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

本報告提出一位因腰椎小面關節損傷引起梨狀肌肌筋膜疼痛症候群之慢性疼痛病例，並以腰椎小面關節類固醇注射方式使其達到完全緩解及止痛。患者爲46歲男性，主訴多年右側臀部疼痛及右腿麻痛。在一般診所接受口服止痛藥、一般物理治療及局部注射治療，但都只達到暫時性的緩解及減輕疼痛。經我們檢查後發現患者的腰椎小面關節受損爲造成其不適感的主因，便改以腰椎小面關節之物理治療處理。經治療後疼痛獲得明顯改善但亦不能完全緩解。後來，以L5-S1之小面關節局部注射，患者的疼痛即刻獲得完全的緩解，並持續超過一年以上。因此，對於某些梨狀肌肌筋膜疼痛症候群之慢性疼痛病例而言，腰椎小面關節損傷可能是壓迫坐骨神經或是造成梨狀肌肌筋膜激痛點的主因之一。針對腰椎小面關節的治療可以改善疼痛的症狀並使患者的症狀獲得長期完全的緩解。

關鍵字

注射；小面關節；梨狀肌肌筋膜疼痛症候群；坐骨神經痛

並列摘要

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.

並列關鍵字

injection ； facet joint ； piriformis myofascial pain syndrome ； sciatica

國際替代計量

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

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