Sign of the Buttock Test

What is the Sign of the Buttock Test?

The Sign of the Buttock Test is a clinical assessment designed to identify serious pathologies in the gluteal region, also known as the buttocks. Created by James Cyriax, this test aims to provoke specific symptoms to evaluate the underlying issues affecting the hip and buttock area (Kesson & Atkins, 2005). The sign of the buttock is actually composed of other signs:

• Enlarged, swollen, and/or tender buttocks
• Painful execution of the Straight Leg Raise Test
• Limited range of movement (ROM) when flexing the trunk
• Pain and limited ROM when flexing the hip and the knee
• Empty feeling at the end of hip flexion
• Non capsular pattern of restriction (or a restriction of movement that is not due to tightness) at the hip
• Painful and weak hip movements or a feeling of resistance, especially with hip extensions

How is this test conducted?

To perform the Sign of the Buttock Test, follow these steps (Palmer & Epler, 1998):

1. With the patient in a supine position, perform a straight leg raise on the affected side
2. Stop when the straight leg raise is limited.
3. Flex the patient's knee
4. With the ipsilateral knee flexed, attempt to further hip flexion.
5. Observe the patient's reaction and range of motion.

How are the results interpreted?

A negative result is indicated if the patient can achieve normal movement without pain.

The first requirement of a positive result is if the patient experiences pain at the end of the straight leg raise. Then, if the patient also reports pain with further flexion or you cannot increase hip joint ROM despite knee flexion, it is a positive test.

A positive test suggests proximal hamstring tendinopathy or another potential pathology. One of the latter sections in this guide provides examples of these pathologies. If the range of motion cannot be increased with the ipsilateral knee flexed, then the hip or buttock is affected, not the hamstrings or sciatic nerve.

How to use our Sign of the Buttock Test template

To effectively use our Sign of the Buttock Test template in your practice, follow these steps:

Step 1: Access the template

First, access the Sign of the Buttock Test template by clicking "Use Template." This button opens the template in the Carepatron app, where you can customize it to include your branding or practice's contact information. You can also add other specific details on the app. Alternatively, you can press "Download" to save a printable PDF on your device.

Step 2: Familiarize yourself with the template and the test’s procedures

Review the template thoroughly to understand each section and the test procedures. Ensure you are clear on the steps and the criteria for a positive and negative result.

Step 3: Do the test

Follow the procedure outlined in the template to perform the Sign of the Buttock Test. Ensure the patient is comfortable and provide any necessary explanations or reassurances. Our template's instructions also include reference images for key positions in the test.

Step 4: Record the findings

After conducting the test, fill out the template with the patient’s information, test findings, and any additional notes. Review the results with the patient and discuss any necessary next steps based on the findings.

What are examples of buttock-related pathologies?

Buttock-related pathologies can vary widely and may involve different structures within the buttock region. Here are some common examples:

• Ischial bursitis: Ischial bursitis is inflammation of the bursa located between the ischial tuberosity and the tendon of the hamstring muscle. It often results from prolonged sitting on hard surfaces.
• Gluteal tendinopathy: This condition involves damage or inflammation of the tendons in the gluteal muscles. It can cause significant pain and limit movement.
• Piriformis syndrome: Piriformis syndrome occurs when the piriformis muscle compresses the sciatic nerve, causing pain, tingling, and numbness along the path of the nerve.
• Proximal hamstring tendinopathy: This is a condition where the tendons of the hamstring muscles near their origin at the pelvis become irritated or inflamed, causing pain in the buttock region.
• Osteomyelitis: This is an infection of the bone, often affecting the pelvis or femur, causing severe pain, fever, and swelling. Early diagnosis and treatment with antibiotics are crucial to prevent bone damage.
• Ischiorectal abscess: An abscess in the ischiorectal fossa can lead to significant pain, swelling, and fever. It typically requires drainage and antibiotics to treat the infection and alleviate symptoms.
• Septic bursitis: An infection of the bursa in the buttock can cause pain, redness, and swelling. Treatment includes antibiotics and sometimes drainage of the infected bursa.
• Neoplasm of the upper femur: Tumors in the upper femur can cause buttock pain, swelling, and functional impairment. Treatment depends on the type of tumor and may include surgery, radiation, or chemotherapy.
• Fractured sacrum: A fracture in the sacrum can result from trauma or pathological conditions like osteoporosis. Symptoms include severe buttock pain, bruising, and difficulty with mobility. Treatment may involve rest, pain management, and sometimes surgery.

Usual causes of buttock-related pathologies

Buttock-related pathologies can arise from various causes, including repetitive activities, such as running or cycling. These can strain the muscles and tendons in the buttocks, leading to inflammation and pain. Moreover, blows or falls can cause bruising, fractures, or other injuries to the buttock region.

However, avoiding injuries does not necessarily mean you will never experience buttock-related pathologies. Sitting for extended periods, especially on hard surfaces, can also lead to conditions like ischial bursitis. Sometimes, simple weakness or tightness in the surrounding muscles can contribute to the development of these pathologies.

Potential complications of buttock-related pathologies

If not addressed properly, potentially serious pathology can lead to complications such as:

• Chronic pain: Persistent buttock pain that radiates to the posterior thigh and even down to the feet can significantly impact daily activities and quality of life.
• Reduced mobility: Pain and inflammation can limit the range of motion and make it difficult to perform routine tasks.
• Nerve compression: Conditions like piriformis syndrome can cause nerve compression, leading to numbness, tingling, and weakness in the affected leg.

How orthopedists usually address buttocks-related pathologies

Orthopedists use various treatment and management options to address buttocks-related pathologies, tailored to the specific condition and severity:

• Physical therapy: Physical therapy often involves targeted exercises to strengthen and stretch the affected muscles and tendons, improving flexibility and reducing pain.
• Medication: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen or naproxen can help reduce pain and inflammation. In some cases, corticosteroid injections may be administered to alleviate severe inflammation.
• Activity modification: Advising patients to avoid activities that exacerbate the patient's symptoms can be crucial. This may include adjusting sitting positions, taking breaks during prolonged sitting, or modifying exercise routines.
• Surgical intervention: In severe cases where conservative treatments fail, surgical options may be considered. For example, procedures such as tendon repair, bursectomy for ischial bursitis, or nerve decompression for piriformis syndrome may be necessary.
• Extracorporeal shockwave therapy (ESWT): This non-invasive treatment uses shockwaves to stimulate healing in the affected tissues, reducing pain and promoting recovery in conditions like tendinopathy.

References

Kesson, M., & Atkins, E. (2005). Orthopaedic medicine. Butterworth-Heinemann.

Palmer, M. L., & Epler, M. E. (1998). Fundamentals of musculoskeletal assessment techniques. Lippincott.