Deep Gluteal Syndrome

Deep gluteal syndrome (DGS) is an underdiagnosed entity characterized by pain and/or dysesthesias in the buttock area, hip or posterior thigh and/or radicular pain due to a non-discogenic sciatic nerve entrapment in the subgluteal space. Multiple pathologies have been incorporated in this all-included “piriformis syndrome,” a term that has nothing to do with the presence of fibrous bands, obturator internus/gemellus syndrome, quadratus femoris/ischiofemoral pathology, hamstring conditions, gluteal disorders and orthopedic causes. The concept of fibrous bands playing a role in causing symptoms related to sciatic nerve mobility and entrapment represents a radical change in the current diagnosis of and therapeutic approach to DGS. The development of periarticular hip endoscopy has led to an understanding of the pathophysiological mechanisms underlying piriformis syndrome, which has supported its further classification.

A broad spectrum of known pathologies may be located nonspecifically in the subgluteal space and can therefore also trigger DGS. These can be classified as traumatic, iatrogenic, inflammatory/infectious, vascular, gynecologic and tumors/pseudo-tumors. Because of the ever-increasing use of advanced magnetic resonance neurography (MRN) techniques and the excellent outcomes of the new endoscopic treatment, radiologists must be aware of the anatomy and pathologic conditions of this space. MR imaging is the diagnostic procedure of choice for assessing DGS and may substantially influence the management of these patients. The infiltration test not only has a high diagnostic but also a therapeutic value.

This condition is caused/worsened by sudden trauma and/or by repetitive trauma.  For example, one person may developed it after a fall from a horse, another from a car running into her.  Repetitive trauma – such as too much sitting over time because of the patients profession.  Either way, sudden or repetitive pressure or “blows” to the nerve(s) from the surrounding muscles compressing on them can be enough of a trauma to exacerbate this condition.

Pain in bottom
Pain in leg
History of minor trauma
Symptoms exacerbated by sport
Altered bowel habit
Pain with sex

  • Non steroidal anti inflammatory drugs
  • Analgesia
  • Muscle relaxants
  • Heat packs
  • Physiotherapy
  • Anticonvulsant medications
  • Avoidance of activities that exacerbate the pain

 

3 areas of research that scientists are currently pursuing in terms of alleviating pain – (compiled by Linda VandeVrede)

1) Finding and blocking the way that “Nav” (sodium) channels in our bodies receive and conduct electrical signals/pain signals – modulators of sodium channels are good because they don’t harm other areas of the body, as opposed to opiates. People with chronic pain from nerve injury have an increased number of sodium channels that are damaged/out of whack. Modulating sodium channels accurately will mean a non-opiod, non-addictive, no-side-effect solution to pain.

2) Using venom from poisonous snakes, centipedes and scorpions to plug a set of ion channels in peripheral nerve cells that, like sodium channels, help the cells send pain signals, and

3) Developing drugs that stimulate stem cells to help the body repair itself and reverse damage.

Announced this month also is a patent on a new class of opiods that binds differently and doesn’t have the problems of opiates – little or no euphoric reward (which leads to abuse and addition), no constipation, and no precipitation of withdrawal. It’s called PPL103, and has been tested only on primates so far.

What’s motivating these scientists is the knowledge of how many people are affected by chronic pain, including cancer patients, and how many people have become addicted to opiates, which have serious side effects and are more like blunt force to alleviate than pain that the specific focus of sodium channel modulators.

TrialReach featured a story about DGS patient, Linda VandeVrede on their blog – read more:

Oxford Journal Information –  “Deep Gluteal Syndrome.”
It’s a form of sciatic nerve entrapment not caused by or related to the spine, and it doesn’t show up on an MRI because it’s too deep in the body.  Get an MRN (Magnetic Resonance Neurography) and also see one of the 2-3 surgeons in the U.S. who know what motions to put you through to determine if you have it.

Abstract – Science Direct
Voltage-gated sodium channels (Navs) are an important family of transmembrane ion channel proteins and Nav drug discovery is an exciting field. Pharmaceutical investment in Navs for pain therapeutics has expanded exponentially due to genetic data such as SCN10A mutations and an improved ability to establish an effective screen sequence for example IonWorks Barracuda®, Synchropatch® and Qube®. Moreover, emerging clinical data (AZD-3161, XEN402, CNV1014802, PF-05089771, PF-04531083) combined with recent breakthroughs in Nav structural biology pave the way for a future of fruitful prospective Nav drug discovery.

Translate »