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The two main causes of hip and buttock pain that arise from the hip joint are age-related changes, known as hip osteoarthritis, and a hip labral tear. The pain may be more pronounced when you are lying on your side.
In most cases these conditions will be characterised by pain in the buttock and groin region. Sometimes the pain may be in the outer or front thigh. However, in some cases, normally when there is a significant defect towards the back of the hip joint, these two conditions can result in buttock pain in isolation.
If the hip joint is suspected to be the cause of buttock pain, x-rays from specialist angles and an MRI scan, possibly with contrast dye injected in to the hip joint (MR arthrogram) may be requested.
The joints and soft tissue structures (ligaments and joint capsules) of the lower spine may all refer pain in to the buttock region. You may be feeling lower back and buttock pain or there may be pain in top of buttocks.
This referred pain is due to the body’s central nervous system being unable, in some cases, to distinguish the exact location of the problem and can occur with all musculoskeletal tissues, such as a spinal stenosis which is the result of a herniated disc.
The second way that a lower spinal problem can cause buttock pain is when there is irritation or compression of the sciatic nerve which runs through the buttock. In these cases, there may be associated pins and needles, tingling or further pain throughout the affected leg.
With suspected spinal causes of buttock pain a consultant orthopaedic specialist will often request an MRI scan to help to confirm the exact tissue responsible.
Buttock pain can arise from the muscles and tendons of this region, such as pain in the buttocks and legs. This can be due to the gluteal muscles or the uppermost tendon of the hamstring muscles, which attach to the sitting bones of the pelvis.
Typically, if these structures are the cause, then the pain will be aggravated with prolonged sitting, or active tasks when the muscles and tendons are placed under load such as sports activity or climbing stairs when you may feel a sharp pain in the buttock.
Diagnostic scans for muscular and tendon causes of buttock pain often only demonstrate normal changes to these structures with age. Therefore, an orthopaedic specialist may only in specific circumstances request an ultrasound scan.
Several other rare causes of buttock pain exist. Some of these causes will be related to medical problems inflaming the soft tissue around the pelvic area (autoimmune diseases).
A further diagnosis which often poses difficulty for clinicians is a condition known as piriformis syndrome. The piriformis is a deep gluteal muscle which runs from the pelvis to the outer hip bone.
As it passes through the middle of the gluteal region this muscle runs in close proximity to the sciatic nerve. Anatomical variants exist among the population but sometimes the nerve passes to one side of the muscle but in others the nerve can pierce the central portion of the piriformis muscle.
In these cases, the sciatic nerve can become irritated by the muscle causing familiar buttock pain which may run down the back of the thigh and calf. It is thought that this condition may be triggered by unaccustomed hip movements or exercises which may lead to tightness or enlargement of the piriformis muscle.
Piriformis syndrome is not reliably diagnosed by scans and as such, under normal circumstances a specialist will refer on to a physiotherapist for treatment.
The symptoms will vary depending on the location of the pain in the buttocks. The most common symptoms are:
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