Deep Gluteal Syndrome: A Narrative Review of Diagnostic Uncertainty and Management

Deep gluteal syndrome (DGS) conventionally refers to non-discogenic irritation or entrapment of the sciatic nerve within the deep gluteal space.It is one possible cause of buttock pain with sciatica-like symptoms, although definitions and diagnostic criteria vary across studies.This narrative review examines the anatomy, diagnostic assessment, rehabilitation, image-guided procedures, and surgical management of DGS.No single clinical test or investigation has been independently validated to confirm the diagnosis.Assessment combines the history, neurological findings, posterior hip provocation tests, and investigations directed at specific diagnostic questions.Conservative care is generally used first, but rehabilitation studies are heterogeneous and largely concern piriformis syndrome.Small trials have reported some between-group differences without establishing a consistently superior rehabilitation or adjunctive treatment.Imageguided injections may relieve symptoms and provide complementary clinical information, but the response alone does not confirm DGS or identify a specific pain source.Endoscopic decompression has produced favorable outcomes in selected observational cohorts, although direct comparisons with structured rehabilitation are lacking.The clinical framework presented in this review represents the authors' synthesis of the available literature and has not been validated.Its proposed assessment and treatment options do not constitute a mandatory sequence of care.