{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,20]],"date-time":"2026-10-20T06:53:01Z","timestamp":1792479181675,"version":"4.5.0"},"reference-count":60,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T00:00:00Z","timestamp":1759795200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Deep Gluteal Syndrome (DGS) has traditionally been defined as a clinical entity caused by sciatic nerve (SN) entrapment. However, recent anatomical and imaging studies suggest that muscle- and tendon-origin pathologies\u2014including enthesopathy\u2014may also serve as primary pain generators. This narrative review aims to broaden the current understanding of DGS by integrating muscle and tendon pathologies into its diagnostic and therapeutic framework. The literature was selectively reviewed from PubMed, Cochrane Library, Google Scholar, PEDro, and Web of Science to identify clinically relevant studies illustrating evolving concepts in DGS pathophysiology, diagnosis, and management. We review clinical features and diagnostic tools including physical examination, MRI, and dynamic ultrasonography, with special attention to deep external rotator enthesopathy. Treatment strategies are summarized, including conservative therapy, ultrasound-guided injections, hydrodissection, and prolotherapy. This narrative synthesis underscores the importance of recognizing muscle-origin enthesopathy and soft-tissue pathologies as significant contributors to DGS. A pathophysiology-based, multimodal approach is essential for accurate diagnosis and effective treatment.<\/jats:p>","DOI":"10.3390\/diagnostics15192531","type":"journal-article","created":{"date-parts":[[2025,10,7]],"date-time":"2025-10-07T12:46:56Z","timestamp":1759841216000},"page":"2531","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Beyond Nerve Entrapment: A Narrative Review of Muscle\u2013Tendon Pathologies in Deep Gluteal Syndrome"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yong Hyun","family":"Yoon","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"},{"name":"Incheon Terminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"},{"name":"International Academy of Regenerative Medicine, Incheon 21574, Republic of Korea"},{"name":"Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Ji Hyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ho won","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Gangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinJae","family":"Lee","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1207-348X","authenticated-orcid":false,"given":"Chanwool","family":"Park","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonghyeok","family":"Lee","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Incheon 21574, Republic of Korea"},{"name":"Bareun Neurosurgery Clinic, Cheongju-si 28402, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Seungbeom","family":"Kim","sequence":"additional","affiliation":[{"name":"International Academy of Regenerative Medicine, Incheon 21574, Republic of Korea"},{"name":"Miso Pain Clinic, Suwon-si 16703, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"JaeYoung","family":"Lee","sequence":"additional","affiliation":[{"name":"Incheon Terminal Orthopedic Surgery Clinic, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeimylo C.","family":"de Castro","sequence":"additional","affiliation":[{"name":"SMARTMD Center for Non-Surgical Pain Interventions, Adventist University of the Philippines, Silang 4118, Cavite, Philippines"}],"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":"The Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong"},{"name":"The Faculty of Medicine, The Chinese University of Hong Kong, New Territories, 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":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11510, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kwan Hyun","family":"Youn","sequence":"additional","affiliation":[{"name":"Division in Biomedical Art, Incheon Catholic University Graduate School, Incheon 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,7]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e1053","DOI":"10.1016\/j.wneu.2019.11.083","article-title":"Nondiscogenic Sciatica: What Clinical Examination and Imaging Can Tell Us?","volume":"134","author":"Guedes","year":"2020","journal-title":"World Neurosurg."},{"key":"ref_2","first-page":"435","article-title":"Piriform syndrome","volume":"124","author":"Pace","year":"1976","journal-title":"West J. 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