Dr Keith Bush talks us through what these symptoms may reveal, and how to manage them.

What symptoms of pain in the buttocks may reveal

Well, this is not an uncommon complaint in musculoskeletal practice and the first thing is to be thoroughly assessed by someone who understands what the possibilities are. Then, further imaging such as an MRI scan of the lumbar spine and or the pelvis may be required to confirm the clinical suspicion.

Differential diagnosis should include:

• Sciatica due to L4/L5 or L5/S1 intervertebral disc herniation
• Referred pain from facet or sacroiliac joint
• Osteoarthritis capsulitis of the hip
• Hamstring origin injury
• Ischial bursitis
• Femoro ischial impingement
• Piriformis syndrome
• Trochanteric bursitis
• Gluteal bursitis
• Gluteus medius tendinosis
• Gluteus minimus tendinosis
• Gluteus maximus tendinosis
• Infection
• Malignancy

Treatment

Once a firm diagnosis has been established then a treatment strategy can be planned. This may range from manual techniques such as physiotherapy, osteopathy, chiropractic or injectional techniques based on anatomical grounds or under image guidance. A positive response to an injection in the short term absolutely confirms the diagnosis and may be long lasting. For instance, over 80% of sciaticas due to disc herniations will resolve with conservative measures. Steroid injections reduce the inflammation of the nerve root buying pain free time whilst most intervertebral disc herniations regress naturally.

On the other hand osteoarthritis of the hip is generally a progressive condition which ultimately may require total hip replacement. However, repeated injections may delay the need for surgery for many years which is important in younger patients. Furthermore, when patients are suffering from dual potential pathology, a positive response to an injection in the short term can be very helpful in localising the predominant pain source that may ultimately require a surgical solution.

Dr Keith Bush is the Consultant Orthopaedic and Sports Physician for the KB Clinic on Harley Street specialising in diagnosing and imaging musculoskeletal disease including sporting injuries. For further information contact the clinic here kbsec@btconnect.com.

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