Table 4 Patho-anatomic approach: Within the gluteal triangle (diagnoses appear in order of frequency in an athletic population)
Define and alignPathologyListen and localisePalpate and recreateAlleviate and investigate
Within the triangleAcute/chronic disc prolapseLumbar back pain , +/− radiation to back of leg“Lasègue” straight leg raise (sensitivity 72–97% specificity 11–66%)48 “Braggards” sign (94% +ve)49Fluroscopic guided nerve root injection50, Magnetic resonance imaging
Lumbar facet jointRevels criteria51 lumbar back pain radiation to buttockPain on palpation of facet joint and worse in extension10Fluroscopic guided facet joint injection51
Piriformis tendonopathyHamstring origin pain with gradual rather than sudden onset and/or sciatic referred painTenderness over sciatic notch and aggravated by flexion, adduction, and internal rotation (Lasègue sign) of the hip52 also FAIR test,53 Pace test10Ultrasound scan54
Pelvic floor dysfunctionPost pregnancy, perineal trauma, cyclistsCoccygeus and levator ani along with the conjoint bellies of pubococcygeus often ignored attachments to pelvis can give cause to gluteal pain54Urine examination, pelvic manometry, MRI of pelvic floor musculature, EMG
Circumflex femoral vein thrombosisHamstring origin pain with gradual onset and deep vein thrombosis risk factorsTenderness and pain on resisted flexion56 without muscle weaknessVenography, duplex ultrasound/MRI
  • EMG, electromyography; FAIR, Flexion, Abduction, Internal rotation; MRI, magnetic resonance imaging.