Middle clunal nerve entrapment

Last revised by Henry Knipe on 22 Nov 2022

Middle clunal nerve entrapment is a potential cause of low back pain. The middle clunal nerves travel beneath the long posterior sacroiliac ligament and this is a potential space for nerve entrapment 1.

Low back pain and leg pain can be caused by entrapment of these nerves. Pain can be exacerbated by rolling, prolonged sitting and walking. Tinel test can be performed caudal to posterior superior iliac spine and lateral edge of the iliac crest that corresponds to nerve compression zone 2. If numbness and radiating pain is elicited, it is considered positive for this test.

The middle clunal nerves are very thin nerves and CT and MRI are not diagnostic for this condition.

Nerve block can be considered to allievate pain at the site of compression and also can aid be diagnosis of this condition 3. Surgical release of the ligament can be considered for refractory cases 2.

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