Deep Gluteal Syndrome

For clinicians

Deep gluteal syndrome is a description for pain in the buttock due to entrapment of the sciatic nerve. In the past, most pain in this area was attributed to piriformis syndrome. However, the sciatic nerve can be entrapped by a number of different structures that are not the piriformis muscle, including gluteal and hamstring muscles, fibrous bands containing blood vessels, gemelli-obdurator internus complex, vascular abnormalities, and space-occupying lesions.

The deep gluteal space is a unique anatomic area because the sciatic nerve enters through the sciatic notch with moves significantly with hip motion.

Differential Diagnosis:

Lumbar spine pathology
Pudendal Nerve Entrapment
Ischiofemoral Impingement
Greater Trochanter Ischial Impingement
Ischial Tunnel Syndrome

Key history components

History of trauma
Pain with sitting
Aching, burning or cramping in the buttock or posterior thigh
Radicular pain of lower back or hip
Paresthesias
Focused uro and gyn history

To review the full exam of the hip, watch this video.

Specific physical exam maneuvers for deep gluteal syndrome are:

Seated piriformis stretch test: passive flexion, adduction with internal rotation while palpating the deep gluteal region

Active piriformis test: active abduction, external rotation while monitoring the piriformis.

Treatment

Therapeutic exercises
Image guided intra-articular and extra-articular injections using local anesthetic and steroid can provide insight into the diagnosis while having a therapeutic benefit.
If the above fails, surgical decompression of the sciatic nerve

For patients