Centre de formation et physiothérapie de Lutry

30/12/2025

🎊🌲Between Christmas and the beginning of the new year, we traditionally publish our ‘Best of’ series featuring the most influential posts of the year that is coming to an end.

📣 Today 🥇 # rank 9 in 2025

𝗕𝗲𝘆𝗼𝗻𝗱 𝗡𝗲𝗿𝘃𝗲 𝗘𝗻𝘁𝗿𝗮𝗽𝗺𝗲𝗻𝘁: 𝗔 𝗡𝗮𝗿𝗿𝗮𝘁𝗶𝘃𝗲 𝗥𝗲𝘃𝗶𝗲𝘄 𝗼𝗳 𝗠𝘂𝘀𝗰𝗹𝗲–𝗧𝗲𝗻𝗱𝗼𝗻 𝗣𝗮𝘁𝗵𝗼𝗹𝗼𝗴𝗶𝗲𝘀 𝗶𝗻 𝗗𝗲𝗲𝗽 𝗚𝗹𝘂𝘁𝗲𝗮𝗹 𝗦𝘆𝗻𝗱𝗿𝗼𝗺𝗲

▶️ Sciatica-like pain is frequently attributed to lumbar disc herniation or spinal stenosis, but in many patients, symptoms persist despite treatment of spinal causes, suggesting extraspinal etiologies (Guedes et al., 2020). Deep Gluteal Syndrome (DGS), first described by McCrory and Bell (1999) as sciatic nerve entrapment, has emerged as a significant source of nondiscogenic buttock and leg pain.

▶️ Prevalence estimates suggest that up to 17% of patients presenting with sciatica may have DGS (Kizaki et al., 2020). Traditionally viewed as a nerve entrapment disorder, more recent evidence highlights the contribution of muscular and tendinous pathologies—particularly enthesopathies of the deep external rotators and hamstring origin—as primary pain generators (Martin et al., 2015; De Lorenzis et al., 2023).
▶️ This evolving perspective necessitates a redefinition of DGS that integrates muscle–tendon pathology with neural mechanisms.

📘 In a brand-new narrative review Yoon et al. (2025, https://www.mdpi.com/2075-4418/15/19/2531 -diagnostics-15-02531) expand the conceptual framework of Deep Gluteal Syndrome beyond sciatic nerve entrapment, emphasizing muscle- and tendon-related pathologies as central contributors.

✅ Pathogenesis: In addition to sciatic nerve compression, pathologies such as ischiofemoral impingement, proximal hamstring tendinopathy, and enthesopathy of the deep external rotators can directly generate pain or secondarily irritate neural structures.

✅ Diagnosis: Clinical differentiation from lumbar radiculopathy is critical. Provocative maneuvers (FAIR, piriformis stretch, Pace’s test) and imaging (high-resolution MRI, MR neurography, dynamic ultrasonography) aid in distinguishing nerve-dominant from tendon-dominant subtypes. This differentiation might be a crucial factor in clinical reasoning.

✅ Treatment: A stepwise strategy is recommended—beginning with conservative care (load management, progressive tendon loading exercises , neural mobilization/desensitization), depending on tendon involvement or neural mechano-hypersensitive with refractory cases reserved for surgery. But, current evidence largely comprises case series and expert opinion underscoring the need for randomized controlled trials.

💡 Conclusion:

DGS should be reframed as a heterogeneous syndrome involving both neural entrapment and muscle–tendon pathology. Recognition of tendon-dominant and mixed subtypes allows for more precise diagnosis and tailored treatment strategies. Future work must focus on validating classification systems and establishing high-level evidence for emerging therapies.

📷 Illustration: Anatomy of the subgluteal space according to Koh (2021) https://pubmed.ncbi.nlm.nih.gov/33827758/

Diagram of the deep muscles of the subgluteal space, with the gluteus maximus muscle removed.

The sciatic nerve (1) typically emerges from beneath piriformis muscle (P), passing over the obturator internusegemellus tendon and muscle complex, quadratus femoris (QF) muscle and lateral to the hamstring origin (H).

