Cluneal neuralgia overview

How cluneal nerve pain develops

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.

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Common causes of cluneal neuralgia

What can cause cluneal nerve compression?

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

Bulging discs that may irritate nearby nerves

Narrowing of the nerve tunnel

Reduced space around the affected nerve

Nerve root irritation

Irritation as nerve roots pass through muscles

Osseo-fibrous canal irritation

Irritation where the nerve passes through the canal

Bad posture

May place additional pressure on affected nerves

Obesity

Increased body weight may contribute to nerve compression

Trauma

Injury may irritate or compress the cluneal nerves

Spinal surgery

Bone graft harvesting may affect or injure these nerves

Cluneal neuralgia symptoms

Where cluneal nerve pain may be felt

The main symptom of cluneal neuralgia is pain in one or more of the following areas:

  • The buttocks.
  • The pelvis.
  • The groin.
  • The thigh.
  • The coccyx (the ‘tailbone’)
  • The upper section of the calf
  • The bottom section of the spine (the ‘lumbosacral angle’)

Of these, the last five are caused by radiated pain, which is where the pain travels along the length of the affected nerve.

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Cluneal neuralgia tests and diagnosis

How cluneal neuralgia is diagnosed

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.

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Cluneal neuralgia treatment options

Managing cluneal nerve pain

Medical treatment with specific drugs may be initiated. Pulsed radiofrequency or peripheral neuromodulation are also used.

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  • Comprehensive pain assessments
  • Individual treatment planning
  • Medication review and optimisation

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