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Sciatic Nerve and Deep Gluteal Syndrome

Sciatic Nerve and Deep Gluteal Syndrome – as taught by Dr. Hal Martin

  • differential diagnostic considerations

    • medial to ischium – consider pudendal nerve
    • lateral to ischium
      • hamstring versus iliofemoral impingement
      • 30 degree versus 90 degree active hamstring test
      • walk them in the hallway (long stride walking) – recreate impingement
      • piriformis active test
      • passive piriformis test
  • Pudendal nerve 

    • serial nerve injections
    • usually use CT 
    • nonoperative treatment is usually effective
    • operative treatments continue to evolve
  • Hamstring

    • diagnose
    • consider ischioplasty + repair
    • tape feet in neutral rotation in MRI scanner to make sure adequate space
  • Deep Gluteal Space Syndrome

    • includes piriformis compression
    • posterior hip pain
    • history of trauma
    • sitting pain (can’t sit more than 30 seconds)
    • Fernandez et al. Radiology 2015
    • treatment
      • therapy, injections, surgical
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