2. Pain in the gluteal region. Discussion

A middle aged male presented with complaints of pain in the right gluteal region. The pain started spontaneously and hampered him from walking. The pain was worse with movement especially in getting up from sitting and climbing stairs. It was relieved temporarily with the use of NSAIDs. There was no associated back pain, no pain on the anterior or medial aspect of the thigh or below the knee. There was no history of numbness or paresthesias. On examination pain was reproduced particularly during flexion, adduction and internal rotation of the hip. There was no local tenderness and no obvious lesions on the skin.

What is the possible cause?

A principle that I follow in evaluating pain is to first think of the possible structures that could be the origin of the patient’s pain. Pain in the gluteal region may arise from the skin, subcutaneous tissue, muscles in the region, joints, bone, nerve or the spinal roots.

An infection in the cutaneous or subcutaneous plane: Furuncle, Abscess, Bursitis

Muscle: Myofascial strain, Myositis

Joint: Sacroiliitis, sacroiliac joint dysfunction

Bone: Osteomyelitis

Nerve: Sciatic nerve compression

Roots: Lumbar Radiculopathy secondary to root compression

How to evaluate the patient?

Local examination: Inspection & Palpation: Check for tenderness, muscle tightness

Move: Range of motion

Stress tests for the sacroiliac joint

Tests for piriformis syndrome

Neurological examination to check for radiculopathy & sciatic nerve dysfunction

Imaging to look for structural pathology

Special tests: SPECT/Magnetic resonance neurography