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Successful Ultrasound-Guided Dry Needling for Treatment of Piriformis Syndrome

ACTA MEDICA INDONESIANA · Vol. 57 No. 2 (2025)

ISSN
2338-2732, 0125-9326
Terbit
2025-07-08
Penerbit
The Indonesian Society of Internal Medicine
Bahasa
eng
Lisensi
creativecommons.org/licenses/by/4.0

Abstrak

Piriformis syndrome is an often overlooked cause of chronic buttock or low back pain, sometimes radiating to the posterior thigh. Despite various treatment options, a definitive standard therapy has not been established. Dry needling has recently gained attention as a non-pharmacological intervention, especially when guided by ultrasound to enhance accuracy and safety. A 69-year-old woman presented with a 9-month history of fluctuating right gluteal pain, aggravated by prolonged sitting and movements. Physical examination revealed tenderness in the piriformis area and positive provocative tests, with no neurological deficits. After failure of previous pharmacological and physiotherapeutic interventions, the patient underwent ultrasound-guided dry needling of the piriformis muscle. The procedure was performed using an in-plane technique with a 0.3 x 75 mm needle and elicited a twitch response. After two sessions, the patient reported a significant reduction in pain intensity from 7/10 to 2/10. Ultrasound-guided dry needling offers several benefits, including precise targeting of the piriformis muscle, avoidance of chemical agents, and reduced risk of adverse effects. The analgesic effect is attributed to inactivation of myofascial trigger points and neuromodulation involving reduced levels of substance P and calcitonin gene-related peptide. We conclude that ultrasound-guided dry needling appears to be a safe, effective, and minimally invasive option in the management of piriformis syndrome, particularly when conventional therapies fail.

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Metadata asli (oai_dc) 
<oai_dc:dc xmlns="http://www.openarchives.org/OAI/2.0/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:oai_dc="http://www.openarchives.org/OAI/2.0/oai_dc/" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xsi:schemaLocation="http://www.openarchives.org/OAI/2.0/oai_dc/  http://www.openarchives.org/OAI/2.0/oai_dc.xsd">
	<dc:title xml:lang="en-US">Successful Ultrasound-Guided Dry Needling for Treatment of Piriformis Syndrome</dc:title>
	<dc:creator>Darmawan, Guntur</dc:creator>
	<dc:creator>bin Mat Arshad, Anwar Samhari</dc:creator>
	<dc:creator>Wibowo, Suryo Anggoro Kusumo</dc:creator>
	<dc:subject xml:lang="en-US">interventional pain</dc:subject>
	<dc:subject xml:lang="en-US">piriformis</dc:subject>
	<dc:subject xml:lang="en-US">dry needling</dc:subject>
	<dc:subject xml:lang="en-US">ultrasound</dc:subject>
	<dc:subject xml:lang="en-US">syndrome</dc:subject>
	<dc:subject xml:lang="en-US">chronic buttock pain</dc:subject>
	<dc:subject xml:lang="en-US">myofascial trigger points</dc:subject>
	<dc:subject xml:lang="en-US">rheumatology</dc:subject>
	<dc:description xml:lang="en-US">Piriformis syndrome is an often overlooked cause of chronic buttock or low back pain, sometimes radiating to the posterior thigh. Despite various treatment options, a definitive standard therapy has not been established. Dry needling has recently gained attention as a non-pharmacological intervention, especially when guided by ultrasound to enhance accuracy and safety.
A 69-year-old woman presented with a 9-month history of fluctuating right gluteal pain, aggravated by prolonged sitting and movements. Physical examination revealed tenderness in the piriformis area and positive provocative tests, with no neurological deficits. After failure of previous pharmacological and physiotherapeutic interventions, the patient underwent ultrasound-guided dry needling of the piriformis muscle. The procedure was performed using an in-plane technique with a 0.3 x 75 mm needle and elicited a twitch response. After two sessions, the patient reported a significant reduction in pain intensity from 7/10 to 2/10.
Ultrasound-guided dry needling offers several benefits, including precise targeting of the piriformis muscle, avoidance of chemical agents, and reduced risk of adverse effects. The analgesic effect is attributed to inactivation of myofascial trigger points and neuromodulation involving reduced levels of substance P and calcitonin gene-related peptide. We conclude that ultrasound-guided dry needling appears to be a safe, effective, and minimally invasive option in the management of piriformis syndrome, particularly when conventional therapies fail.</dc:description>
	<dc:publisher xml:lang="en-US">The Indonesian Society of Internal Medicine</dc:publisher>
	<dc:date>2025-07-08</dc:date>
	<dc:type>info:eu-repo/semantics/article</dc:type>
	<dc:type>info:eu-repo/semantics/publishedVersion</dc:type>
	<dc:format>application/pdf</dc:format>
	<dc:identifier>http://www.actamedindones.org/index.php/ijim/article/view/2941</dc:identifier>
	<dc:source xml:lang="en-US">Acta Medica Indonesiana; Vol. 57 No. 2 (2025): Acta Medica Indonesiana; 273</dc:source>
	<dc:source>2338-2732</dc:source>
	<dc:source>0125-9326</dc:source>
	<dc:language>eng</dc:language>
	<dc:relation>http://www.actamedindones.org/index.php/ijim/article/view/2941/803</dc:relation>
	<dc:rights xml:lang="en-US">Copyright (c) 2025 Guntur Darmawan, Anwar Samhari bin Mat Arshad, Suryo Anggoro Kusumo Wibowo </dc:rights>
	<dc:rights xml:lang="en-US">https://creativecommons.org/licenses/by/4.0</dc:rights>
</oai_dc:dc>