in Pain Management of Piriformis Syndrome

Aim: To analyze the effectiveness of gluteal muscles strengthening in piriformis syndrome. Study design: Experimental study Place and duration of study: Department of Physiotherapy, Mayo Hospital, Lahore from 1st February 2019 to 31st July 2019. Methodology: Fifty patients presenting with piriformis syndrome were enrolled. They were divided in two groups. Control group received piriformis stretching, ultrasound and conventional isometrics. Experimental group received piriformis stretching, ultrasound and a gluteal strengthening program. The baseline parameters were assessed using the Visual Analogue Scale (VAS) and Manual Muscle Testing (MMT). Patients were treated for 40 minutes 3 times a week for 4weeks. Results: Reduction in intensity of pain as well as improvement in ROM was seen in both groups. There was significant improvement in lateral rotation of hip in experimental group, and as piriformis is also a lateral rotator of hip joint, hence improvement in range of lateral rotation shows that a gluteal strengthening program has significant in increasing ROM of joint. There was significant improvement in MMT grade of gluteal muscles comparatively in the experimental group. Conclusion: Experimental group showed improvements in decreasing pain and improvements in strength, with a significant improvement in lateral rotation shows that gluteal strengthening program can be used to treat pts with piriformis syndrome. Key words: Manual Muscle Testing, Visual analog scale

Pyomyositis of the Piriformis Muscle—A Case of Piriformis Syndrome

Piriformis syndrome is a rare cause of sciatica, which results in low backache due to sciatic nerve compression. This syndrome is associated with abnormalities in the piriformis muscle, which cause sciatic nerve entrapment, like anatomical variations, muscle hypertrophy, and inflammation. It can also result from the abnormal course of sciatic nerve itself through normal piriformis muscle. Piriformis syndrome due to pyomyositis of the piriformis muscle is extremely rare and only 23 cases are reported in literature. Herein, we report one such rare case of a patient, with pyomyositis of piriformis muscle, who presented with piriformis syndrome.

Acute piriformis syndrome mimicking cauda equina syndrome: illustrative case

BACKGROUND This report depicts a rare case of acutely developed urinary retention as well as sensory and motor disturbances caused by formation of a large hematoma within the piriformis muscle, which caused compression of nerves within the suprapiriform and infrapiriform foramina, thus imitating cauda equina syndrome. Although cases of acute lumbosacral plexopathy have been described, this case is the first time both urinary retention and sensory and motor disturbances were present. OBSERVATIONS The most useful tools for diagnosis of acute piriformis syndrome are detailed patient history, magnetic resonance imaging (MRI) of the pelvic region, and electrophysiological testing performed by an experienced electrophysiologist. As a result of diligent rehabilitation, including physiotherapy and electrostimulation, the patient was able to successfully recover, regardless of acute compression of the sacral plexus that lasted 6 days. LESSONS Clinicians should actively ask about previous pelvic trauma when taking a patient history in similar cases, especially if the patient is receiving anticoagulation treatment. If MRI of the lumbar spine does not reveal any pathologies, MRI of the pelvic region should be performed. Acute surgical decompression is crucial for preserving neurological function. In similar cases, it is possible to differentiate between spinal cord, cauda equina, and pelvic lesions using electrophysiological studies.