Freiberg Sign | Piriformis Syndrome | Deep Gluteal Syndrome Hip

Deep gluteal syndrome, abbreviated as DGS is defined as pain in the buttock area caused by a non-discogenic entrapment of the sciatic nerve in the subgluteal space.

The structures that can be involved in sciatic nerve entrapment are not only the piriformis but also fibrous bands containing blood vessels, gluteal muscles, hamstring muscles, the gemelli-obturator internus complex, vascular abnormalities and space-occupying lesions. For this reason, the term “deep gluteal syndrome” instead of “pirformis syndrome” is now preferred.

Commonly reported symptoms include hip or buttock pain and tenderness in the gluteal and retro-trochanteric region. The pain is often described to be sciatica-like, often unilateral and exacerbated with rotation of the hip in flexion and knee extension. Other symptoms include intolerance of sitting for more than 20 to 30 minutes, limping, disturbed or loss of sensation in the affected extremity and pain at night getting better during the day.

No diagnostic studies have been done on the Freiberg maneuver yet, which is why we give it a questionable clinical value in practice.

Before you conduct the test, make sure you have examined and excluded more prevalent pathologies in the lumbar spine and SI joint that could explain the patient’s symptoms.To perform the test, have the patient in supine position. Then, the examiner forcefully internally rotates the extended thigh of the affected leg in an attempt to stretch the irritated piriformis and provoke sciatic nerve compression.The test is positive if the patient’s familiar complaints of gluteal pain and/or paraesthesia radiating into the posterior aspect of the lower extremity are reproduced

Other common tests to assess for deep gluteal syndrome are:

• Heel Contralateral Knee (HCLK) maneuver
• Pace Maneuver
• Seated Piriformis Stretch Test
• FAIR Test
• Piriformis Test
• Beatty Maneuver
• Active Piriformis Test

21 OF THE MOST USEFUL ORTHOPAEDIC TESTS IN CLINICAL PRACTICE

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Freiberg, A. H. (1937). Sciatic pain and its relief by operations on muscle and fascia. Archives of Surgery, 34(2), 337-350.

Kirschner, J. S., Foye, P. M., & Cole, J. L. (2009). Piriformis syndrome, diagnosis and treatment. Muscle & nerve, 40(1), 10-18.