Iliolumbar ligament synrome/inj versus cluneal nerve entrapment/inj

[Timeoutofmind]

Quick question:

How are you differentiating these two clinical entities?

Also, I see some people doing iliolumbar ligament injections the same way I would do a cluneal:

http://thepainsource.com/iliolumbar-ligament-injection/

How are you guys doing these injections? Cluneal is 7cm lateral from midline on the illiac crest, posterior approach...three needles a cm or so apart?

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[lobelsteve]

Never seen either need an injection.

Topical nsaid and exercise program.

 

[nvrsumr]

zebras but for the iliolumbar I walk off tip of L5 TP caudally and advance a cm

 

[Timeoutofmind]

Never seen either need an injection.

Topical nsaid and exercise program.

How is HEP going to help a nerve entrapment?

 

[lobelsteve]

How is HEP going to help a nerve entrapment?

How is sticking a needle going to help an imaginary nerve entrapment syndrone?

In other words: are you basing your diagnosis on anything ither than a clinical hunch on a ridiculously uncommon condition.

 

[bedrock]

Agree this is very rare, however in the past seven years I had two patients, (out of the four patients I tried this on), who responded beautifully to iliolumbar ligament injections, and those two patients had previously failed everything, including PT, NSAIDS, massage, ESI, MBB, SIJ, etc.

 

[pmrmd]

IL ligament pain is real. Localized pain with contralateral side bend. TTP at the spur that invariably is off the crest. Personally I'm more oblique than the picture in that link. That cluneal thing is full-on ******.

 

[olafa]

cluneal seems to be rare- but have seen it, patients w fusion and bones taken from illiac crest location. the nerves drape over the iliac crest. whereas the iliolumbar lig slightly cephalad from L5 tp extending laterally to the iliac crest attachment. Also not common but easy treat if keeping in mind the clinical correlation w exam findings. depends on which part is painful. Not the case in cluneal, measured form midline 3 locations. Could probably use US for better localization, but I have not seen one in a while. Will have to try that...

 

[Aether2000]

Iliolumbar ligament enthesopathy should cause pain on contralateral lumbar lateral flexion- cluneal nerve should not. Cluneal nerve entrapment is probably a reach of a diagnosis in most patients but since there is no way to accurately diagnose it, determine the anatomical pathway of the nerves, and no effective treatment long term. It is probably overdiagnosed, even as uncommonly as it is diagnosed. Here is a link to an article on cluneal nerve entrapment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794535/

 

[Timeoutofmind]

Iliolumbar ligament enthesopathy should cause pain on contralateral lumbar lateral flexion- cluneal nerve should not. Cluneal nerve entrapment is probably a reach of a diagnosis in most patients but since there is no way to accurately diagnose it, determine the anatomical pathway of the nerves, and no effective treatment long term. It is probably overdiagnosed, even as uncommonly as it is diagnosed. Here is a link to an article on cluneal nerve entrapment: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4794535/

I know everyone keeps saying this but I feel like 30% of my pts have contralateral pain on lumbar lateral flexion...

 

[bedrock]

I know everyone keeps saying this but I feel like 30% of my pts have contralateral pain on lumbar lateral flexion...

Exactly. That physical finding is very nonspecific

 

[Aether2000]

Then 70% it is a finding in iliolumbar enthesopathy, which is better specificity than the SLR test in those over 40 with a HNP and symptomatic radicular pain . (https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4400709/figure/F1/) However very few of our physical exam tests have high levels of sensitivity or specificity. Anyone noted anything specific on MRI of the iliolumbar ligament with enthesopathy?

 

[eindoc]

I know I'm late in getting on this thread so I apologize. Patient had a positive superior cluneal nerve block. Anyone know any other tests to confirm a diagnosis for possible medial SCN entrapment? I found an article that uses a Hi-res ultrasound that can do it but it is from Japan. Any help would be much appreciated.

 

[Ligament]

I posted a nice iliolumbar ligament injecition picture here on SDN some time ago, should be able to find it with a search.