Acute piriformis syndrome in a military pilot with chronic lumbar radiculopathy: A case report

Piriformis syndrome (PS) is a neuromuscular condition in which irritation or dysfunction of the piriformis muscle leads to compression of the sciatic nerve, resulting in radiating pain in the buttock and lower limb. Accurate diagnosis is often complicated by the clinical overlap between PS and other neurologic conditions such as lumbar radiculopathy or sciatica, as these disorders may present with similar symptomatology.

This case report describes the diagnosis and treatment of PS in a 37-year-old male military pilot. The patient had a history of lumbar disc herniation and experienced an acute tingling sensation in his left lower extremities following a high gravitational force (G-force) flight sortie.

PS was diagnosed based on ultrasonographic findings, which revealed a piriformis muscle thickness of 1.03 cm.

The patient initially underwent a blinded trigger point injection targeting the left piriformis muscle, which yielded partial pain relief. Nevertheless, due to ongoing radiating pain in the lower extremity, the patient was referred to a tertiary outpatient clinic, where an ultrasound-guided injection into the piriformis muscle was subsequently performed.

An ultrasound-guided piriformis injection was administered, leading to a significant decrease in pain and enabling the patient to resume flight sorties.

This case highlights the importance of accurately diagnosing and treating PS in patients with lumbar disc herniation and suggests that ultrasound-guided piriformis injection can be an effective treatment method.