Deep gluteal syndrome

Deep gluteal syndrome
Medical illustration of the posterior deep gluteal space anatomy.
Deep gluteal space anatomy
SymptomsPain in the hip, buttocks, or thigh. Often pain when sitting or with certain hip movements. Often unilateral radiating pain.[1]
CausesMost common are (1) fibrotic adhesions tethering the sciatic nerve and (2) piriformis syndrome.[2]
Diagnostic methodFirst ruling out lumbar pathology. Then stretch/activation tests, magnetic resonance imaging / magnetic resonance neurography, and diagnostic injections.[3]
Differential diagnosispudendal nerve entrapment, ischiofemoral impingement, greater trochanter ischial impingement, and ischial tunnel syndrome.[1]
TreatmentConservative treatments include physical therapy, analgesics, and injections.[2][4] Surgical treatment is a sciatic nerve decompression and/or muscle resection.[5]

Deep gluteal syndrome describes the non-discogenic extrapelvic entrapment of the sciatic nerve in the deep gluteal space.[1] In simpler terms this is sciatica due to nerve irritation in the buttocks rather than the spine or pelvis. It is an extension of non-discogenic sciatic nerve entrapment beyond the traditional model of piriformis syndrome.[4] Where sciatic nerve irritation in the buttocks was once thought of as only piriformis muscle, it is now recognized that there are many other causes. Symptoms are pain or dysthesias (abnormal sensation) in the buttocks, hip, and posterior thigh with or without radiating leg pain. Patients often report pain when sitting.[1] The two most common causes are piriformis syndrome and fibrovascular bands (scar tissue), but many other causes exist.[2] Diagnosis is usually done through physical examination, magnetic resonance imaging, magnetic resonance neurography, and diagnostic nerve blocks.[6] Surgical treatment is an endoscopic sciatic nerve decompression where tissue around the sciatic nerve is removed to relieve pressure.[7]

  1. ^ a b c d Cite error: The named reference :0 was invoked but never defined (see the help page).
  2. ^ a b c Metikala S, Sharma V (March 2022). "Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review". Cureus. 14 (3): e23153. doi:10.7759/cureus.23153. PMC 9010003. PMID 35444897.
  3. ^ Cite error: The named reference :9 was invoked but never defined (see the help page).
  4. ^ a b Park JW, Lee YK, Lee YJ, Shin S, Kang Y, Koo KH (May 2020). "Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain". Bone Joint J. 102-B (5): 556–567. doi:10.1302/0301-620X.102B5.BJJ-2019-1212.R1. PMID 32349600. S2CID 217593533.
  5. ^ Cite error: The named reference :8 was invoked but never defined (see the help page).
  6. ^ Cite error: The named reference :1 was invoked but never defined (see the help page).
  7. ^ Kay J, de Sa D, Morrison L, Fejtek E, Simunovic N, Martin HD, Ayeni OR (December 2017). "Surgical Management of Deep Gluteal Syndrome Causing Sciatic Nerve Entrapment: A Systematic Review". Arthroscopy. 33 (12): 2263–2278.e1. doi:10.1016/j.arthro.2017.06.041. PMID 28866346.