An overlooked cause of low back pain is entrapment of the superior cluneal nerve.
The cluneal nerve is compromised of the posterior rami of L1, L2 and L3 and provides sensation to the upper buttocks.
Three distributions of the cutaneous branches of the nerve exist. Lu et al described the anatomical relationship of the superior cluneal nerve to the posterior iliac crest. The medial branch of the superior cluneal nerve is confined within a tunnel consisting of fascia and the superior rim of the iliac crest. The location is 7-8 cm lateral to the spinous process on the iliac crest. It is lateral and superior to the posterior superior iliac spine.
The nerve can be entrapped between the fascia and the iliac crest causing pain and restriction in motion. This is similar to carpal tunnel syndrome where the fascia constricts the median nerve.
Case reports have documented the entrapment of the superior cluneal nerve as a cause of unilateral back and buttock pain. Patients who have undergone iliac crest bone grafts for lumbar fusions are at risk for entrapment. Stem cell therapy is an alternative to spinal surgery and fusions.
The Centeno-Schultz Clinic is committed to establishing an accurate diagnosis so effective treatment can be started and you can return to your passions.