Deep Gluteal Pain Syndrome

This page is currently undergoing work, but please come back later to check out new information!

Original Editor - Mariam Hashem Top Contributors - Mariam Hashem, Kim Jackson, Lucinda hampton, Mandy Roscher, Ewa Jaraczewska, Tarina van der Stockt and Tony Lowe

Introduction

The gluteal/buttock area is complicated and hasn't been much explored in the literature. The symptoms are often diagnosed as Lumbar Radiculopathy and when not treated could be considered chronic pain.

Gluteal Pain Syndrome is often defined as pain or numbness in the buttock, the hip, or the posterior thigh with radiation or radicular pain in the Sciatic Nerve distribution.

Symptoms:

• Buttock/Gluteal pain and sometimes behind the greater trochanter.
• Pain is usually unilateral
• Patients usually struggle with prolonged seating for more than 20 or 30 minutes
• They also struggle with stride into a terminal extension
• They may limp
• They may have neurological changes in testing
• Severe night pain with disturbed sleep

Anatomy

The deep gluteal space is bounded superiorly by the Sciatic Notch, which includes Piriformis. Inferiorly, by the Ischial Tuberosity, which has the attachment of the Hamstring tendon. Laterally by the Linea Aspersa of the femur and the greater trochanter and medially by the Sacrotuberous ligament, which has yet another highly nociceptive structure.

Underneath the Glute Max and Med lie the "deep six" which include the Piriformis muscle, which attaches under the medial facet on the greater trochanter. And below the Piriformis muscle, are the small Obturators and Gemelli's. The Superior Gemelli, Obturator Internis, Inferior Gemelli and Quadratus Femoris.

You cannot palpate Obturator Externus directly, because that is on the ventral side. Of the ''deep six'', the two muscles that will be easiest for you to palpate are the Piriformis and the Quadratus Femoris.

The Sciatic Nerve exits underneath the Piriformis muscle where it becomes a possible source of entrapment.

The sciatic nerve lies over the Obturator and Gemelli complex then it sits laterally to the Ischial Tuberosity. And on top of the Ischial Tuberosity is the insertion of the Biceps Femoris, which then has fibres that intermingle and go proximally onto the Sacrotuberous Ligament. The Sciatic Nerve is bound on the medial side, by the Ischial Tuberosity and on the lateral side, by the lesser trochanter of the femur.

Resources

• bulleted list

or

1. numbered list

or

1. • bullets and numbers