The upper outer quadrant of the buttock, the sciatic nerve problem, the fat-depth problem, and why most modern guidance points elsewhere.
Key points
- 01Where the site is. The dorsogluteal site is the upper outer quadrant of the buttock, over the gluteus maximus. It is the site most people picture when they hear the phrase a shot in the backside, and for decades it was the default intramuscular site in general practice and on hospital wards.
- 02How it was traditionally located. Two landmarks were taught. One divides the buttock into four quadrants and uses the upper outer one. The other draws an imaginary line from the posterior superior iliac spine to the greater trochanter and injects above and outside that line, where the muscle is thickest.
- 03Why the quadrant method is criticised. The quadrant method depends on where you decide the buttock starts and ends, which is a soft-tissue judgement rather than a bony one. Nursing reviews describe wide variation between practitioners using the same instruction on the same body.
- 04The sciatic nerve is the headline concern. The sciatic nerve runs beneath the gluteal region, and the nursing literature has documented injection-related nerve injury from this site. That is the reason cited most often when guidance recommends moving to the ventrogluteal site, where no large nerve lies in the target.
- 05The superior gluteal artery is the second concern. Vascular structures in the region are the reason aspiration was traditionally taught at this site specifically. Whether that step reliably detects a vessel is now contested, but the anatomical reason it was introduced here is real.
- 06The depth problem is the quieter one. A 2022 study in the Journal of Clinical Nursing measured the depth needed to reach muscle at this site by body mass index and gender. The finding that matters to patients is that a standard needle does not always get there, so the injection lands in fat instead.
- 07Ultrasound studies confirm the miss rate. A 2019 study in the Pakistan Journal of Medical Sciences used ultrasonography to assess how often a dorsogluteal injection was truly intramuscular. Work like this is why the phrase intended intramuscular has crept into the literature.
- 08An injection that lands in fat is not the same injection. Subcutaneous fat has a poorer blood supply than muscle, so a medication designed for intramuscular absorption behaves differently there. Depot and long-acting formulations are the ones where this matters most, and they are exactly the ones often given here.
- 09Body shape changes the answer more than most people expect. A 2018 paper in the Journal of Clinical Nursing looked at gender, body mass index and body shape together and found they change the theoretical outcome at the gluteal sites. Two people given the same needle at the same landmark can get two different routes.
- 10The systematic review comparison. A 2023 systematic review in Nursing Open compared adverse effects at the dorsogluteal and ventrogluteal sites and reported a less favourable picture for the dorsogluteal site. That review is the shortest answer to why did my nurse start using my hip.
- 11It has not disappeared from practice. A 2024 quality-improvement report in the Journal of the American Psychiatric Nurses Association described supporting the safe use of this site, which tells you it is still used for long-acting injections. The clinical answer is often make it safer rather than abolish it.
- 12Older adults are a specific case. A 2024 paper in the International Journal of Older People Nursing examined the safety of both gluteal sites in older adults. Age-related muscle loss changes what is under the needle, which is why site choice in older patients is a clinician judgement rather than a habit.
- 13The ventrogluteal site is the usual replacement. Guidance that moves away from the buttock almost always moves to the side of the hip. Our ventrogluteal injection site guide covers the three bony landmarks and the hand position, which is the part people find unfamiliar at first.
- 14The deltoid is the other alternative, with a volume limit. For smaller volumes, the upper arm is the usual choice. Our deltoid injection site post covers the landmark and why volume, not convenience, is what rules that site in or out. Large-volume and oily depot injections are not deltoid material.
- 15The Z-track technique came out of this problem. Displacing the skin before insertion and letting it snap back afterwards was developed to keep irritant medication from tracking back up into subcutaneous tissue. Our Z-track technique post covers the hand movement and what the trials measured.
- 16Aspiration guidance is not uniform any more. Some services still require the pull-back at gluteal sites, others have dropped it after reviews including a 2025 JBI systematic review found no clear benefit. Follow the instruction your own service gave you rather than a rule from a forum.
- 17None of this applies to GLP-1 medications. Ozempic, Wegovy, Mounjaro, Zepbound, Saxenda and Victoza are subcutaneous. The buttock is not an approved site for any of them, and the labels name the abdomen, thigh and upper arm. Our post on injecting into muscle instead of fat covers the accident.
