Deep Gluteal Syndrome

Abstract

Deep gluteal syndrome is characterized by nondiscogenic, extrapelvic sciatic nerve compression presenting with symptoms of pain and dysesthesias in the buttock area, hip, or posterior thigh and/or as radicular pain. The piriformis muscle and tendon are the most common source of extrapelvic sciatic nerve entrapment. However, a number of structures can entrap the sciatic nerve in the deep gluteal space, including bone structures, fibrous scar bands, and muscular structures other than the piriformis. The main differential diagnoses are intra-articular hip pathologies, spine issues, intrapelvic abnormalities, ischiofemoral impingement, hamstring's origin tendinopathy, and puden-dal nerve entrapment. A comprehensive history and physical examination is crucial for the diagnosis of deep gluteal syndrome. Guided injections and magnetic resonance imaging are useful comple-mentary diagnostic tools. The nonoperative treatment of deep gluteal syndrome is successful in most patients. Endoscopic sciatic nerve decompression may be indicated in cases of failure of the conservative treatment.