II. Definitions

  1. Deep Gluteal Syndrome
    1. Sciatic nerve or pudendal nerve entrapment causing deep buttock pain with Sciatica worse with sitting
    2. Causes include Piriformis Syndrome
    3. Entrapment may also occur with proximal hamstring or Gemelli–Obturator Internus entrapment

III. Pathophysiology

  1. Peripheral Neuropathy due to sciatic nerve impingement
    1. Proximal or radicular impingement (e.g. Lumbar Disc Herniation)
    2. Distal impingement (e.g. Piriformis Syndrome)

IV. Symptoms

  1. Region: Low Back Pain
  2. Radiation: posterior buttock or postero-lateral thigh

V. Diagnosis: Sciatica as a predictor for Lumbar Disc Disease

  1. Overall
    1. Only 4% of Sciatica is Lumbar Disc Disease
    2. Patients with symptomatic Lumbar Disc Herniation have Sciatica in 99% of cases
  2. Findings that increase Specificity of Sciatica for Lumbar Disc Disease
    1. Pain worse in the leg than the back
    2. Pain or numbness follows a typical dermatomal pattern
    3. Pain worse with Valsalva Maneuver (e.g. coughing or sneezing)
  3. Findings suggesting diagnosis other than Lumbar Disc Herniation
    1. See Low Back Pain Red Flags

VI. Differential Diagnosis: Sciatica

  1. Spinal conditions
    1. Lumbar Disc Herniation (most common cause)
    2. Lumbar spine Degenerative Joint Disease (osteophytes, bone spurs)
    3. Sponylolisthesis
    4. Facet Arthropathy
    5. Spinal Tumors
    6. Lumbar Spinal Stenosis (Pseudoclaudication)
    7. Vertebral Fracture
    8. Disciitis
  2. Musculoskeletal conditions external to the spine
    1. Greater Trochanteric Bursitis
    2. Iliotibial Band Syndrome
    3. Meralgia Paresthetica
    4. Piriformis Syndrome or other Deep Gluteal Syndrome
    5. Ischiofemoral Impingement
    6. Radiation from Hip Pain (may mimic L4 Lumbar Radiculopathy)
    7. Sacroiliac Joint Dysfunction or Spondyloarthropathy with Sacroiliitis

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