Disclosures: Boss Povieng: Nothing to disclose

Case Description: The patient presented to pain clinic with progressing hip and sciatic pain that involved the buttock, posterior thigh and foot 1 year after undergoing periacetabular osteotomy and femoral neck osteoplasty. On physical exam, findings were consistent with diagnosis of bilateral piriformis syndrome. The patient was treated with piriformis injections and physical therapy.

Setting: Tertiary care academic hospital system

Patient: 29-year-old female with chronic pain secondary to hypermobility type Ehlers-Danlos Syndrome (hEDS)

Assessment/Results: This patient had a return of her hip and buttock pain symptoms 1 year after hip surgery. In contrast the piriformis injections and physical therapy were able to reduce pain symptoms by 50% for 2.5 months on average. She continued to manage her pain relief with intermittent injections for 6 years.

Discussion: hEDS is a rare disorder causing skin hyperextensibility, fragility, pelvic floor abnormalities, and musculoskeletal complaints such as joint subluxations contributing to chronic pain. Management of this patient population is complex. From the conservative approach, modalities including physical therapy, bracing, acupuncture, pharmaceutical manipulation, and interventional steroid injections are available, though efficacy of these interventions in hEDS is not well documented in the literature. Surgery remains an invasive option for hEDS patients however data pertaining to surgical outcomes remains unclear. The propensity of hEDS patients to exhibit poor surgical healing, hardware failure, susceptibility to cardiovascular complications, subluxations, ligamentous tears, and neurological sequelae warrants consideration for more conservative strategies.

Conclusion: The details of this case report provide supportive evidence which argues the advantages of a conservative approach in treating chronic pain in an hEDS patient with poor surgical outcome. Future studies are needed to quantify and expand upon both the adverse effects of surgical outcomes and the efficacy of conservative treatment including interventional options in this patient population.

Level of Evidence: Level V

« Back to AAPM&R Annual Assembly 2019

PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/bilateral-piriformis-syndrome-after-surgery-in-a-young-female-with-hypermobility-type-ehlers-danlos-syndrome-a-case-report/