Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: a
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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 Kazuha Kizaki1,3 · Soshi Uchida2 · Ajaykumar Shanmugaraj3 · Camila Catherine Aquino1 · Andrew Duong3 · Nicole Simunovic1,3 · Hal David Martin4 · Olufemi R. Ayeni1,3 Received: 12 February 2020 / Accepted: 23 March 2020 © European Society of Sports Traumatology, Knee Surgery, Arthroscopy (ESSKA) 2020
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-toinjection, 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. Keywords Hip · Deep gluteal syndrome · Disease definition · Diagnostic pathway · Systematic review 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
* Olufemi R. Ayeni [email protected]
3
Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre, McMaster Universi
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