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The purpose of this case series was to describe the outcomes of diagnostic ultrasound-assisted dry needling in the management of piriformis syndrome.Case 1: a 45-year-old woman reported gluteal pain occasionally radiating in the sciatic region. Her magnetic resonance imaging showing sciatic nerve edema in the underlying portion of the piriformis muscle. Case 2: a 55-year-old man had gluteal pain after deep palpation or being in a prolonged sitting position. A previous magnetic resonance imaging showed a disk herniation at L2-L3. Case 3: a 65-year-old woman reported pain in the sciatic area when she was walking and at nighttime rest. All patients had been treated with oral drugs, with poor results.Patients had the same quality and duration of symptoms. The treatments of piriformis muscle and gluteus minimus, medius, and maximus muscles were performed using a convex probe and a 0.30 × 60 mm needle, which was inserted out of plane, maintaining a constant view of its tip. All patients were treated over 10 days and followed up for 6 months. Their symptoms resolved during this time and no adverse reactions were reported.For these 3 patients with piriformis syndrome who were treated with ultrasound-guided dry-needling treatment, their symptoms resolved and their quality of life improved.