Abstract
BackgroundThe purpose of this study is to assess the effectiveness of endoscopic sciatic nerve decompression and evaluated the differences of clinical results between atraumatic and traumatic groups.MethodsSixty consecutive patients. We retrospectively reviewed sixty consecutive patients without major trauma (45 hips) or with major trauma (15 hips) groups to compare the outcomes of endoscopic treatment.). The mean follow-up period was 24 ± 2.6 months (range, 24–38.4 months).ResultsThe mean duration of symptoms was 14.1 months (range, 12 to 32 months). Compromising structures were piriformis muscle, fibrovascular bundles, and adhesion with scar tissues. The mean VAS score for pain decreased from 7.4 ± 1.5 to 2.6 ± 1.5 (P = .001). The mean mHHS increased from 81.7 ± 9.6 to 91.8 ± 7.6 (P = .003). Clinically, positive paresthesia and seated piriformis test were statistically significant to diagnosis sciatic entrapment syndrome. Paresthesia and sitting pain were significantly improved at the final follow-up (P = .002). More favorable outcome was observed a group without major trauma. No complication was observed.ConclusionsEndoscopic sciatic nerve decompression is a safe and effective procedure for the management of DGS. Patients with major trauma could have poor clinical outcome. Seated piriformis test, FADIR, and tenderness of sciatic notch are maybe useful guide for pre and postoperative evaluation of DGS.
Highlights
The purpose of this study is to assess the effectiveness of endoscopic sciatic nerve decompression and evaluated the differences of clinical results between atraumatic and traumatic groups
Deep gluteal syndrome (DGS) involves pain in the buttock caused from entrapment of the sciatic nerve in deep gluteal space [1]
Diagnosis can made by several physical examinations include tenderness on sciatic notch, Flexion-ADduction-Internal Rotation (FADIR) test, Pace sign [6], Lasègue test and seated piriformis test [2, 4, 7]
Summary
The purpose of this study is to assess the effectiveness of endoscopic sciatic nerve decompression and evaluated the differences of clinical results between atraumatic and traumatic groups. Deep gluteal syndrome (DGS) involves pain in the buttock caused from entrapment of the sciatic nerve in deep gluteal space [1]. The boundaries of deep gluteal space are femoral neck anteriorly, gluteus maximus posteriorly, linea aspera of proximal femur laterally, sacrotuberous ligament medially, inferior margin of the sciatic notch superiorly and hamstring muscle inferiorly (Fig. 1). Any contents of deep gluteal space can cause sciatic nerve entrapment syndrome [2]. Diagnosis can made by several physical examinations include tenderness on sciatic notch, Flexion-ADduction-Internal Rotation (FADIR) test, Pace sign [6], Lasègue test and seated piriformis test [2, 4, 7]. A variant of the Freiberg test involves flexion, adduction, and internal rotation of the hip [3, 8]. Magnetic resonance arthrography (MRA) and electromyography (EMG) usually don’t provide proper
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