Recently, Liaocheng City Second Hospital Pain Comprehensive Outpatient Clinic received a male patient, only 22 years old, but the left lower limb intermittent pain and soreness has been up to three years, in Jinan City, a hospital to seek medical treatment is not effective, then go to a famous orthopaedic hospital in Beijing, the doctor assessed the condition, and then arrived at the diagnosis of pear-shaped muscle syndrome. Due to the tight medical resources and the long waiting time for hospitalization, the doctor advised him to return to his hometown and look for opportunities for treatment. By chance, he learned about the Pain Comprehensive Outpatient Clinic of Liaocheng City No.2 Hospital and came to the clinic.

  After a careful examination by Dr. Wang Zhizhen, the attending physician found that the patient's left lower extremity straight leg raising test (+), pearly muscle tenderness was obvious, the adductor muscle group tenderness, and the muscle strength was slightly decreased, which was determined to be pearly muscle syndrome. Dr. Wang proposed two treatment options to the patient, who was very pleased to hear and recognized, coinciding with his unsuccessful treatment in Beijing.

  On November 20, 2023, the patient underwent his first treatment, ultrasound-guided peripheral nerve release, in the outpatient operating room. In the operating room, the patient was placed in a prone position with relaxed muscles and full exposure of the buttocks. After routine disinfection, Dr. Wang placed the probe on top of the patient's pain point and chose the optimal imaging mode. Through the patient's muscle image, he found that the affected side of the pyriformis muscle ultrasonographically showed a full morphology, which was thickened compared with that of the healthy side, and the outer membrane was not smooth, with disorganized texture of the muscle filament, and the internal echogenicity was not uniform, and uneven and abnormal echogenicity could be seen. The patient's buttocks were sore and painful, with pain radiating along the sciatic nerve. Dr. Wang adjusted the probe to show the long axis section of the sciatic nerve, observed the internal echogenicity, boundary and course of the sciatic nerve, and used the heterogeneous echogenicity area in the pyriformis muscle as the target point for needling, and then accurately stabbed the 0.9㎜×80㎜ needle into the target area under ultrasound guidance, and injected the configured medication into the muscular layer for separation. After the injection, the ligament was quickly cut with a small needle knife to loosen the fascial tissue and restore its dynamic balance.

  Immediately after the release surgery, the patient tried simple lower limb activities, and the effect of the treatment surprised him. He did not expect that his left leg could be lifted up, and tried to walk a few steps, which felt less uncomfortable. One week later, the patient followed the doctor's instructions and came to the outpatient operating room for the second treatment, and after the second treatment, the patient's life basically returned to normal.

  Ultrasound-guided nerve release is a combination of physical examination and ultrasound imaging visualization assistance to carry out precise nerve block and small needle release around the patient's painful tissues, effectively treating pain and promoting the recovery of normal peripheral nerve tissues. It is suitable for neck, shoulder, lumbar and leg pain, shoulder pain after hemiplegia, suprapatellar bursa effusion, medial and lateral collateral ligament injuries, tennis elbow, tenosynovitis, acromioclavicular arthritis, trigeminal neuralgia, herpes zoster, post-herpetic neuralgia, post-surgical pain of the limbs and other conditions.