Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review

Abstract

Purpose Clinicians are not confident in diagnosing deep gluteal syndrome (DGS) because of the ambiguity of the DGS disease definition and DGS diagnostic pathway. The purpose of this systematic review was to identify the DGS disease definition, and also to define a general DGS diagnostic pathway. Methods A systematic search was performed using four electronic databases: PubMed, MEDLINE, EMBASE, and Google Scholar. In eligibility criteria, studies in which cases were explicitly diagnosed with DGS were included, whereas review articles and commentary papers were excluded. Data are presented descriptively. Results The initial literature search yielded 359 articles, of which 14 studies met the eligibility criteria, pooling 853 patients with clinically diagnosed with DGS. In this review, it was discovered that the DGS disease definition was composed of three parts: (1) non‐discogenic, (2) sciatic nerve disorder, and (3) nerve entrapment in the deep gluteal space. In the diagnosis of DGS, we found five diagnostic procedures: (1) history taking, (2) physical examination, (3) imaging tests, (4) response‐to‐injection, and (5) nerve‐specific tests (electromyography). History taking (e.g. posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (e.g. tenderness in deep gluteal space, pertinent positive results with seated piriformis test, and positive Pace sign), and imaging tests (e.g. pelvic radiographs, spine and pelvic magnetic resonance imaging (MRI)) were generally performed in cases clinically diagnosed with DGS. Conclusion Existing literature suggests the DGS disease definition as being a non‐discogenic sciatic nerve disorder with entrapment in the deep gluteal space. Also, the general diagnostic pathway for DGS was composed of history taking (posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (tenderness in deep gluteal space, positive seated piriformis test, and positive Pace sign), and imaging tests (pelvic radiographs, pelvic MRI, and spine MRI). This review helps clinicians diagnose DGS with more confidence. Level of evidence IV.

Endoscopic Shelf Acetabuloplasty Concomitant With Labral Repair, Cam Osteoplasty, and Capsular Plication to Treat Acetabular Dysplasia in Artistic Athletes: A Case Series

“…A total of 3 artistic athletes (2 competitive dancers and 1 recreational dancer) could not return to artistic activities due to postoperative deep gluteal syndrome (DGS) as a complication. 9 , 23 These 3 patients underwent continued physical therapy and occasional ultrasound-guided injection of 1 mL of 1% bupivacaine and 9 mL of normal saline. One of them underwent surgical decompression of the sciatic nerve and posterior femoral cutaneous nerve in a deep gluteal space.…”

“…In our study, 3 dancers (13%) experienced postoperative DGS, defined as a nondiscogenic sciatic nerve with entrapment in the deep gluteal space. 9 The diagnosis of DGS was based on a detailed clinical history, including a description of the current condition, date of onset, mechanism of injury (traumatic or nontraumatic), factors that increased or decreased pain, prior consultations, prior surgical interventions, pain level, and narcotics use. A recent study 23 in a series of 1167 patients undergoing hip arthroscopy reported that the incidence of postoperative DGS was 0.9%, and predictors for postoperative DGS after hip arthroscopic surgery were female sex, generalized joint laxity, multiple hip surgical procedures, and acetabular dysplasia.…”

Sciatic nerve movement in the deep gluteal space during hip rotations maneuvers

“…Currently, pain at this level is classed as “deep gluteal pain” (Fernández‐Hernando et al, 2015, 2016; Kizaki et al, 2020; Martin et al, 2011; Pérez‐Carro et al, 2016). This indicates the etiopathogenic complexity of the process and therefore its symptoms and exploration.…”

Editorial Commentary: Subgluteal Hip Arthroscopy for Sciatic Nerve Entrapment, Ischiofemoral Impingement, or Proximal Hamstring Tears: Beyond the Comfort Zone

“…Except for hamstring tears, I have found the IFI and particularly the SNE diagnosis to be challenging, and I agree with Park et al that many physicians remain unfamiliar with the concept of deep gluteal syndrome. 11 Clinical assessment of deep gluteal syndrome, defined as nondiscogenic sciatic nerve entrapment, 12 can be difficult but is critical and one of the skills that we as hip sports surgeons, need to master. 4 As Aguilera-Bohórquez et al mentioned, their study was not without limitations; nonetheless, this is a valuable study, and I applaud the work presented.…”