Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature

Andrea Santamato, Maria Francesca Micello, Giovanni Valeno, Raffaele Beatrice, Nicoletta Cinone, Alessio Baricich, Alessandro Picelli, Francesco Panza, Giancarlo Logroscino, Pietro Fiore, Maurizio Ranieri, Andrea Santamato, Maria Francesca Micello, Giovanni Valeno, Raffaele Beatrice, Nicoletta Cinone, Alessio Baricich, Alessandro Picelli, Francesco Panza, Giancarlo Logroscino, Pietro Fiore, Maurizio Ranieri

Abstract

Piriformis muscle syndrome (PMS) is caused by prolonged or excessive contraction of the piriformis muscle associated with pain in the buttocks, hips, and lower limbs because of the close proximity to the sciatic nerve. Botulinum toxin type A (BoNT-A) reduces muscle hypertonia as well as muscle contracture and pain inhibiting substance P release and other inflammatory factors. BoNT-A injection technique is important considering the difficult access of the needle for deep location, the small size of the muscle, and the proximity to neurovascular structures. Ultrasound guidance is easy to use and painless and several studies describe its use during BoNT-A administration in PMS. In the present review article, we briefly updated current knowledge regarding the BoNT therapy of PMS, describing also a case report in which this syndrome was treated with an ultrasound-guided injection of incobotulinumtoxin A. Pain reduction with an increase of hip articular range of motion in this patient with PMS confirmed the effectiveness of BoNT-A injection for the management of this syndrome.

Keywords: botulinum toxin type A; piriformis muscle syndrome; ultrasound guide.

Figures

Figure 1
Figure 1
Positioning of the probe initially with its lateral side medial to the greater trochanter (a) and finally positioned with its medial side lateral to the ischial tuberosity (b).
Figure 2
Figure 2
Ultrasound identification of the piriformis muscle between gluteus maximus muscle and ischial spine.

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