Piriformis syndrome: Clinical practice guideline for intervention Case Solution And Analysis, HBR Case Study Solution & Analysis of Harvard Case Studies

Piriformis syndrome: Clinical practice guideline for intervention Case Solution

Level 4

Approximately 20 patients were subjected to this research. In this study, the patients were injected with Botulinum toxic type B injections. After injecting the patients, the patients were taken the follow-up in the lower back and hip pain at 2, 12, and 16 weeks. It has been found that the 95% of the patients have shown a positive result after injecting treatment. It has shown that the botulinum toxic type B injection has shown the potential results in the pain treatment imputed to Piriformis syndrome. (Lang, 2004)

Level 3

In this clinical study, Twenty-nine patients were suspected ofPiriformis syndrome. These twenty-nine patients were divided into two groups. Group 1 consists of 20 patient’s whereas group 2 is divided into 9 patients. In 20 patients, Botulinum type A 150 U was injected by using CT guidance. Whereas the other 9 patients have injected with methadone 5mg and 1% Lidocaine. The patients were observed after few weeks that whether the visible change in patients is co-occurred or not. After taking the patient’s follow-up it has been concluded that Botulinum type A injected patients have seen the visible change in pain after 4 weeks whereas the patient’s injected with methadone has seen no visible change. (M.D., 2007)

Level 3

This study was suggested to determine the efficacy of CT-guided injection of anesthetic and corticosteroid for the pain treatment in patients suffering from Piriformis syndrome. For this purpose, we enrolled 23 patients suffering from PS, among them 13 patient’s inoculated to the methyl prednisone-lidocaine injection. Whereas the other 10 patients were refused to get any injected treatment. A clinical assessment was performed with four operations, such as:Lase’gue sign, Fair test, Beatty, Freiberg maneuver, and as well as assessment such as questionnaire were developed to check the patient’s progress before and after the treatment. It has been seen that after 2 months the patient’s showed the following follow-up;

2 out of 13 patients showed a positive result to fair test, whereas 2 patients were positive to Lase’gue sign, 1 patient was positive in Beatty maneuver. It shows that after 2 months the patients who undergo the treatment showed positive results in pain decrement whereas the other 10 patients remained unchanged. (Masala, 2011)

Level 5

This study has been conducted to review the ideal locations for the injection used in Piriformis syndrome with the help of modified sehilr’s method. This method was applied on 15 specimens. The study shows that the person suffering from the syndrome undergoing the injected treatment method can be applied on two positions, one is the greater trochanter and the other is the lateral part of the sacrum. It can also use several other effective agents other than botulinum toxin. These agents are:

Steroids
Anesthetic
Saline water

It has been shown that all of these agents show promising results in the injecting treatment method. Whereas the correct injecting placement for the syndrome, where the absorption is greater and results are efficient is one-fifth and two-fifths of the position of the sacrum to the greater trochanter.(Anat, 2020)

evel 2

This study has been conducted between eight patients (7 women’s, 1 man). They all are aged between 44 to 63 years. These patients were suffering from sacramental spine pain and having irritation in the legs. All of these patients were gone through the MRI diagnosing modality. According to the results, it has been shown that 1 patient was diagnosed with uterine myoma, whereas the other was shown with lesions in the lumbar spine (L4-L5) And (L5-LS) segment. All of these patients undergo fluoroscopy along with Xeomin, dexame thasone, and methamphetamine for therapeutic purposes.

The injected therapy of the syndrome concerning fluoroscopy technique has shown great results in the treatment of the Piriformis syndrome.

The therapeutic effects of these injections are given below:

Xeomin: It shows the effect after 4-12 months

Dexamethasone: 2-3 weeks

Betamethasone: up to 3 months

It shows that the patient inoculated dexamethasone has promising results followed by the other two drugs.

Apart from these three injections, the study has also highlighted the effectiveness of the botulinum therapy technique under the CT fluoroscopy which also shows promising results in treating the patients. (AL, 2020)

Grade B-Moderate evidence

After going through relevant articles and case studies, it has been shown that the injections have moderate effects on the treatment procedure of PS. However, It is a good practice to treat PS along with therapy for better results. The treatment procedure and duration of effects may vary from person to person depending upon the person’s condition.

