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The Hidden Culprit: Unveiling the Impact of the Superior Cluneal Nerve on Low Back

As clinicians, we often encounter patients complaining of low back pain, which can be a challenging condition to diagnose and treat effectively. While many causes of low back pain are well-known, there is one lesser-known culprit that deserves our attention: superior cluneal nerve syndrome. In this discussion, we will explore the anatomy and function of the superior cluneal nerve and shed light on its potential role in causing low back pain.


Anatomy of the Superior Cluneal Nerve

The superior cluneal nerve is a sensory nerve derived from the posterior rami of the lower thoracic spinal nerves, specifically T12, L1, and L2. It emerges from the deep fibers of the erector spinae muscle and courses laterally across the iliac crest, ultimately providing sensory innervation to the skin overlying the upper and outer buttock region.


Superior Cluneal Nerve Syndrome: An Overlooked Culprit

Superior cluneal nerve syndrome occurs when the nerve becomes entrapped or irritated along its course. Prolonged sitting, repetitive movements, trauma, or structural abnormalities may contribute to the development of this condition. Many will blame other structures as the culprit, but do not forget what nerves are locally to the pain.


Clinical Presentation

Patients with superior cluneal nerve syndrome typically present with chronic low back pain that is localized to the upper and outer buttock region. The pain may extend laterally along the iliac crest and occasionally radiate to the lower back. Physical examination may reveal tenderness and sensitivity over the path of the superior cluneal nerve, but in particular at the iliac crest posteriorly.


Nerve manipulation therapies offer the best approach in resolving this clinical ailment as the problem is not of disc or facet origin.

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