Ultrasound-guided Dextrose Prolotherapy for Refractory Piriformis Syndrome: A Retrospective Study

Objective: Piriformis syndrome is a neuromuscular condition characterized by sciatic nerve compression by the piriformis muscle, resulting in buttock pain radiating to the posterior thigh. While physical therapy and corticosteroid injections are commonly used, treatment-refractory cases remain challenging. Dextrose prolotherapy is a regenerative technique gaining interest, but its efficacy in piriformis syndrome is not well established. Materials and Methods: This retrospective study included 43 patients diagnosed with piriformis syndrome based on clinical criteria, including a positive FAIR test and at least one additional provocative maneuver. Patients received three sessions of ultrasound-guided injections of 5% dextrose (1 mL per site, 5 mL total) targeting the piriformis musculotendinous junction at 3-week intervals. Pain and functional status were assessed at baseline, 1-month, and 3-month follow-ups using the visual analog scale (VAS) and oswestry disability index (ODI). Patient satisfaction and adverse events were also recorded. Results: Mean VAS scores decreased from 7.6 to 2.3 (p<0.001), and median ODI scores improved from 48 to 20 over three months (p<0.001). Eighty-eight per- cent of patients reported satisfaction with the treatment. No major complications were observed; minor adverse events were mild and self-limiting. Conclusion: Ultrasound-guided dextrose prolotherapy significantly reduced pain and improved function in patients with refractory piriformis syndrome. These findings support its role as a minimally invasive treatment option, warranting further prospective studies.