Note that the gemellus muscles lie superior (SG) and inferior (IG) to the obturator internus tendon within the subgluteal space; the obturator internus muscle belly lies deep to the subgluteal space within the pelvis (not drawn).

Medial to the sciatic nerve lies the PCNT (2). The inferior gluteal nerve (3) and pudendal nerve (4) emerge from below piriformis further medially within the subgluteal space.

The superior gluteal nerve (5) is seen superiorly within the subgluteal space, passing superior to the piriformis muscle and adjacent to the SI joint.

📚 References

Battaglia, P.J., Mattox, R., Haun, D.W., Welk, A.B., & Kettner, N.W. (2016). Dynamic ultrasonography of the deep external rotator musculature of the hip: A descriptive study. PM&R, 8(7), 640–650. https://doi.org/10.1016/j.pmrj.2015.11.001

De Lorenzis, E., Natalello, G., Simon, D., Schett, G., & D’Agostino, M.A. (2023). Concepts of entheseal pain. Arthritis & Rheumatology, 75(3), 493–498. https://doi.org/10.1002/art.42299

Guedes, F., Brown, R.S., Lourenço Torrão-Júnior, F.J., Siquara-de-Sousa, A.C., & Pires Amorim, R.M. (2020). Nondiscogenic sciatica: What clinical examination and imaging can tell us? World Neurosurgery, 134, e1053–e1061. https://doi.org/10.1016/j.wneu.2019.11.083

Hauser, R.A., Lackner, J.B., Steilen-Matias, D., & Harris, D.K. (2016). A systematic review of dextrose prolotherapy for chronic musculoskeletal pain. Clinical Medicine Insights: Arthritis and Musculoskeletal Disorders, 9, 139–159. https://doi.org/10.4137/CMAMD.S39160

Hernando, M.F., Cerezal, L., Pérez-Carro, L., Abascal, F., & Canga, A. (2015). Deep gluteal syndrome: Anatomy, imaging, and management of sciatic nerve entrapments in the subgluteal space. Skeletal Radiology, 44(7), 919–934. https://doi.org/10.1007/s00256-015-2112-6

Kizaki, K., Uchida, S., Shanmugaraj, A., Aquino, C.C., Duong, A., Simunovic, N., Martin, H.D., & Ayeni, O.R. (2020). Deep gluteal syndrome is defined as a non-discogenic sciatic nerve disorder with entrapment in the deep gluteal space: A systematic review. Knee Surgery, Sports Traumatology, Arthroscopy, 28(10), 3354–3364. https://doi.org/10.1007/s00167-020-05966-x

Martin, H.D., Reddy, M., & Gómez-Hoyos, J. (2015). Deep gluteal syndrome. Journal of Hip Preservation Surgery, 2(2), 99–107. https://doi.org/10.1093/jhps/hnv029

McCrory, P., & Bell, S. (1999). Nerve entrapment syndromes as a cause of pain in the hip, groin and buttock. Sports Medicine, 27(4), 261–274. https://doi.org/10.2165/00007256-199927040-00005

Yen, Y.S., Lin, C.H., Chiang, C.H., & Wu, C.Y. (2024). Ultrasound-guided sciatic nerve hydrodissection can improve the clinical outcomes of patients with deep gluteal syndrome: A case-series study. Diagnostics, 14(4), 757. https://doi.org/10.3390/diagnostics14040757

Yoon, Y.H., Hwang, J.H., Lee, H.W., Lee, M., Park, C., Lee, J., Kim, S., Lee, J., de Castro, J.C., Lam, K.H.S., et al. (2025). Beyond nerve entrapment: A narrative review of muscle–tendon pathologies in deep gluteal syndrome. Diagnostics, 15(19), 2531. https://doi.org/10.3390/diagnostics15192531

26/12/2025

Differences in Psychological Factors Between People With Persistent Tendinopathy and Those Without Tendinopathy: A Systematic Review With Meta-Analysis

in the December JOSPT

Read ➡️ https://ow.ly/Fae650XNV7l

23/12/2025

22/12/2025

15/12/2025

The basic question remains: what is the real cause of symptoms, or predisposing factor and with clinical experience you will probably mention the nervus interosseus posterior and the arcade of Frohse, or all other adverse mechanical interface on tlhe radial nerve pathway.

