Deep Gluteal syndrome

Deep gluteal syndrome can cause pain in the buttock. The cause of this pain is not arising from or radiating from the spine. However, the sciatic nerve can have pressure on it by structures such as the piriformis tendon in the buttock region. (extra-pelvic entrapment of the sciatic nerve in the gluteal space).

The diagnosis of deep gluteal syndrome is based on the history and physical examination of the hip. Typical symptoms comprise aching, burning sensation or cramping in the buttock or posterior thigh. A sitting pain for example, can be associated with sciatic entrapment beneath the piriformis muscle. A walking pain lateral to the ischium (the bone we sit on) can be associated with ischiofemoral impingement, in which the lesser trochanter rubs the lateral border of the ischium.

Specific clinical examination test will also be helpful when evaluating a patient for deep gluteal syndrome such as the seated piriformis stretch test and the active piriformis test. In addition, palpation of the specific structure in the gluteal regions will assist in determining the diagnosis. Finally, provocative test will also assist in reproducing the symptoms of deep gluteal syndrome.

The treatment of deep gluteal syndrome in the majority is successful with a combination of conservative management, physiotherapy, non-steroidal inflammatory medication and injections. Imaging guided intra-articular and extra-articular injections (local anesthetic and steroids) are precise and reproducible for discriminating between these complex pathologies. In rare cases where conservative management has failed, open or arthroscopic surgery may be considered

The aim of surgery would be to identify the areas of compression or scar tissue leading to compression of the nerve and relieving this pressure.

The aim of rehabilitation is to gain mobility and maintain the range of motion of the hip joint and avoid provocative stretching of the nerve that can reproduce the symptoms and stretching of the sciatic nerve. The rehabilitation can often take an average of 24 weeks to return close to previous activity.