Superior Cluneal Nerve Entrapment

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Some authors posit that cluneal nerve entrapment is an under-diagnosed cause of chronic low back pain, and it can cause neuropathic type symptoms.

Anatomy and Pathophysiology

Superior and middle cluneal nerves with typical entrapment sites. Multiple branches of the superior cluneal nerves can be entrapped where they pierce the thoracolumbar fascia over the iliac crest. Middle cluneal nerve entrapment can occur where it passes under or through the long posterior sacroiliac ligament.

Superior cluneal nerve (SCN) entrapment occurs where the nerve pierces the thoracolumbar attachment at the posterior iliac crest. The medial branch of the SCN consistently passes through an osteofibrous tunnel and can be spontaneously entrapped.

The middle cluneal nerve (MCN) is comprised of the sensory branches of the S1 to S3 dorsal rami. It travels below the PSIS in an approximately horizontal route and supplies the skin overlying the posteromedial buttock. The S1 to S2 composition could explain why some patients may get leg symptoms. It can become trapped with passing underneith or through the long posterior sacroiliac ligament. MCN entrapment can be confused with sacroiliac joint pain. Even a positive sacroiliac joint block could still indicate LPSL pain or MCN entrapment if there is dorsal extravasation of the local anaesthetic.

Diagnosis

There is no gold standard diagnostic method. The diagnosis can be considered by tenderness over the iliac crest or LPSL causing provocation of symptoms. Pain relief following local anaesthetic injection can give further weight to the diagnosis.

The SCN tender point is typically on the posterior iliac crest, approximately 70mm from the midline and 45mm from the PSIS. The MCN tender point is typically on the LPSL within 40mm caudal to the PSIS.

Treatment

Injections

Trigger point injections have been described.

Surgery

Reports have been published on SCN release and MCN release. Most reports are on SCN release.

Literature Review

Literature Review

Reviews from the last 7 years: review articles, free review articles, systematic reviews, meta-analyses, NCBI Bookshelf

Articles from all years: PubMed search, Google Scholar search.

TRIP Database: clinical publications about evidence-based medicine.

Other Wikis: Radiopaedia, Wikipedia Search, Wikipedia I Feel Lucky, Orthobullets,