MSK causes of buttock pain
- OA hip
- Lumbar spine referral (buttock pain with or without L Spine pain, +/- referred symptoms)
- Sacro iliac joint pain (tender over SIJ specifically)
- Hamstring tendonopathies (usually specific ischial tuberosity pain, worse on bending forward, can be post traumatic or overuse)
- Piriformis syndrome (buttock pain, burning, +/- tingling in sciatic nerve distribution, caused by increase in activity intensity)
History
Rarely traumatic unless hamstring tear/avulsion suspected
Signs
Hip OA frequently associated with reduced range of hip motion. May not have focal buttock tenderness
SIJ source of pain frequently associated with localised SIJ pain on palpation
Hamstring tendinopathy frequently associated with localised pain on ischium
Localised pain to deep palpation in piriformis region in piriformis syndrome (see photo below)
Who to refer:
Urgent referral for acute, traumatic buttock/proximal posterior thigh pain if any concern of acute hamstring tear
Who not to refer:
Hip OA can cause buttock as well as groin pain. If XRs show OA, refer to Arthroplasty service
Lumbar spine referred pain – consider referral to NHS Lothian Integrated Back Pain service or physiotherapy referral
Red flags – see home page
How to refer:
SCI gateway > Laurison Buildings > Orthopaedics – Other
(Please note that the pathway will change soon to ANAH – Adult Non-Arthritic Hip)
Routine referral to ANAH if Lumbar Spine, SIJ, OA ruled out and ONLY if course of physiotherapy has been completed
Primary care investigations
XR pelvis to exclude hip OA
Primary care treatment
Refer to physiotherapy for at least 3 months targeted physiotherapy
