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
Affiliations
Andrea Santamato
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
Maria Francesca Micello
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
Giovanni Valeno
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
Raffaele Beatrice
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
Nicoletta Cinone
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
Alessio Baricich
Physical Medicine and Rehabilitation, Department of Health Sciences, University of Eastern Piedmont, Novara 28100, Italy
Alessandro Picelli
Neuromotor and Cognitive Rehabilitation Research Center, Department of Neurological, Biomedical and Movement Sciences, University of Verona, Verona 37134, Italy
Francesco Panza
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy
Giancarlo Logroscino
Neurodegenerative Disease Unit, Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy
Pietro Fiore
Department of Basic Medicine, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari 70120, Italy
Maurizio Ranieri
Physical Medicine and Rehabilitation Section, "OORR" Hospital, University of Foggia, Foggia 71100, Italy
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.