- 18What to do if this site is what you were taught. Do not switch on your own. Ask the prescriber or the nurse who trains you whether the ventrogluteal site is appropriate for your particular medication and volume, and ask to be shown the landmark in person. Site choice is part of the prescription, not a preference.
- 19Keep a record of side and site. Whichever site is used, write down which one and which side. Repeated injection into the same patch of muscle is associated with hardened tissue and unpredictable absorption, and a record is the only thing that makes rotation real. See our injection record guide.
Common mistakes
- Electric, shooting or burning pain down the leg during or immediately after the injection.
- Numbness, tingling, foot drop or weakness in the leg after an injection in this area, which needs same-day assessment.
- Spreading redness, heat, swelling or pus at the site, with or without fever.
- A hard, painful lump that grows over days rather than settling, or a lump that becomes red and hot.
- Bleeding that does not stop with several minutes of gentle pressure, which matters more on a blood thinner.
- Rash, breathlessness or swelling of the face or throat after any injection, which is an emergency.
Frequently asked questions
Where is the dorsogluteal injection site?+
It is the upper outer quadrant of the buttock, over the gluteus maximus, traditionally located either by dividing the buttock into quadrants or by drawing a line from the posterior superior iliac spine to the greater trochanter. Educational information only, not medical advice.
Why do nurses avoid it now?+
Two reasons appear repeatedly in the literature. The sciatic nerve runs beneath the region, and the subcutaneous fat layer means an injection intended for muscle often lands in fat. A 2023 systematic review in Nursing Open compared it with the ventrogluteal site on adverse effects.
Is the dorsogluteal site banned?+
No. It is still used in practice, including for long-acting injections, and a 2024 quality-improvement report in the Journal of the American Psychiatric Nurses Association described how services support its safe use. Guidance prefers alternatives rather than prohibiting it.
What is used instead?+
Usually the ventrogluteal site on the side of the hip for larger volumes, and the deltoid in the upper arm for small ones. Which is appropriate depends on the medication, the volume and the person, so it is a prescriber decision.
Does the injection reach muscle?+
Not always. A 2022 study in the Journal of Clinical Nursing measured the depth needed at this site by body mass index and gender, and ultrasound work has assessed how often the injection is truly intramuscular. That is the depth problem in one sentence.
Should I aspirate at this site?+
Follow the instruction your service gave you. The pull-back step was introduced here because of the vascular anatomy, but recent reviews including a 2025 JBI systematic review question the benefit, and protocols now differ between services.
Can I inject Ozempic or Wegovy in my buttock?+
No. Those are subcutaneous medications and their labels name the abdomen, thigh and upper arm. Our guides to where to inject Ozempic and where to inject Wegovy cover the approved sites.
Can I give myself an injection at this site?+
It is difficult to reach and to landmark on yourself, which is one more reason services move to alternatives for self-administration. Any intramuscular self-injection should be taught and signed off in person first.
How long should it ache afterwards?+
Patient-education material describes a dull ache for a day or so as common after an intramuscular injection. Shooting pain down the leg, numbness or weakness is different, and is a reason to be seen.
What is the Z-track technique for?+
Displacing the skin sideways before insertion and releasing it afterwards seals the needle track so irritant medication does not track back into subcutaneous tissue. Our Z-track post covers the hand movement and the trial evidence on pain and leakage.
Sources
- Adverse effects of dorsogluteal versus ventrogluteal intramuscular injection: a systematic review. Nursing Open, 2023.
- Dorsogluteal intramuscular injection depth needed to reach muscle tissue according to body mass index and gender. Journal of Clinical Nursing, 2022.
- Assessment rate of true dorsogluteal intramuscular drug injection using ultrasonography. Pakistan Journal of Medical Sciences, 2019.
- Examining the Safety of Dorsogluteal and Ventrogluteal Sites for Intramuscular Injection in Older Adults. International Journal of Older People Nursing, 2024.
- Ogston-Tuck S. 2014. Intramuscular injection technique: an evidence-based approach. Nursing Standard 29(4):52-59.