Buttock pain

Buttock pain is a common complaint within the non-athletic and athletic population. Buttock pain can be a difficult problem to diagnose for healthcare professionals as there can be various causes all of which may not be detectable on specific diagnostic tests such as scans and blood tests.

Due to the difficulty in diagnosing the cause of buttock pain a consultation with a specialist orthopaedic spine or hip surgeon can be helpful as the first step. Circle Health is able to offer short notice appointments with one of our specialists who will provide a detailed provisional diagnosis as well as any relevant diagnostic scans before a follow up appointment is arranged to discuss the best onward treatment plan.

An initial consultation for buttock pain will involve enquiring whether the pain arose from an injury or related to a particular task. The consultant will also locate the specific site of the buttock pain and will question to determine if there are any associated symptoms such as other areas of pain, pins and needles or tingling. A full medical screening will also be taken at the initial consultation.

To confirm possible sources of buttock pain, the consultant will examine specific tissues around the spine and hips with certain physical examination tests.

Two causes of pain arising from the hip joint are age related changes known as hip osteoarthritis and a hip labral tear. In the vast majority of cases these conditions will be characterized by pain in the inguinal or groin region and sometimes in to the outer or front thigh. However, in some cases, normally when there is a significant defect towards the back of the hip joint these two conditions can result in buttock pain in isolation.

If the hip joint is suspected to be the cause of buttock pain, x-rays from specialist angles and an MRI scan, possibly with contrast dye injected in to the hip joint (MR arthrogram) may be requested.

The joints and soft tissue structures (ligaments and joint capsules) of the lower spine may all refer pain in to the buttock region. In some cases buttock pain may be felt without any low back pain being felt. This referred pain is due to our central nervous system (brain and spinal cord) being unable in some cases to distinguish the exact location of the problem and can occur with all musculoskeletal tissues.

The second way that a lower spinal problem can cause buttock pain is when there is irritation or compression of the sciatic nerve which runs through the buttock. In these cases, there may be associated pins and needles, tingling or further pain throughout the affected leg.

With suspected spinal causes of buttock pain a consultant orthopaedic specialist will often request an MRI scan to help to confirm the exact tissue responsible.

Buttock pain can arise from the muscles and tendons of this region. This can be due to the gluteal muscles or the uppermost tendon of the hamstring muscles which attach to the sitting bones of the pelvis. Typically, if these structures are the cause of buttock pain the pain will be aggravated with prolonged sitting, or active tasks when the muscles and tendons are placed under load such as sports activity or climbing stairs.

Diagnostic scans for muscular and tendon causes of buttock pain often only demonstrate normal changes to these structures with age. Therefore, an orthopaedic specialist may only in specific circumstances request an ultrasound scan.

Several other rare causes of buttock pain exist. Some of these causes will be related to medical problems inflaming the soft tissue around the pelvic area (autoimmune diseases).

A further diagnosis which often poses difficulty for clinicians is a condition known as piriformis syndrome. The piriformis is a deep gluteal muscle which runs from the pelvis to the outer hip bone. As it passes through the middle of the gluteal region this muscle runs in close proximity to the sciatic nerve. Anatomical variants exist among the population but sometimes the nerve passes to one side of the muscle but in others the nerve can pierce the central portion of the piriformis muscle.

In these cases, the sciatic nerve can become irritated by the muscle causing familiar buttock pain which may run down the back of the thigh and calf. It is thought that this condition may be triggered by unaccustomed hip movements or exercises which may lead to tightness or enlargement of the piriformis muscle. Piriformis syndrome is not reliably diagnosed by scans and as such, under normal circumstances a specialist will refer on to a physiotherapist for treatment.

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