The gluteal triangle: A clinical patho-anatomical approach to the diagnosis of gluteal pain in athletes

Centre for Health, Exercise and Sports Medicine, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria 3010 Australia.
British Journal of Sports Medicine (Impact Factor: 5.03). 12/2008; 43(6):460-6. DOI: 10.1136/bjsm.2007.042317
Source: PubMed


Gluteal pain is a common presentation in sports medicine. The aetiology of gluteal pain is varied, it may be referred from the lower back, mimic other pathology and refer to the hip or the groin. The complex anatomy of the buttock and pelvis, variability of presentation and non specific nature of signs and symptoms make the diagnostic process difficult. To date the approaches to this problem have focused on individual pathologies. The paper proposes a novel educational system based on patho-anatomic concepts. Anatomical reference points were selected to form a diagnostic triangle, which provides the discriminative power to restrict the differential diagnosis, and form the basis of ensuing investigation. This paper forms part of a series addressing the three dimensional nature of proximal lower limb pathology. The 3G approach (groin, gluteal and greater trochanter triangles) acknowledges this, permitting the clinician to move throughout the region, considering pathologies appropriately. These papers should be read in conjunction with one another in order to fully understand the conceptual approach.

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    ABSTRACT: Groin and hip injuries are common in sport. The diagnosis, treatment and rehabilitation of these injuries has long been identified as a complex and challenging area for all clinicians involved in the management of such injuries. While our knowledge increases steadily the challenge still remains for appropriate and successful treatment strategies. Rehabilitation has been identified as an important factor in the management of hip and groin pain. Rehabilitation can occur prior to and after surgery or can be a stand alone treatment for long standing or acute pain. Due to the number and complexity of injuries in the hip and groin area, the physiotherapist must have a strong anatomic and biomechanical knowledge base in order to identify possible aggravating structures or movement abnormalities during the assessment process. Often there is not one single cause for the symptoms but multiple causes. If rehabilitation is appropriate the physiotherapist must put in place a progressively graded rehabilitation programme appropriate to a given sport. There are still gaps in the literature on the provision of the specifics of successful rehabilitation. Therefore the physiotherapist must use sound principles of healing, exercise physiology, manual therapy and rehabilitation, in addition to knowledge of specific stresses and strains that the pelvic area is exposed to within a given sport, in order to provide a successful outcome for the athlete.
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    ABSTRACT: Groin, gluteal and hip pain are common pre-sentations in sports medicine. The pathology is varied and can be referred from any of these regions due to the three-dimensional nature of the anatomy. There is a tendency in modern medical school curricula for less time to be devoted to didactic as well as practical anatomy teaching, possibly to the detriment of students' ability to formulate a differential diagnosis when investigating musculoskeletal conditions. This is particularly important in areas of com-plex anatomy. This paper proposes a novel diagnostic sys-tem based on the underlying anatomical struc-tures, to form a series of triangles which act as a grid, by which the clinician may narrow the diagnosis in spite of a lesser understanding of the anatomical relations. This acknowledges the problem based approach, where problem solving without this encyclopedic knowledge is attempted. In dividing the proximal lower limb into triangles, the authors propose a new educa-tional reference point termed '3G'. This point is located in the line of the femur, anteriorly at the midpoint between the anterior superior iliac spine and the superior pole of the patella, and posteriorly, at a point on the femur fol-lowing the line between the spinous process of L5 lumbar vertebra and the ischial tuberosity. These points were found to correlate and are common to all triangles.
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