2.4 Surgery

Level 4

In this case study, a 34-year-old was presented with right buttock pain, lumbering in the lower limb for the last 3 years. It has been found that there is no such evidence of any pain or trauma in the patient’s medical history. After examining the patient’s physically it has been seen that there is tenderness along the right posterior thigh to the right calf on pressing the right gluteal region. However, after performing several test studies such as stretch test and pace test it has been found that the patient had impaired dorsiflexion of the big toe.

The primer working analysis was Piriformis condition. The Nerve conduction study neglected to distinguish any irregularity. X-ray of the lumbosacral spine didn't uncover proof of neurological pressure. X-ray of the pelvis uncovered the presence of distorted strands of the privilegedPiriformis muscle foremost to its principle mass. The basic peroneal part of the privileged sciatic nerve seemed to fan out proximally and travel between the variant and principle muscle majority of the Piriformis

The patient went through surgery under broad sedation and MRI discoveries were affirmed. The normal peroneal part of the sciatic nerve was distinguished to enter between the principal mass and the distorted muscle strands of the Piriformis with a space noted at the infiltration site. It has been seen that the Neurological assessment and impression of the correct lower limb were ordinary without any complications. The patient had an emotional improvement of side effects. (Chin, 2020)

Level 4

In this clinical case practice, a sum of 19 patients was treated with Piriformis condition. It has been tracked down that these patients have pyramidal muscle conditions and are experiencing rear end and back thigh pain. In the wake of treating the patients with medical surgery, it has been tracked down that a normal of 8 patients had relief from discomfort, whereas the two-third of the patients were seen well after their tenotomy. (Indrekvam, 2002)

Level 4

In this clinical study, seven patients went through the removal of the Piriformis from the femur. Patients with remaining side effects after moderate treatment had sensational alleviation of sciatica and 70% continued standard work after a medical procedure. The last follow-up was 31 (normal: 51 months). The early finding can try not to delay ineffectual empiric treatment and inability with agreeable outcomes accomplished in many patients by traditionalist treatment and help of sciatica in selected surgical cases. (Foster, 2002)

Level 1

According to several studies, it has been found that the main cause of buttock and lower back pain is due to spasm in the Piriformis muscle. Four cases represent the treatment of Piriformis syndrome. All of these four patients were determined with lower leg and back pain. The major findings include tenderness in the buttock region extending from sacrum to greater enchanter. Whereas the minor findings include leg length discrepancy, weak hip abductors, and pain in a prolonged sitting position. For the treatment purposes, a rational schema is demonstrated that is the patient suffering from the syndrome may go to first physical therapy procedures, muscles stretching exercises, a trial of steroid injections and if all of these strategies failed, the patient then look up to surgery method. (M.Barton, 1991)

Level 3

The study has been conducted between three elderly individuals. One patient is 70 years old suffering from leg and buttock pain for the past 3 years. The second patient is 51 years old suffering from extended pain of the right hip towards the right leg for the past year. Whereas, the third patient is 39 years old suffering from right buttock pain from multiple years of history. All of these three patients are women. All of these women were diagnosed with PS and had been into therapies but does not get the proper results. The study has been conducted to proceed the women into surgeries.

After proceeding to surgery, all of the patients were asked to visit the clinic for a checkup at the appointed time.

Patient 1	Symptom-free after 12 months of period
Patient 2	Symptom-free after 12 months of period
Patient 3	Still having pain in the right hip and leg after 15 months of period

It has been shown that 3 out of 2 patients were seen symptom-free after 12 months of post-surgery and has sufficient results. Whereas the third patient does not seems better and shows sufficient results after even 15 months post-surgery. (Hogan, 2020)

Grade C-Weak Evidence

After going through several articles, it has been found that surgical treatment does not manifest promising result in the treatment of the syndrome. However, the surgery can be done in one of a thousand rare cases. Although having a surgery for this syndrome is quite not a good idea for the patient. The surgery can only be done when the patient is suffering from unbearable and excessive pain. The surgery may decompress the nerve and reduces the pain at the moment, but the efficient results are not predictable after going through a surgery. The person may feel pain and spasm after span of time. In short, it is good to reduce pain and treat this syndrome by doing exercises and medications and avoid getting surgeries.........................

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Piriformis syndrome: Clinical practice guideline for intervention Harvard Case Solution & Analysis