𝗤𝘂𝗮𝗻𝘁𝗶𝘁𝗮𝘁𝗶𝘃𝗲 𝗮𝗻𝗱 𝗤𝘂𝗮𝗹𝗶𝘁𝗮𝘁𝗶𝘃𝗲 𝗔𝗻𝗮𝗹𝘆𝘀𝗲𝘀 𝗼𝗳 𝘁𝗵𝗲 𝗟𝗮𝘁𝗲𝗿𝗮𝗹 𝗘𝗹𝗯𝗼𝘄

▫️ This post explores an anatomic study by Bernholt et al. focused on the lateral ligamentous complex and extensor tendon origins of the elbow.
▫️ The research was conducted to provide precise, quantitative measurements of these structures relative to bony landmarks, aiding surgeons in the treatment of pathologies like elbow instability and lateral epicondylitis.

❗ 𝗧𝗵𝗲 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗣𝗿𝗼𝗯𝗹𝗲𝗺

▫️ Elbow dislocations are a frequent injury, representing up to 25% of all traumatic elbow injuries, with damage to the lateral ligamentous complex being the primary lesion associated with these events.
▫️ Improper healing can lead to chronic laxity and posterolateral rotary instability, a condition causing pain and functional limitation.
▫️ While the lateral ulnar collateral ligament is crucial for preventing posterolateral rotary instability, the radial collateral ligament and the overlying extensor musculature also play significant roles in stability.
▫️ Despite the frequency of these repairs, previous studies lacked quantitative descriptions of these attachment sites relative to specific bony landmarks.

🔬 𝗦𝘁𝘂𝗱𝘆 𝗠𝗲𝘁𝗵𝗼𝗱𝗼𝗹𝗼𝗴𝘆

▫️ The researchers utilized 10 fresh-frozen, nonpaired human cadaveric elbows, all male, mean age 42.2 years.
▫️ They employed a 3-dimensional coordinate measuring device to map the footprints of ligaments, tendons, and bony landmarks with high precision.
▫️ The measurements were taken with the elbow clamped in full extension and supination.

🔧 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗟𝗶𝗴𝗮𝗺𝗲𝗻𝘁𝗼𝘂𝘀 𝗔𝗻𝗮𝘁𝗼𝗺𝘆

■ 🔹 Lateral Ulnar Collateral Ligament (LUCL)
▫️ On the humerus, the LUCL footprint was located 7.1 mm anterior and 9.8 mm distal to the lateral epicondyle.
▫️ It was also positioned 8.6 mm proximal to the radiocapitellar joint line.
▫️ On the ulna, the center of the attachment was found near the supinator tubercle, 1.4 mm anterior and 2.4 mm proximal.
▫️ Qualitatively, the LUCL was present in all specimens, though its proximal attachment often blended with the radial collateral ligament, making the distal attachment more distinct.

■ 🔹 Radial Collateral Ligament (RCL)
▫️ The humeral footprint for the radial collateral ligament was found 6.6 mm anterior and 5.6 mm distal to the lateral epicondyle.

■ 🔹 Annular Ligament
▫️ The center of the ulnar attachment for this ligament was located 17.3 mm proximal to the supinator tubercle.

💪 𝗞𝗲𝘆 𝗙𝗶𝗻𝗱𝗶𝗻𝗴𝘀: 𝗠𝘂𝘀𝗰𝘂𝗹𝗮𝗿 𝗔𝗻𝗮𝘁𝗼𝗺𝘆

■ 🔹 Extensor Carpi Radialis Brevis (ECRB)
▫️ This was the only humeral footprint found to cross the radiocapitellar joint line.
▫️ It extended a mean distance of 5.9 mm distal to the joint line and possessed a robust attachment to the elbow joint capsule.
▫️ This capsular attachment comprised roughly 20.4% of the muscle belly.

