Deep gluteal syndrome.

H D Martin,M Reddy,J Gomez-Hoyos

doi:10.1093/jhps/hnv029

Abstract

Deep gluteal syndrome describes the presence of pain in the buttock caused from non-discogenic and extrapelvic entrapment of the sciatic nerve. Several structures can be involved in sciatic nerve entrapment within the gluteal space. A comprehensive history and physical examination can orientate the specific site where the sciatic nerve is entrapped, as well as several radiological signs that support the suspected diagnosis. Failure to identify the cause of pain in a timely manner can increase pain perception, and affect mental control, patient hope and consequently quality of life. This review presents a comprehensive approach to the patient with deep gluteal syndrome in order to improve the understanding of posterior hip anatomy, nerve kinematics, clinical manifestations, imaging findings, differential diagnosis and treatment considerations.

Highlights

The progress in understanding posterior hip anatomy and sciatic nerve kinematics has helped to identify several locations where the sciatic nerve can be entrapped
Failure to identify the cause of pain in a timely manner can increase pain perception, and affect mental control, patient hope and quality of life
This review presents a comprehensive approach to the patient with deep gluteal syndrome in order to improve the understanding of posterior hip anatomy, nerve kinematics, clinical manifestations, imaging findings, differential diagnosis and treatment considerations

Summary

INTRODUCTION

The progress in understanding posterior hip anatomy and sciatic nerve kinematics has helped to identify several locations where the sciatic nerve can be entrapped. This review presents a comprehensive approach to the patient with deep gluteal syndrome in order to improve the understanding of posterior hip anatomy, nerve kinematics, clinical manifestations and treatment considerations as well as the differential diagnoses like pudendal nerve entrapment, ischiofemoral impingement, greater trochanter ischial impingement and ischial tunnel syndrome. It has been reported that in deep flexion, abduction and external rotation of the hip, the sciatic nerve glide across the posterior border of the greater trochanter. Once the lumbar pathology is ruled out using specific tests and spine imaging, the physical examination should be directed toward the deep gluteal space as a cause of posterior pain. The mHHS went from 56 pre- to 79 post-operative on average Frequent use of intra-operative fluoroscopy will confirm the proper location of the endoscopic view

To identify and resect the piriformis muscle and tendon

Findings

CONCLUSION