Ultrasound-Guided Injection of Botulinum Toxin Type A for Piriformis Muscle Syndrome: A Case Report and Review of the Literature.
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.
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. andrea.santamato@unifg.it.
Andrea
A
Santamato
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. francescami@live.it.
Maria Francesca
MF
Micello
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. gvaleno@libero.it.
Giovanni
G
Valeno
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. raffaelebeatrice@tiscali.it.
Raffaele
R
Beatrice
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. n.cinone@gmail.com.
Nicoletta
N
Cinone
Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara 28100, Italy. alessio.bar@gmail.com.
Alessio
A
Baricich
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona 37134, Italy. alessandro.picelli@univr.it.
Alessandro
A
Picelli
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy. geriat.dot@geriatria.uniba.it.|Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce 73039, Italy. geriat.dot@geriatria.uniba.it.|Geriatric Unit & Laboratory of Gerontology and Geriatrics, Department of Medical Sciences, IRCCS "Casa Sollievo della Sofferenza", San Giovanni Rotondo, Foggia 71013, Italy. geriat.dot@geriatria.uniba.it.
Francesco
F
Panza
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy. giancarlo.logroscino@uniba.it.|Department of Clinical Research in Neurology, University of Bari Aldo Moro, "Pia Fondazione Cardinale G. Panico", Tricase, Lecce 73039, Italy. giancarlo.logroscino@uniba.it.
Giancarlo
G
Logroscino
Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy. pietro_fiore@hotmail.it.
Pietro
P
Fiore
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy. maurizio.ranieri@unifg.it.
Maurizio
M
Ranieri
D019274:Botulinum Toxins, Type A / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007273:Injections, Intramuscular; D008297:Male; D008875:Middle Aged; D055958:Piriformis Muscle Syndrome / Q000188:drug therapy*; D000069453:Ultrasonic Waves
D019274:Botulinum Toxins, Type A
botulinum toxin type A; piriformis muscle syndrome; ultrasound guide