Physician Montefiore Hospital Bronx, New York, United States
Case Diagnosis: Deep Gluteal Syndrome
Case Description: A fifteen-year-old female developed acute right leg pain while cooking, which gradually progressed to her lower back and feet, eventually shifting to her left lateral hip and knee. Her symptoms included weakness, paresthesias in her left foot, and impaired ambulation. On examination, she had weakness in left ankle dorsiflexion and plantar flexion, along with decreased patellar reflexes bilaterally. Initial MRI scans of the brain, cervical, thoracic, and lumbar spine were unremarkable, but follow-up MRI of the pelvis and sacrum revealed sciatic nerve entrapment in the subgluteal space, compressed by a fibrous band beneath the piriformis muscle. Electrodiagnostic studies indicated reduced motor unit recruitment in the left tibialis anterior, consistent with neurapraxia without significant axonal injury. Treatment included physical therapy focused on strengthening and stretching, along with a carbon fiber ankle-foot orthosis (AFO) to manage foot drop.
Discussions: Deep Gluteal Syndrome is an uncommon etiology of sciatic neuropathy, where nerve entrapment by fibrous structures can cause acute motor and sensory deficits. This case highlights the utility of serial imaging and electrodiagnostic testing in identifying Deep Gluteal Syndrome, which can present with symptoms mimicking other neuropathies. The patient’s presentation and imaging findings suggest mechanical compression of the sciatic nerve, rather than a systemic or infectious neuropathy. Early non-surgical interventions, including targeted physical therapy and orthotic support, are crucial in managing symptoms and preventing chronic impairment.
Conclusions: This case highlights the importance of thorough evaluation for atypical neuropathies and the role of a multidisciplinary approach. The patient’s favorable prognosis, due to the absence of significant axonal damage, supports conservative management as an effective treatment path. Regular follow-up will be essential to monitor symptom resolution and guide adjustments to her care plan if necessary.
