The Deep Gluteal Syndrome, an underestimated etiological factor for Sciatica, Low Back Pain and other chronic pain conditions?

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The Deep Gluteal Syndrome or Piriformis Syndrome, an underestimated etiological factor for Sciatica, Low Back Pain and other chronic pain conditions? A case series report, review of the literature and a proposal for diagnostic criteria.
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Objective:
This article proposes a new diagnostic entity called the Deep Gluteal Syndrome and makes a very rough estimation of its minimum prevalence in a primary care environment.
Design
It is based on a collection of case reports on retrospectively collected data from an unselected patient material in a Norwegian primary care setting.

Results
Deep Gluteal Syndrome (DGS) was diagnosed in 187 out of 986 patients, giving a prevalence of 19.9%. Only patients with anamnestic signs of Deep Gluteal Syndrome were investigated. This means that the real prevalence of Deep Gluteal syndrome may be higher. Deep Gluteal Syndrome was found in association with a range of conditions including lumbago, diffuse neck/shoulder/arm problems, hip and buttock pain, sciatica and diffuse lower abdomen/pelvic pain, fibromyalgia and tension headache.

The syndrome is defined as tenderness and abnormal pain sensitivity in the Parasacrococcygeal area. The pain disappears together with the above mentioned associated conditions after appropriate stretching, or injection with local anaesthetics. The syndrome can be treated with a probable success rate of more than 80%.
The main treatments are exercise, manipulation, stretching exercises, manual manipulation of the deep gluteal muscles, ultrasound treatment, steroid and/or botulinum toxin injections and surgery.
Conclusions
These data suggests that the so-called Deep Gluteal Syndrome(DGS) is severely underdiagnosed. It also postulates DGS as a possible etilogical factor for Low Back Pain, Sciatica and several other chronic pain conditions. With more research, and education about appropriate diagnosis and treatment, there might be a huge potential for relief of suffering and financial savings to the health system.
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