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Gluteal pain is common in athletes and is often ascribed to hamstring origin pain however; back pain may be a source of referred gluteal pain. 1
It can be seen how this can present a diagnostic conundrum. The presentation of gluteal strains, hamstring tears or sacroiliac joint pathology is similar and for the clinician, eliciting the significant features in order to differentiate the diagnosis can be a challenge.
This paper sets out a method based on patho-anatomic principles for a systematic examination of the chronically painful gluteal region and posterior thigh. This enables the clinician to discriminate more easily between pathological conditions and target their management to specific diagnoses.
THE GLUTEAL TRIANGLE
The 3G point
From anthropometric measurements in previous cadaveric dissection studies, 2 the authors have defined a new reference point at the apex of the triangle. This point was termed the "3G point" in reference to the three-dimensional pathology and the groin, gluteal and greater trochanteric regions. The relationship of this point in the posterior coronal plane is that of, double the distance from the spinous process of L5 lumbar vertebrae to the ischial tuberosity, as a continuation of that line to the femur.
The specific anatomical landmarks and borders of the gluteal triangle are set out in fig 1 :
Spinous process of L5 lumbar vertebrae
Lateral edge of greater trochanter
3G point
ANATOMICAL RELATIONSHIPS OF THE BORDERS OF THE GLUTEAL TRIANGLE
Superficially in all cases the skin provides the surface covering, with epidermis and dermis, with underlying superficial fat superficial to the fascia. 3 Last's Anatomy was used as the reference text along with the authors current anatomical work. 2 4 The fascia overlying the gluteal triangle is a continuation of the posterior lumbar fascia, in which Gluteus maximus is embedded then extending to join tensor fasciae latae and form the iliotibial band with a slip insertion into the greater trochanter. This gives rise to a continuous layer of fascia which plays a significant role in the pathology.
SUPERIOR BORDER OF TRIANGLE
Iliolumbar ligament and fascia
Gluteus maximus
Gluteus medius
Gluteus minimus
The spinous process of L5 lumbar vertebrae was selected for its ease of location and the associated lumbar pathology. This is an easily palpable reference point located at the...