Imaging of peripheral nerve causes of chronic
buttock pain and sciatica
By Eamon Koh
Chronic buttock pain is a debilitating symptom, which severely impacts daily activities and sleep and may affect performance in athletes. Its prevalence is unknown; however, piriformis syndrome, a common cause of buttock pain, may be seen in up to 6% of patients with back and/or sciatica pain.
Although posterior hip or hamstring pathology are often considered as the primary diagnosis, neural pathology may be a significant cause of chronic buttock pain, particularly if there are co-existing radicular symptoms or back pain. In these cases, lumbar disc herniation is usually considered to be the cause of symptoms; however, if lumbar spine pathology has been excluded, pelvic causes of neural pain should be considered, especially if symptoms are present for6 months, when symptoms from an acute disc lesion should typically have resolved.
Along with neural features, such as sharp or shooting pain and pins and needles in the buttock and/or leg, patients with pelvic neural causes of pain may complain of sitting or walking pain and nocturnal pain, with sitting pain being particularly common.1e3 An antalgic sitting posture and neural sensitisation lateral to the ischial tuberosity may be seen at examination.