This randomized, double-blind prospective trial investigates whether ultrasound-guided interfascial hydrodissection using 10% dextrose is more effective than dry needling in treating gluteal myofascial pain coexisting with piriformis syndrome. Following diagnostic piriformis injection response, eligible patients will be randomized into two treatment arms and followed at 1 hour, 1 week, 1 month, and 3 months. The primary hypothesis is that interfascial hydrodissection will provide superior long-term analgesic outcomes due to fascial separation, neuromodulation, and nociceptor suppression.
Adults aged 18 to 75 years
Buttock pain with or without radiation to the lower extremity
Ability to understand and provide written informed consent
Active lumbar radiculopathy
History of hip joint pathology or prior hip surgery
Previous injection or dry needling treatment to the gluteal region within the last 3 months
Coagulation disorders or use of anticoagulant therapy
Parallel
Ultrasound-Guided Interfascial Hydrodissection
Procedure/SurgeryUltrasound-guided interfascial hydrodissection is performed in the interfascial plane between the gluteus maximus and piriformis muscles.
Ultrasound-Guided Gluteus Maximus Dry Needling
Procedure/SurgeryUltrasound-guided dry needling is performed on the gluteus maximus muscle without fluid administration.
Pain Intensity Assessed by Numeric Rating Scale
Pain intensity is assessed using the Numeric Rating Scale (NRS, 0-10) for pain at rest, during activity, at night, while standing, sitting, lying down, and for overall pain.
Pain Intensity Assessed by Numeric Rating Scale
Pain intensity is assessed using the Numeric Rating Scale (NRS, 0-10) for pain at rest, during activity, at night, while standing, sitting, lying down, and for overall pain.
Pain Intensity Assessed by Numeric Rating Scale
Pain intensity is assessed using the Numeric Rating Scale (NRS, 0-10) for pain at rest, during activity, at night, while standing, sitting, lying down, and for overall pain.
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