■ 🔹 Extensor Digitorum Communis (EDC)
▫️ The EDC fibers were closely associated with the thick fascia of the extensor carpi radialis brevis, running deep to the extensor digitorum communis muscle belly.

🏥 𝗖𝗹𝗶𝗻𝗶𝗰𝗮𝗹 𝗜𝗺𝗽𝗹𝗶𝗰𝗮𝘁𝗶𝗼𝗻𝘀

■ 🔹 Anatomic Reconstruction
▫️ By providing measured distances from clinically relevant landmarks, such as the radiocapitellar joint line, which is easily identified intraoperatively, surgeons can more accurately reproduce the native anatomy during ligament reconstruction.

■ 🔹 Lateral Epicondylitis
▫️ The finding that the extensor carpi radialis brevis has a significant capsular attachment extending distal to the joint line is important for surgeons performing injections or debridement for tennis elbow.
▫️ Understanding this anatomy helps define safe zones for arthroscopic procedures to avoid damaging the lateral ulnar collateral ligament.

⚠️ 𝗟𝗶𝗺𝗶𝘁𝗮𝘁𝗶𝗼𝗻𝘀

▫️ The study was limited by a small sample size of 10 specimens, all of which were male.
▫️ Consequently, the reported distances may vary based on the s*x and stature of the patient, and the study could not assess normal anatomic variants across a broader population.

🖼️ 𝘼𝙣𝙖𝙡𝙤𝙜𝙮

▫️ To understand the importance of this study, imagine trying to hang a heavy picture frame on a wall where specific studs are hidden.
▫️ Before this research, surgeons knew roughly where the studs were based on general knowledge.
▫️ This study acts like a precise stud finder blueprint, giving exact millimeter measurements from visible corners of the room, ensuring the picture is hung exactly where it belongs for maximum stability.

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⚠️Disclaimer: Sharing a study or a part of it is NOT an endorsement. Please read the original article and evaluate critically.⚠️

Link to Article 👇

14/12/2025

Very specific and sensitive the Radar SIJ Examination test, blog on IMTA web site!

13/12/2025

Just published in NEJM 🔥

Complex Regional Pain Syndrome

📘 Goebel (2025), https://www.nejm.org/doi/full/10.1056/NEJMcp2415752

👉 Complex regional pain syndrome (CRPS) is a rare post-traumatic chronic pain condition that affects a distal limb and is classified in the International Classification of Diseases, 11th Revision, as “chronic primary pain”; the condition may be autoimmune mediated.

👉 CRPS is diagnosed according to the Budapest criteria, which require the presence of objective limb abnormalities in two of four categories: sensory, vasomotor, edema or sudomotor, and motor or trophic.

👉 Approximately 80% of patients have substantial improvement within 18 months after disease onset;later improvement is rare.

👉Patient information should emphasize the nerve-function–related cause of CRPS that explains the relentless pain despite no or minor tissue change.

👉 Rehabilitative treatment with CRPS-specific physical and occupational therapy is key to improving function in the impaired limb.

👉 Treatment with simple analgesic drugs, tricyclic agents, and serotonin–norepinephrine reuptake inhibitors may improve quality of life but will typically incompletely reduce pain. Multidisciplinary pain-management treatment that follows the principles of cognitive behavioral therapy and spinal cord stimulator treatment — in persistent CRPS — can be offered at specialist centers.

📷 Illustration: . Pain Mechanisms. Shown are the mechanisms of nociceptive pain (Panel A), neuropathic pain (Panel B), and nociplastic pain (Panel C). CRPS itself is considered (mostly) nociplastic pain.

13/12/2025

How many different lens' do you have when trying to understand, explore or explain to people 🤔

The August JOSPT editorial calls for a flexible approach and explains several of the many different viewpoints (lens') we can take to understanding and helping people to understand pain.

See for yourself 🕵️ ➡️ https://ow.ly/Mk5b50WCn56

21/11/2025

NEW IN

Our Hip Pain and Mobility Deficits - Hip Osteoarthritis has been updated

Access the update ➡️https://ow.ly/vMIu50Xnzs1

Orthopedics