Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain

Park, Jung-Wee; Lee, Youngkyun; Lee, Yun Jong; Shin, Saeam; Kang, Yusuhn; Koo, Kyung‐Hoi

doi:10.1302/0301-620x.102b5.bjj-2019-1212.r1

Cited by 44 publications

(43 citation statements)

References 111 publications

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“…Hamstring tears around the ischial tuberosity can also be a cause of DGS. Further, proximal hamstring tendon pathologies can cause a ganglion cyst that irritates or compresses the adjacent nerves [6]. In our case, ganglion cysts along the pudendal nerve seemed to be associated with a full-thickness tear of the proximal hamstring tendon.…”

Section: Discussionmentioning

confidence: 51%

“…PNE may also cause pain in the posterior hip, the buttocks while seated, or in the medial thigh; referred sciatic pain has also been reported [1]. Recently, the concept of deep gluteal syndrome (DGS) has been introduced and defined as compression of the sciatic or pudendal nerve due to a non-discogenic pelvic lesion [6]. Thus, PNE can be considered to be part of the DGS spectrum.…”

Section: Introductionmentioning

confidence: 99%

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Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve

Kim

2021

Yeungnam Univ J Med

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Pudendal nerve entrapment (PNE) syndrome refers to the condition in which the pudendal nerve is entrapped or compressed. Reported cases of PNE associated with ganglion cysts are rare. Deep gluteal syndrome (DGS) is defined as compression of the sciatic or pudendal nerve due to a non-discogenic pelvic lesion. We report a case of PNE caused by compression from ganglion cysts and treated with steroid injection; we discuss this case in the context of DGS. A 77-year-old woman presented with a 3-month history of tingling and burning sensations in the left buttock and perineal area. Ultrasonography showed ganglion cystic lesions at the subgluteal space. Magnetic resonance imaging revealed cystic lesions along the pudendal nerve from below the piriformis to the Alcock's canal and a full-thickness tear of the proximal hamstring tendon. Aspiration of the cysts did not yield any material. We then injected steroid into the cysts, which resolved her symptoms. Steroid injection into a ganglion cyst should be considered as a treatment option for PNE caused by ganglion cysts.

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Section: Discussionmentioning

confidence: 51%

Section: Introductionmentioning

confidence: 99%

Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve

Kim

2021

Yeungnam Univ J Med

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“…According to Aquino-Jose et al, successful US-guided injection of a short-acting local anesthetic into the piriformis muscle leads to pain relief for up to 48 hours (38) . In a randomized controlled trial, no difference in outcome was observed between intramuscular deposition of a local anesthetic and corticosteroid versus local anesthetic only, which gives the idea that piriformis syndrome is mostly muscular in origin, and corticosteroids do not give an varies from 5 to 8%, although the actual rate is probably higher due to the overlap in the clinical presentation with other conditions (25) . It is estimated that nearly one in five patients with chronic buttock and low back pain suffer from the piriformis syndrome (26) .…”

Section: Piriformis Syndromementioning

confidence: 91%

Ultrasound-guided injections in pelvic entrapment neuropathies

et al. 2021

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Pelvic entrapment neuropathies represent a group of chronic pain syndromes that significantly impede the quality of life. Peripheral nerve entrapment occurs at specific anatomic locations. There are several causes of pelvic entrapment neuropathies, such as intrinsic nerve abnormality or inflammation with scarring of surrounding tissues, and surgical interventions in the abdomen, pelvis and the lower limbs. Entrapment neuropathies in the pelvic region are not widely recognized, and still tend to be underdiagnosed due to numerous differential diagnoses with overlapping symptoms. However, it is important that entrapment neuropathies are correctly diagnosed, as they can be successfully treated. The lateral femoral cutaneous nerve, ischiadic nerve, genitofemoral nerve, pudendal nerve, ilioinguinal nerve and obturator nerve are the nerves most frequently causing entrapment neuropathies in the pelvic region. Understanding the anatomy as well as nerve motor and sensory functions is essential in recognizing and locating nerve entrapment. The cornerstone of the diagnostic work-up is careful physical examination. Different imaging modalities play an important role in the diagnostic process. Ultrasound is a key modality in the diagnostic work-up of pelvic entraptment neuropathies, and its use has become increasingly widespread in therapeutic procedures. In the article, the authors describe the background of pelvic entrapment neuropathies with special focus on ultrasound-guided injections.

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“…Currently, it is recommended that patients begin with conservative treatment and then progress to invasive treatment if symptoms fail to resolve (4). In a study done by Vassalou et al (16) 65 patients with suspected piriformis syndrome were identified.…”

Section: Conservative Managementmentioning

confidence: 99%

“…PS is a form of deep gluteal syndrome. Deep gluteal syndrome encompasses all neurogenic posterior hip pains and also includes the proximal hamstring syndrome, the ischiofemoral impingement syndrome, and the gemelliobturator internus syndrome (4). However, PS and deep gluteal syndrome are often used synonymously.…”

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confidence: 99%

Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review

et al. 2021

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Context: Piriformis syndrome is a solely clinical diagnosis that often eludes the practitioner and goes underdiagnosed. PS is a pain syndrome and for those it affects, causes persistent pain and limits daily activity and work capacity. It is a form of deep gluteal syndrome that needs to be considered on the differential of low back pain as it comprises between 0.3% - 6% of all low back pain cases and is frequently underdiagnosed. Piriformis syndrome may be primary due anatomic anomalies or secondary, though the majority of cases are secondary to some insult. The objective of this manuscript is to provide a description of the epidemiology and presentation of piriformis as well as both non-operative and operative treatment options. We review all of the recent clinical evidence regarding the aforementioned therapies. Evidence Acquisition: Literature searches were performed using the below MeSH Terms using Mendeley version 1.19.4. Search fields were varied until further searches revealed no new articles. All articles were screened by title and abstract. Decision was made to include an article based on its relevance and the list of final articles was approved three of the authors. This included reading the entirety of the article. Any question regarding the inclusion of an article was discussed by all authors until an agreement was reached. Results: Medical management and physical therapy show some promise; however, when conservative treatment fails minimally invasive methods such as steroid injections, botulinum toxin injections, dry needling are all efficacious and there is substantial clinical evidence regarding these therapies. In those patients in which minimally invasive techniques do not result in an adequate relief of pain and return of function, endoscopic release can be considered. Endoscopic release is far superior to open release of the piriformis syndrome given the higher success and lower rate of complications. Conclusions: Piriformis syndrome is an important differential diagnosis in the work up of lower back pain and should not be ruled out with proper examination and testing. Clinicians should consider medical management and conservative management in the initial treatment plan for piriformis syndrome. There are many options within the conservative management and the literature shows much promise regarding these. Physical therapy, steroid injections, botulinum toxin injections, and dry needling are all potentially effective therapies with few adverse effects. Surgical options remain as gold standard, but only when conservative management has failed and the symptoms are significant to affect daily living activities. Endoscopic decompression of the sciatic nerve with or without release of the piriformis muscle has a reported high likelihood of success and a low complication rate. Current literature supports the preference of the endoscopic approach over the open approach due to improved outcomes and decreased complications. Further research is to well define the metrics for the diagnosis of piriformis syndrome and may include a need to develop diagnostic criteria.

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Deep gluteal syndrome as a cause of posterior hip pain and sciatica-like pain

Cited by 44 publications

References 111 publications

Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve

Pudendal nerve entrapment syndrome caused by ganglion cysts along the pudendal nerve

Ultrasound-guided injections in pelvic entrapment neuropathies

Surgical and Non-surgical Treatment Options for Piriformis Syndrome: A Literature Review

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