Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
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Gait Improvement after Botulinum Toxin Injection in a Patient with Piriformis Muscle Syndrome

이상근 증후군에서 보툴리눔 독소 주사 후 보행의 호전

  • Choi, Soojin (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Bang, Myeong Hwan (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Park, Jung Hyun (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine)
  • 최수진 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소) ;
  • 방명환 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소) ;
  • 박중현 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소)
  • Received : 2019.09.17
  • Accepted : 2019.11.17
  • Published : 2020.06.30
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Abstract

Piriformis muscle syndrome is a condition that causes direct muscle pain around piriformis muscle or sciatica from irritated sciatic nerve and the diagnosis remains debatable. The main treatment is symptomatic relief from conservative therapy such as medication and piriformis stretching exercise, and various therapeutic injections including local anesthetic, corticosteroid, botulinum toxin can be considered for diagnostic and therapeutic purposes. In this case, a 54-year-old male who had sciatica and gait disturbance showed piriformis muscle hypertrophy in the pelvis MRI. From imaging studies, electrodiagnostic study and physical examination, he was diagnosed with piriformis muscle syndrome. He underwent trigger point injection and botulinum toxin injection into the piriformis muscle, and pain and gait disturbance significantly improved. This case reports a case of piriformis muscle syndrome with clinical symptom of gait disturbance, which was improved by botulinum toxin injection.

Keywords

References

  1. Kirschner JS, Foye PM, Cole JL. Piriformis syndrome, diagnosis and treatment. Muscle Nerve 2009; 40: 10-18 https://doi.org/10.1002/mus.21318
  2. Durrani Z, Winnie AP. Piriformis muscle syndrome: an underdiagnosed cause of sciatica. J Pain Symptom Manage 1991; 6: 374-379 https://doi.org/10.1016/0885-3924(91)90029-4
  3. Benzon HT, Katz JA, Benzon HA, Iqbal MSJATJotASoA. Piriformis Syndrome Anatomic Considerations, a New Injection Technique, and a Review of the Literature. Anesthesiol 2003; 98: 1442-1448 https://doi.org/10.1097/00000542-200306000-00022
  4. Sayson SC, Ducey JP, Maybrey JB, Wesley RL, Vermilion DJP. Sciatic entrapment neuropathy associated with an anomalous piriformis muscle. Pain 1994; 59: 149-152 https://doi.org/10.1016/0304-3959(94)90060-4
  5. Al-Al-Shaikh M, Michel F, Parratte B, Kastler B, Vidal C, Aubry S. An MRI evaluation of changes in piriformis muscle morphology induced by botulinum toxin injections in the treatment of piriformis syndrome. Diagn Interv Imaging 2015; 96: 37-43 https://doi.org/10.1016/j.diii.2014.02.015
  6. Halpin RJ, Ganju A. Piriformis syndrome: a real pain in the buttock? Neurosurg 2009; 65: A197-A202 https://doi.org/10.1227/01.neu.0000335788.45495.0c
  7. Fishman LM, Anderson C, Rosner B. BOTOX and physical therapy in the treatment of piriformis syndrome. Am J Phys Med Rehabil 2002; 81: 936-942 https://doi.org/10.1097/00002060-200212000-00009
  8. Rodrigue T, Hardy RWJNC. Diagnosis and treatment of piriformis syndrome. Neurosurg Clin 2001; 12: 311-319 https://doi.org/10.1016/S1042-3680(18)30056-1
  9. Fishman LM, Dombi GW, Michaelsen C, Ringel S, Rozbruch J, Rosner B, et al. Piriformis syndrome: diagnosis, treatment, and outcome-a 10-year study. Arch Phys Med Rehabil 2002; 83: 295-301 https://doi.org/10.1053/apmr.2002.30622
  10. Fishman LM, Wilkins AN, Rosner B. Electrophysiologically identified piriformis syndrome is successfully treated with incobotulinum toxin a and physical therapy. Muscle Nerve 2017; 56: 258-263 https://doi.org/10.1002/mus.25504