Treatment of Piriformis Myofascial Pain Syndrome related to Lumbar Facet Lesion: A Case Report

This case report describes a patient with chronic pain due to piriformis myofascial pain syndrome related to lumbar facet joint lesion. The purpose is to demonstrate the elimination of the underlying etiological lesion by lumbar facet joint injection with steroid suspension for a complete and effective treatment of piriformis myofascial pain syndrome in order to obtain a permanent pain relief. A 46 year-old male patient had chronic pain in the right gluteal region and right leg (with tingling) for many years. Initially, he had been treated as piriformis syndrome with oral medicine, physical therapy and local injection, and had only temporary and incomplete pain relief. Finally, he visited our pain clinic and received physical therapy to the lumbar spine based on the presence of positive facet sign that reproduced his clinical symptoms. After physical therapy, he had pain relief much remarkably than before, but still incompletely. Then he received a lumbar facet joint injection at L5-S1 level. Immediately after the injection, he had pain subsided completely. This effectiveness lasted for longer than one year. It is concluded that, in some cases of piriformis myofascial pain syndrome is related to a lumbar facet joint lesion. Treatment of the lumbar facet joint can suppress the symptoms completely for a significantly long period. ( Tw J Phys Med Rehabil 2009; 37(2): 115 122 )