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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

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Knee Surgery, Sports Traumatology, Arthroscopy Aims and scope

Abstract

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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Abbreviations

DGS:

Deep gluteal syndrome

MINORS:

The methodological index for non-randomized studies

MRI:

Magnetic resonance imaging

PRISMA:

The preferred reporting items for systematic reviews and meta-analyses

SI:

Sacroiliac

95% CI:

95% confidence interval

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Funding

No financial support for this review.

Author information

Authors and Affiliations

  1. Department of Health Research Methods, Evidence, and Impact, McMaster University, 1200 Main St. W, Hamilton, ON, L8N 3Z5, Canada

    Kazuha Kizaki, Camila Catherine Aquino, Nicole Simunovic & Olufemi R. Ayeni

  2. Department of Orthopaedic Surgery, Wakamatsu Hospital for the University of Occupational and Environmental Health, Kitakyushu, 808-0024, Japan

    Soshi Uchida

  3. Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster University, 1200 Main Street West, 4E15, Hamilton, ON, L8N 3Z5, Canada

    Kazuha Kizaki, Ajaykumar Shanmugaraj, Andrew Duong, Nicole Simunovic & Olufemi R. Ayeni

  4. Hip Preservation Center, Baylor University Medical Center at Dallas, Dallas, TX, USA

    Hal David Martin

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  1. Kazuha Kizaki
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  6. Nicole Simunovic
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  7. Hal David Martin
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Contributions

KK, SU, and OA conceptualized the work and formatted the research question. KK and AS performed searching. KK and CA assessed the quality of the included studies. KK, NS and AD performed data acquisition and statistical analysis. SU, HM, and OA interpreted the data and commented on the data. KK wrote the manuscript. OA supervised the study and edited the manuscript.

Corresponding author

Correspondence to Olufemi R. Ayeni.

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Conflict of interest

We disclosed conflict of interest in the ICMJE file.

Ethical approval

This is a systematic review, and therefore, IRB approval is not required.

Informed consent

This is a systematic review, and therefore, informed consent is not required.

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Appendix

Appendix

See Tables 3 and 4.

Table 3 MINORS scores of the included studies
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Table 4 Deep gluteal space definition in the included studies
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Kizaki, K., Uchida, S., Shanmugaraj, A. et al. Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a systematic review. Knee Surg Sports Traumatol Arthrosc 28, 3354–3364 (2020). https://doi.org/10.1007/s00167-020-05966-x

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