Relapsing piriformis syndrome treated with botulinum toxin injections

• Published in: BMJ case reports Vol. 12; no. 8; p. e230981
• Main Authors: Ripellino, Paolo, Cianfoni, Alessandro, Izzo, Mikael Gian Andrea, Gobbi, Claudio
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 01-08-2019; BMJ Publishing Group
• Subjects: Adult; Botulinum toxin; Botulinum Toxins, Type A - administration & dosage; Case reports; Humans; Images In; Male; Neuroimaging; Neuromuscular Agents - administration & dosage; Pain; Piriformis Muscle Syndrome - drug therapy; Recurrence; botulinum toxin; pain (neurology); peripheral nerve disease; neuroimaging
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2019-230981

Piriformis syndrome should be suspected when more common conditions, such as S1 radiculopathy, sacroiliitis, facet arthropathy and lumbar disk disease, have been excluded by imaging.1 Moreover, MRI of the pelvic girdle is extremely helpful to assist the diagnosis, because it can show structural changes in the muscle,2 as in the present case. MRI demonstrated asymmetric hypertrophy of the right piriformis muscle (figure 1A) and was unremarkable in the lumbar spine.2 Conservative treatment with anti-inflammatory analgesic therapy, physical therapy and pregabalin 300 mg/day for 4 months did not lead to pain improvement. Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.