Piriformis Syndrome and Deep Gluteal Syndrome: Presentation, Diagnostic Imaging, and Management

Deep gluteal syndrome is a type of entrapment neuropathy of the deep gluteal space where patients present with chronic buttock pain and/numbness with or without sciatica. Piriformis syndrome is one of the etiologies of deep gluteal syndrome wherein there is suspected compression of static or dynamic sciatic nerve due to the piriformis muscle and its variations. Good clinical history and examination can help in raising the clinical suspicion for deep gluteal syndrome. Imaging not only aids in the diagnosis but also has a large role in the treatment of this condition. MR neurography is an indispensable aid for the diagnosis of neuromuscular alterations associated with this syndrome. During evaluation of the deep gluteal syndrome, discogenic etiology for sciatica needs to be excluded as well. Conservative management includes medications for pain relief and muscle relaxation and physiotherapy. Image-guided interventions like intramuscular Botox injection and perineural sciatic injection can provide longer term relief. Patients with a history of failed conservative management and image-guided interventions can be considered for surgical intervention. Timely diagnosis of deep gluteal syndrome can help guide patient management and avoid unnecessary procedures.