Introduction
Neuralgia is the medical term used to describe an intense, sometimes stabbing or burning pain along the length of a nerve, and the medical term 'cluneal' means pertaining to the buttocks.
The cluneal nerves (referred to as the inferior, medial and superior cluneal nerves) are 'cutaneous' nerves, that is they supply areas of skin on the body - the inferior nerves connect to the skin on the lower section of the buttocks, the medial nerves the skin of the central section of the buttocks and the superior nerves the skin on the upper buttocks.
The inferior nerves connect via a nerve in the thigh, and the medial and superior nerves connect directly to spinal nerves at the base of the spine.
It is believed that cluneal neuralgia may be an overlooked cause of lower back pain.
Causes
The pain of cluneal neuralgia is understood to be caused by compression (sometimes also referred to as 'entrapment' or 'inflammation') of the cluneal nerves at a site on the 'iliac crest' (the top section of the hip bone), although another theory suggests that the nerve compression may instead be located at another section of the medial nerve where it passes underneath the long posterior sacroiliac ligament.
Other possible causes include…
- Disc protrusions.
- Narrowing of the tunnel the nerve goes through.
- Irritation of the nerve roots as they pass through muscles.
- Irritation within the 'osseo-fibrous canal'.
In turn this type of irritation/compression is generally caused by…
- Bad posture.
- Obesity.
- Trauma (i.e. injury).
- Spinal surgery where bone graft harvesting may affect or injure these nerves.
Symptoms
The main symptom of cluneal neuralgia is pain in one or more of the following areas…
- The buttocks.
- The bottom section of the spine (the 'lumbosacral angle').
- The pelvis.
- The coccyx (the 'tailbone') .
- The groin.
- The thigh.
- The upper section of the calf.
Of these, the last five are caused by radiated pain, which is where the pain travels along the length of the affected nerve.
Tests / Diagnosis
Diagnosis of cluneal neuralgia is challenging due to the similarity of symptoms to other conditions, such as sciatica, lumbar radiculopathy and spinal stenosis. Tests generally include a physical examination, especially of the iliac crest region and in some cases an injection of anaesthetic at the site to check if symptoms go away.
Treatment
Medical treatment with specific drugs may be initiated.
Pulsed radiofrequency or peripheral neuromodulation are also used.