Quadratus Femoris muscle causing deep gluteal syndrome: A rare cause of refractory sciatica of extraspinal origin in the presence of an anatomic variation

Girolami, Marco; Tonetti, Laura; Pipola, Valerio; Rimondi, Eugenio; Albisinni, Ugo; Ricci, Alessandro; Gasbarrini, A.

doi:10.3233/bmr-191523

Cited by 1 publication

(7 citation statements)

References 8 publications

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“…The initial literature search yielded 359 articles, of which 14 studies (e.g. 11 full papers and 3 conference proceedings) met the eligibility criteria pooling 853 patients clearly diagnosed with DGS [2, 3, 7, 9, 10, 12, 16, 22–24, 26, 27, 29, 33]. In the pooled population, the mean age was 48.1 years (range 5–80 years) and 57.6% of the patients were female, as shown in Table 1.…”

Section: Resultsmentioning

confidence: 99%

“…The DGS disease definition comprised three characteristics: (1) non‐discogenic, (2) sciatic nerve pain, and (3) entrapment in deep gluteal space. Seven studies described deep gluteal space [2, 9, 10, 16, 23, 24, 26], as shown in Appendix Table 4. The most recognizable definition of deep gluteal space is as follows: Anterior border: posterior acetabular column Posterior border: gluteus maximus muscle Medial border: sacrotuberous ligament Lateral border: gluteal tuberosity Superior border: sciatic notch Inferior border: Ischial tuberosity …”

Section: Resultsmentioning

confidence: 99%

“…aFADIR test (flexion–adduction–internal rotation of the hip) was positive when buttock pain aggravated [10]. When posterior hip pain was worsened by passive flexion of the hip, it was also categorized as FADIR test positive [9]…”

Section: Resultsmentioning

confidence: 99%

“…bPace sign (pain and weakness with resisted abduction and external rotation of the hip) includes posterior hip pain aggravation when active Piriformis test [2, 27, 33] and active extension of the hip against resistance [9]…”

Section: Resultsmentioning

confidence: 99%

“…FADIR test (flexion-adduction-internal rotation of the hip) was positive when buttock pain aggravated [10]. When posterior hip pain was worsened by passive flexion of the hip, it was also categorized as FADIR test positive [9] b Pace sign (pain and weakness with resisted abduction and external rotation of the hip) includes posterior hip pain aggravation when active Piriformis test [2,27,33] and active extension of the hip against resistance [9] Ref. [2] Ref.…”

Section: Definition Of Dgs Disease and Deep Gluteal Spacementioning

confidence: 99%

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Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review

Kizaki

Uchida

Shanmugaraj

et al. 2020

Knee Surg Sports Traumatol Arthrosc

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Purpose Clinicians are not confident in diagnosing deep gluteal syndrome (DGS) because of the ambiguity of the DGS disease definition and DGS diagnostic pathway. The purpose of this systematic review was to identify the DGS disease definition, and also to define a general DGS diagnostic pathway. Methods A systematic search was performed using four electronic databases: PubMed, MEDLINE, EMBASE, and Google Scholar. In eligibility criteria, studies in which cases were explicitly diagnosed with DGS were included, whereas review articles and commentary papers were excluded. Data are presented descriptively. Results The initial literature search yielded 359 articles, of which 14 studies met the eligibility criteria, pooling 853 patients with clinically diagnosed with DGS. In this review, it was discovered that the DGS disease definition was composed of three parts: (1) non‐discogenic, (2) sciatic nerve disorder, and (3) nerve entrapment in the deep gluteal space. In the diagnosis of DGS, we found five diagnostic procedures: (1) history taking, (2) physical examination, (3) imaging tests, (4) response‐to‐injection, and (5) nerve‐specific tests (electromyography). History taking (e.g. posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (e.g. tenderness in deep gluteal space, pertinent positive results with seated piriformis test, and positive Pace sign), and imaging tests (e.g. pelvic radiographs, spine and pelvic magnetic resonance imaging (MRI)) were generally performed in cases clinically diagnosed with DGS. Conclusion Existing literature suggests the DGS disease definition as being a non‐discogenic sciatic nerve disorder with entrapment in the deep gluteal space. Also, the general diagnostic pathway for DGS was composed of history taking (posterior hip pain, radicular pain, and difficulty sitting for 30 min), physical examination (tenderness in deep gluteal space, positive seated piriformis test, and positive Pace sign), and imaging tests (pelvic radiographs, pelvic MRI, and spine MRI). This review helps clinicians diagnose DGS with more confidence. Level of evidence IV.

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