II. Definitions
- Deep Gluteal Syndrome
- Sciatic nerve or pudendal nerve entrapment causing deep buttock pain with Sciatica worse with sitting
- Causes include Piriformis Syndrome
- Entrapment may also occur with proximal hamstring or Gemelli–Obturator Internus entrapment
III. Pathophysiology
-
Peripheral Neuropathy due to sciatic nerve impingement
- Proximal or radicular impingement (e.g. Lumbar Disc Herniation)
- Distal impingement (e.g. Piriformis Syndrome)
IV. Symptoms
- Region: Low Back Pain
- Radiation: posterior buttock or postero-lateral thigh
V. Diagnosis: Sciatica as a predictor for Lumbar Disc Disease
- Overall
- Only 4% of Sciatica is Lumbar Disc Disease
- Patients with symptomatic Lumbar Disc Herniation have Sciatica in 99% of cases
- Findings that increase Specificity of Sciatica for Lumbar Disc Disease
- Pain worse in the leg than the back
- Pain or numbness follows a typical dermatomal pattern
- Pain worse with Valsalva Maneuver (e.g. coughing or sneezing)
- Findings suggesting diagnosis other than Lumbar Disc Herniation
VI. Differential Diagnosis: Sciatica
- Spinal conditions
- Lumbar Disc Herniation (most common cause)
- Lumbar spine Degenerative Joint Disease (osteophytes, bone spurs)
- Sponylolisthesis
- Facet Arthropathy
- Spinal Tumors
- Lumbar Spinal Stenosis (Pseudoclaudication)
- Vertebral Fracture
- Disciitis
- Musculoskeletal conditions external to the spine
- Greater Trochanteric Bursitis
- Iliotibial Band Syndrome
- Meralgia Paresthetica
- Piriformis Syndrome or other Deep Gluteal Syndrome
- Ischiofemoral Impingement
- Radiation from Hip Pain (may mimic L4 Lumbar Radiculopathy)
- Sacroiliac Joint Dysfunction or Spondyloarthropathy with Sacroiliitis