Ultrasound-guided quadratus femoris muscle injection in patients with lower buttock pain: Novel ultrasound-guided approach and clinical effectiveness

Abstract

Background: The quadratus femoris (QF) muscle is a possible source of lower buttock pain as evidenced by what is known about the pathophysiology of ischiofemoral impingement syndrome. However, there are few reports about the interventional management of the QF muscle as a pain generator. Objective: To describe an ultrasound-guided QF muscle injection technique in patients with lower buttock pain suspected of QF muscle pathology and to report the result of treatment. Study Design: Retrospective evaluation. Setting: Outpatient department for interventional pain management at a university hospital. Methods: We studied 14 patients who had deep tenderness localized to the lower buttock region at a point halfway between the lateral prominence of the greater trochanter and the ischial tuberosity corresponding to the location of the QF muscle belly. Under ultrasound guidance, 8 mL of 0.25% lidocaine was injected into the QF muscle. Pain scores were assessed prior to the first injection and 2 weeks after the last injection. Patient satisfaction was also assessed. Results: When compared before and 2 weeks after last QF muscle injection, the mean pain score decreased by 49.3% (6.7 ± 2.3 to 3.4 ± 2.1, P < 0.001). Two weeks after the last injection, approximately 70% of patients (10 of 14 patients) expressed their satisfaction as excellent or good and the average frequency of injection was 2.5 times. There were no complications observed. Limitations: The results of this study should be considered preliminary owing to the small sample size and lack of a control group, and the retrospective characteristics of this study may have introduced a selection bias. Conclusions: Ultrasound-guided QF muscle injection with local anesthetic helps alleviate pain in patients with lower buttock pain attributed to the QF muscle, and leads to high levels of satisfaction for patients. A randomized placebo-controlled trial should be considered in the future.