Deep gluteal syndrome (DGS) describes a condition that creates pain in the buttock. Pain may travel down the back of the leg when the sciatic nerve is irritated. There’s various structures that can result in sciatic nerve entrapment within the gluteal space. These include the piriformis muscle; fibrous bands containing blood vessels; the gluteal muscles; hamstring muscles, the Gemelli-obturator internus complex, vascular abnormalities; and space-occupying lesions.
The unique features within a patient’s history and physical examination can help to differentiate and define the specific site of sciatic nerve entrapment. It’s common for patients with sciatic nerve entrapment to have a prior history of trauma and radiating pain from the low back and/or hip with tingling into the affected leg. If the nerve becomes damaged, diminished reflexes and/or muscle weakness can also occur.
The relationship between the lower back and the hip is important. In examination, both regions rule out the cause or a contributing factor to a patient’s symptoms. Failure to do this in a timely fashion can lead to chronic pain and reduce quality of life from an inaccurate diagnosis and treatment.
Deep Gluteal Syndrome Study
In a study, researchers found that a tight piriformis muscle plays a role in cases of DGS. The piriformis muscle can also be stretched from a seated position. First, cross the leg, grasp the knee of the crossed leg, and pull toward the opposite shoulder. Second, arch the low back during this process and twist the trunk to the crossed knee side. Third, move the crossed knee in a circular manner to work the entire muscle. Perform this for 30-60 seconds per side, multiple times a day.
The important key to management is a prompt, accurate diagnosis followed by conservative care. Conservative treatment approaches stretch the piriformis muscle and reduce any pressure on the sciatic nerve. To reduce pain and improve function, more invasive treatments such as injections or surgery may be necessary.
