Citation, DOI, disclosures and article data
Citation:
Sriselvakumar S, Knipe H, Middle clunal nerve entrapment. Reference article, Radiopaedia.org (Accessed on 18 Apr 2024) https://doi.org/10.53347/rID-156880
Disclosures:
At the time the article was last revised Henry Knipe had the following disclosures:
- Radiopaedia Events Pty Ltd, Speaker fees (past)
- Integral Diagnostics, Shareholder (ongoing)
- Micro-X Ltd, Shareholder (ongoing)
These were assessed during peer review and were determined to
not be relevant to the changes that were made.
View Henry Knipe's current disclosures
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.
Treatment and prognosis
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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1. Konno T, Aota Y, Saito T et al. Anatomical Study of Middle Cluneal Nerve Entrapment. J Pain Res. 2017;10:1431-5. doi:10.2147/JPR.S135382 - Pubmed
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2. Isu T, Kim K, Morimoto D, Iwamoto N. Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain. Neurospine. 2018;15(1):25-32. doi:10.14245/ns.1836024.012 - Pubmed
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3. Fujihara F, Isu T, Kim K et al. Clinical Features of Middle Cluneal Nerve Entrapment Neuropathy. Acta Neurochir. 2021;163(3):817-22. doi:10.1007/s00701-020-04676-0 - Pubmed
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