Inferior gluteal neuropathy
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Inferior gluteal nerve neuropathy like superior gluteal nerve neuropathy is rather uncommon and often associated with iatrogenic injury 1.
The diagnosis might be made by a combination of clinical symptoms and abnormal electrodiagnostic testing. Isolated denervation changes of the gluteus maximus on imaging can further support the diagnosis. Lumbosacral radiculopathy, plexopathy and sciatic neuropathy should be ruled out 1.
Clinical presentation includes weakness in leg extension and muscle atrophy of the gluteus maximus 1,2.
Electrophysiologic studies of the gluteus maximus should be abnormal 1.
The inferior gluteal nerve is formed by the L5-S2 nerve roots supplying motor innervation to the gluteus maximus muscle. It exits the pelvis through the greater sciatic foramen below the piriformis muscle and turns backwards splitting into branches entering the gluteus maximus 2,3.
Potential causes of superior gluteal nerve injury include the following 1-3:
- iatrogenic injury
- hip surgery (total hip replacement, posterior access)
- intramuscular injections
- acute traumatic injury
- chronic compression
Due to its small size visualization of inferior gluteal nerve abnormalities might be difficult. The nerve can be seen while exiting the pelvis on coronal images and then on axial planes deep to the gluteus maximus. Denervation changes affect the gluteus maximus and include muscle edema, muscle atrophy and fatty degeneration 2,3.
The radiology report should include a description of the following:
- the appearance of the inferior gluteal nerve
- denervation changes
- etiology of nerve compression
Treatment and prognosis
Like superior gluteal nerve entrapment, the treatment will depend on the etiology and include conservative measures including physiotherapy, stretching local anesthetics and non-steroidal anti-inflammatory drugs. Surgery might be necessary for the removal of space-occupying lesions and involves decompression and neurolysis.
The differential diagnosis of sacral neuropathy includes 1-3:
- 1. Craig A. Entrapment Neuropathies of the Lower Extremity. PM&R. 2013;5(5 Suppl):S31-40. doi:10.1016/j.pmrj.2013.03.029 - Pubmed
- 2. Petchprapa C, Rosenberg Z, Sconfienza L, Cavalcanti C, La Rocca Vieira R, Zember J. MR Imaging of Entrapment Neuropathies of the Lower Extremity. Radiographics. 2010;30(4):983-1000. doi:10.1148/rg.304095135 - Pubmed
- 3. Martinoli C, Miguel-Perez M, Padua L, Gandolfo N, Zicca A, Tagliafico A. Imaging of Neuropathies About the Hip. Eur J Radiol. 2013;82(1):17-26. doi:10.1016/j.ejrad.2011.04.034 - Pubmed