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Patients also frequently report persistent or intermittent pain or dysthesias in posterior hip, buttocks, or thigh. [4] Unlike discogenic sciatica (caused by the spine), patients with deep gluteal syndrome report exacerbation of symptoms with pressure in the buttocks, such as tenderness or pain on deep palpation, or pain on prolonged sitting.
Sciatica is pain going down the leg from the lower back. [1] This pain may go down the back, outside, or front of the leg. [3] Onset is often sudden following activities such as heavy lifting, though gradual onset may also occur. [5] The pain is often described as shooting. [1] Typically, symptoms are only on one side of the body. [3]
The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage.
Piriformis syndrome is often left undiagnosed and mistaken with other pains due to similar symptoms with back pain, quadriceps pain, lower leg pain, and buttock pain. These symptoms include tenderness, tingling and numbness initiating in low back and buttock area and then radiating down to the thigh and to the leg. [ 72 ]
Neurogenic claudication must be differentiated from other causes of leg pain, which may be present in a number of conditions involving the spine and musculoskeletal system. The differential diagnosis for NC includes: [9] Vascular claudication; Lumbosacral radicular pain secondary to lumbar disc herniation
Meralgia paresthetica or meralgia paraesthetica is pain or abnormal sensations in the outer thigh not caused by injury to the thigh, but by injury to a nerve which provides sensation to the lateral thigh. Meralgia paresthetica is a specific instance of nerve entrapment. [5] The nerve involved is the lateral femoral cutaneous nerve (LFCN).
The diagnosis is confirmed when the patient reports a significant change in relief from pain and the diagnostic injection is performed on two separate visits. Published studies have used at least a 75 percent change in relief of pain before a response is considered positive and the sacroiliac joint deemed the source of pain.
Previous studies show a medial approach is beneficial for type I and II while a posterior approach is better for type III and IV. [4] Additionally, the use of Botulinum Toxin A has been used as an alternative noninvasive treatment for functional PAES. [27] A diagnosis of functional PAES is made if symptoms are improved after Botulinum injection.