Deep Gluteal Pain in Orthopaedics: A Challenging Diagnosis

Abstract

Identifying the specific source of gluteal pain can elude the most seasoned orthopaedic diagnosticians. Patients will often present with a protracted course of symptoms, and failure to successfully identify and treat the underlying etiology leads to frustration for both patient and clinician. Pain deep in the buttocks can arise from compression, inflammation, or injury of one or more of the structures in this anatomically dense area. Although sacroiliitis, hip arthritis, and trochanteric bursitis may also masquerade as gluteal pain, sciatic nerve irritation in its various presentations causes a substantial percentage of cases. Deep gluteal syndrome, hamstring syndrome, and ischiofemoral impingement can have overlapping presentations but can be differentiated by clinical examination and judiciously placed diagnostic corticosteroid injections. Although nonsurgical management, including physical therapy, relative rest, and injections represent the mainstay of treatment, open and endoscopic surgical approaches have yielded encouraging success rates in refractory cases.

Endoscopic Sciatic Neurolysis for Deep Gluteal Syndrome: A Systematic Review

“…Awareness of these differences and myriad potential causes is critical to narrow the differential diagnosis. Precise palpation of anatomical structures and a combination of special examination maneuvres could enhance the clinical diagnostic yield [ 6 , 11 ]. Over the years, with the development and generous application of high-resolution imaging techniques in conjunction with rapid progress in the field of hip arthroscopy, much has changed in the management approach to DGS.…”

“…A typical antalgic sitting position, bearing weight on the unaffected ischium, is frequently seen in the affected individual [ 4 ]. The physical examination includes sciatic notch tenderness with positive flexion-adduction-internal rotation (FADIR) test, active piriformis, and seated piriformis stretch tests [ 6 , 11 , 12 ]. Plain radiographs, ultrasound (US), and magnetic resonance imaging (MRI) are the standard investigations in the diagnostic work-up of DGS.…”