{"id":24566,"date":"2025-07-09T15:08:12","date_gmt":"2025-07-09T14:08:12","guid":{"rendered":"https:\/\/apps.nhslothian.scot\/refhelp\/?page_id=24566"},"modified":"2026-04-22T13:52:28","modified_gmt":"2026-04-22T12:52:28","slug":"buttock-pain-2","status":"publish","type":"page","link":"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/buttock-pain-2\/","title":{"rendered":"Buttock pain"},"content":{"rendered":"\n<p><strong>MSK causes of buttock pain<\/strong><strong><\/strong><\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>OA hip<\/li>\n\n\n\n<li>Lumbar spine referral <em>(buttock pain with or without L Spine pain, +\/- referred symptoms)<\/em><\/li>\n\n\n\n<li>Sacro iliac joint pain <em>(tender over SIJ specifically)<\/em><\/li>\n\n\n\n<li>Hamstring tendonopathies (<em>usually specific ischial tuberosity pain, worse on bending forward, can be post traumatic or overuse)<\/em><\/li>\n\n\n\n<li>Piriformis syndrome <em>(buttock pain, burning, +\/- tingling in sciatic nerve distribution, caused by increase in activity intensity)<\/em><\/li>\n<\/ul>\n\n\n\n<p><strong>History<\/strong><\/p>\n\n\n\n<p>Rarely traumatic unless hamstring tear\/avulsion suspected<\/p>\n\n\n\n<p><strong>Signs&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;<\/strong><\/p>\n\n\n\n<p>Hip OA frequently associated with reduced range of hip motion.&nbsp; May not have focal buttock tenderness<\/p>\n\n\n\n<p>SIJ source of pain frequently associated with localised SIJ pain on palpation<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"561\" height=\"225\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Buttock-pain.png\" alt=\"Buttock pain\" class=\"wp-image-24565\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Buttock-pain.png 561w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/Buttock-pain-300x120.png 300w\" sizes=\"auto, (max-width: 561px) 100vw, 561px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p>Hamstring tendinopathy frequently associated with localised pain on ischium<\/p>\n\n\n\n<p>Localised pain to deep palpation in piriformis region in piriformis syndrome (see photo below)<\/p>\n\n\n<div class=\"wp-block-image\">\n<figure class=\"aligncenter size-full\"><img loading=\"lazy\" decoding=\"async\" width=\"620\" height=\"457\" src=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3.png\" alt=\"ANAH Services 3\" class=\"wp-image-24562\" srcset=\"https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3.png 620w, https:\/\/apps.nhslothian.scot\/files\/sites\/2\/ANAH-Services-3-300x221.png 300w\" sizes=\"auto, (max-width: 620px) 100vw, 620px\" \/><figcaption><span class=\"media-credit\">NHS Lothian<\/span><\/figcaption><\/figure>\n<\/div>\n\n\n<p><\/p>\n\n\n\n<div class=\"wp-block-getwid-tabs\" data-active-tab=\"0\"><ul class=\"wp-block-getwid-tabs__nav-links\"><\/ul>\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Referral  Guidelines<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<h4 class=\"wp-block-heading\">Who to refer:<\/h4>\n\n\n\n<p>Urgent referral for acute, traumatic buttock\/proximal posterior thigh pain if any concern of acute hamstring tear<\/p>\n\n\n\n<h4 class=\"wp-block-heading\"><strong>Who not to refer:<\/strong><\/h4>\n\n\n\n<p>Hip OA can cause buttock as well as groin pain.&nbsp; If XRs show OA, refer to Arthroplasty service<\/p>\n\n\n\n<p>Lumbar spine <strong>referred pain &#8211; <\/strong>consider referral to NHS Lothian Integrated Back Pain service<strong> or physiotherapy referral<\/strong><\/p>\n\n\n\n<p>Red flags &#8211; see home page <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/guidelines\/orthopaedics\/adult-non-arthritic-hip-service\/\" target=\"_blank\" rel=\"noreferrer noopener\">Adult Non Arthritic Hip Service \u2013 RefHelp<\/a><\/p>\n\n\n\n<h4 class=\"wp-block-heading\">How to refer:<\/h4>\n\n\n\n<p class=\"has-standard-black-color has-text-color has-link-color wp-elements-4b6dad01661039205a45c182fbfe87b2\"><strong>SCI gateway &gt; Lauriston Buildings &gt; Orthopaedics \u2013 Hip &gt; LI Adult Non Arthritic Hips\u00a0<\/strong><\/p>\n\n\n\n<p>Routine referral to ANAH if Lumbar Spine, SIJ, OA ruled out and ONLY if course of physiotherapy has been completed<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Primary Care Management<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><strong>Primary care investigations<\/strong><\/p>\n\n\n\n<p>XR pelvis to exclude hip OA<\/p>\n\n\n\n<p><strong>Primary care treatment<\/strong><\/p>\n\n\n\n<p>Refer to physiotherapy for at least 3 months targeted physiotherapy<\/p>\n<\/div><\/div>\n\n\n\n<div class=\"wp-block-getwid-tabs__nav-link\"><span class=\"wp-block-getwid-tabs__title-wrapper\"><a href=\"#\"><span class=\"wp-block-getwid-tabs__title\">Resources and Links<\/span><\/a><\/span><\/div><div class=\"wp-block-getwid-tabs__tab-content-wrapper\"><div class=\"wp-block-getwid-tabs__tab-content\">\n<p><a href=\"https:\/\/www.edinburghorthopaedics.org\/patient-information-pages\/hip\/\" target=\"_blank\" rel=\"noreferrer noopener\">Edinburgh Orthopaedics<\/a><\/p>\n<\/div><\/div>\n<\/div>\n","protected":false},"excerpt":{"rendered":"<p>MSK causes of buttock pain History Rarely traumatic unless hamstring tear\/avulsion suspected Signs&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Hip OA frequently associated with reduced range of hip motion.&nbsp; 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<\/p>\n","protected":false},"author":6,"featured_media":0,"parent":24555,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"categories":[1267],"class_list":["post-24566","page","type-page","status-publish","hentry","category-https-apps-nhslothian-scot-refhelp-buttock-pain-2"],"publishpress_future_workflow_manual_trigger":{"enabledWorkflows":[]},"rttpg_featured_image_url":null,"rttpg_author":{"display_name":"heatherlevy","author_link":"https:\/\/apps.nhslothian.scot\/refhelp\/author\/heatherlevy\/"},"rttpg_comment":0,"rttpg_category":" <a href=\"https:\/\/apps.nhslothian.scot\/refhelp\/category\/orthopaedics\/https-apps-nhslothian-scot-refhelp-adult-non-arthritic-hip-service\/https-apps-nhslothian-scot-refhelp-buttock-pain-2\/\" rel=\"tag\">Buttock pain<\/a>","rttpg_excerpt":"MSK causes of buttock pain History Rarely traumatic unless hamstring tear\/avulsion suspected Signs&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; Hip OA frequently associated with reduced range of hip motion.&nbsp; 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","_links":{"self":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24566","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/comments?post=24566"}],"version-history":[{"count":5,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24566\/revisions"}],"predecessor-version":[{"id":27726,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24566\/revisions\/27726"}],"up":[{"embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/pages\/24555"}],"wp:attachment":[{"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/media?parent=24566"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/apps.nhslothian.scot\/refhelp\/wp-json\/wp\/v2\/categories?post=24566"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}