Visualizing Anatomic Variants of the Sciatic Nerve Using Diagnostic Ultrasound During Piriformis Muscle Injection: An Example of 4 Cases

• Published in: Journal of chiropractic medicine Vol. 21; no. 3; pp. 213 - 219
• Main Authors: Güleç, Gamze Gül, Kurt Oktay, Kübra Neslihan, Aktaş, İlknur, Yılmaz, Barış
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2022; Elsevier
• Subjects: Anatomic Variation; Case Report; Myofascial Pain Syndromes; Piriformis Muscle Syndrome; Sciatic Nerve; Ultrasonography; Myofascial Pain Syndromes; Anatomic Variation; Sciatic Nerve; Piriformis Muscle Syndrome; Ultrasonography
• ISSN: 1556-3707; 1556-3715
• DOI: 10.1016/j.jcm.2022.02.017

The aim of this article is to present examples of patients in whom piriformis muscle (PM) and sciatic nerve (SN) variations were detected by a diagnostic ultrasound (US)–guided examination and were successfully diagnosed and treated for piriformis syndrome (PS) by US-guided injections. This series includes 4 cases. In case 1, a 30-year-old woman with a 7 numeric rating scale (NRS) score for pain (on a 0-10 scale) was evaluated for complaints of left gluteal pain radiating to the thigh for 5 years and right gluteal pain for 2 years. Case 2 involves a 32-year-old man with a 7 NRS score presenting with left gluteal pain radiating to his leg for 1 year. The third case presents a 37-year-old man who had pain (6 NRS score), numbness, and discomfort radiating from the right hip to the leg that lasted for 7 years. Finally, in case 4, a 23-year-old male patient was examined with deep gluteal paresthesia and discomfort on the left side for 1 year. Diagnostic US evaluation of the gluteal region for each patient revealed anatomical variations of the SN. In 3 of the cases, corresponding contralateral US images demonstrated similar anatomic variations. Diagnosis of PS in each patient was made by US-guided injection. After the injection of 4 cm3 of lidocaine 2% into the PM, the patients’ complaints resolved almost fully. The anatomical variations of the SN and PM might be a facilitating factor for myofascial pain syndrome in PS. These cases demonstrate that SN variations could be visualized with the help of diagnostic US.