{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T14:46:49Z","timestamp":1788274009545,"version":"build-2803163510"},"reference-count":26,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T00:00:00Z","timestamp":1774915200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Bioengineering"],"abstract":"<jats:p>Background: Deep gluteal syndrome (DGS) has traditionally been attributed to sciatic nerve entrapment within the deep gluteal space. However, increasing evidence suggests that enthesopathy and soft tissue pathology of the short external rotators may also contribute to its pathogenesis. Conventional ultrasound-guided interventions primarily target the sciatic nerve through perineural hydrodissection (HD), which may not address enthesis-related pathology. However, the anatomical feasibility of delivering injectate along the deep gluteal fascial plane has not yet been investigated in cadaveric studies. Methods: This cadaveric anatomical demonstration evaluated whether an ultrasound-guided fascial plane injection within the deep gluteal space could simultaneously reach the enthesis of the short external rotators and the region of the sciatic nerve. Ultrasound scanning protocols were first demonstrated in a healthy volunteer to establish anatomical orientation for the injection pathway. Injection experiments were then performed in a fresh-frozen cadaver (83-year-old male) using a cranial-to-caudal in-plane approach. Ten milliliters of methylene blue dye was injected along the fascial plane overlying the short external rotator enthesis, followed by layer-by-layer cadaveric dissection to assess dye distribution. Results: Cadaveric dissection demonstrated that methylene blue injected along the deep gluteal fascial plane extended to the enthesis of the short external rotators and spread toward the surface of the sciatic nerve. Comparable distribution patterns were observed in both hips. These findings suggest that a single ultrasound-guided fascial plane injection trajectory may anatomically access both the enthesis region and the adjacent sciatic nerve within the deep gluteal space. Conclusions: Ultrasound-guided fascial plane HD in the deep gluteal space provides an anatomical pathway that can simultaneously access the enthesis of the short external rotators and the region of the sciatic nerve. This approach may represent a potential anatomical basis for a fascial plane-based intervention strategy in DGS. Further studies are required to evaluate in vivo behavior and clinical effectiveness.<\/jats:p>","DOI":"10.3390\/bioengineering13040412","type":"journal-article","created":{"date-parts":[[2026,3,31]],"date-time":"2026-03-31T16:34:08Z","timestamp":1774974848000},"page":"412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["An Anatomical Cadaveric Demonstration of an Ultrasound-Guided Fascial Plane Injection Pathway in the Deep Gluteal Space"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9692-4838","authenticated-orcid":false,"given":"Sang-Hyun","family":"Kim","sequence":"first","affiliation":[{"name":"College of Korean Medicine, Woosuk University, 443, Samnye-ro, Samnye-eup, Wanju-gun 55338, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8990-1213","authenticated-orcid":false,"given":"U-Young","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, The Catholic University of Korea, Seoul 06649, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"Incheon Terminal Orthopedic Surgery Clinic, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"MSKUS, 1035 E. Vista Way #128, Vista, CA 92084, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonghyeok","family":"Lee","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Bareun Neurosurgery Clinic, 39, Daenong-ro, Heungdeok-gu, Cheongju-si 28402, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungbeom","family":"Kim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Miso Pain Clinic, 1569, Bongyeong-ro, Yeongtong-gu, Suwon-si 16703, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Faculty of Medicine, The University of Hong Kong, Kowloon, Hong Kong"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, New Territory, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11470, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"261","DOI":"10.2165\/00007256-199927040-00005","article-title":"Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock","volume":"27","author":"McCrory","year":"1999","journal-title":"Sports Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"3354","DOI":"10.1007\/s00167-020-05966-x","article-title":"Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review","volume":"28","author":"Kizaki","year":"2020","journal-title":"Knee Surg. 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