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Gracie Schneider

Professor Workman

English 1201

19 March 2020

Literature Review

There are many different factors that can cause lower back pain in people. In many

cases, someone can go their whole life without finding out what the actual cause of their pain

is. Superior cluneal nerve entrapment(SCN-E) can be the cause of low back pain, which can also

go into other areas such as the legs and iliac crest. Once being diagnosed with the condition,

there are many things to be done to pinpoint the pain, determine how it is being caused, and

there are multiple ways to treat the pain. For my essay, I will be answering the question: How

does superior cluneal nerve entrapment cause pain, and what are the ways of diagnosing and

treating it?

One key point seen in many articles and sources, is the way to diagnose superior cluneal

nerve entrapment. In an article by MD James Inklebarger, he discusses how a diagnosis is made

“by palpation of the iliac crest...resulting in marked local tenderness and pain relief after local

anesthetic injection”(1). Similarly, in another report it discusses the steps in which you diagnose

SCN-E, “[If] the maximum tender point was on the posterior iliac crest… and [when] palpation

of the maximally tender point reduced the chief complaint of LBP… a nerve block injection was

performed”(Hiroshi et al. 4). These two studies both claim the same method for diagnosing

SCN-E by doing an injection to release the pressure put on the nerves. Likewise, the three other

reports do not go into as much detail as the Inklebargers and Hiroshi and his companions,
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although they briefly describe the same methods. In the article, “Superior and Middle Cluneal

Nerve Entrapment as a Cause of Low Back Pain”, it says, “... the detection of a Tinel-like sign at

the point of the thoraco-lumbar fascia and pain disappearance upon nerve blockage are of

diagnostic relevance”(Isu et al.). Although it sounds different than the other ways of diagnosing

the condition, it is saying the same thing. This article describes exactly where the injection is

going to relieve the pain, in between the fascia and nerves. All articles either directly say an

injection is done to diagnose the issue or describe the process of releasing pressure put on the

nerve by the fascia, which are the actions that take place by doing an injection.

While the sources all state the same ways for determining if someone has superior

cluneal nerve entrapment, they don't all agree on the ways for treating the pain. In the article,

“Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment Neuropathy”, it

discusses the main treatments to get rid of the pain caused by SCN-E. “[In patients] whose pain

is not relieved by conservative treatment with repeated SCN blocks, surgical release of the

entrapment is performed”(Miki et al.). Additionally, the article written by Isu and his team of

three others have similar ways of treating SCN-E. “[they] reported that 68% of their patients

experienced lower back pain relief by more than 50% after 1-3 superior cluneal nerve blocks…

in patients… whose pain is not relieved by conservative treatment with drugs, or nerve

blockage, surgical release of the entrapment may be effective”(1). Both sources from the US

National Library of Medicine agree on ways of treatment for the condition. They are credible

articles and provide statistics from studies conducted with patients suffering from nerve

entrapment. Contrary to what Isu and Miki say, that article, “Cluneal Nerve Entrapment”

suggests different ways of treating the issues. “Many practitioners can utilize manipulation of
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the segments… instrument assisted myofascial mobilization, pin and stretch techniques, and

soft tissue mobilization techniques”(Morgan). This suggests that going to a chiropractor is a

better option for treating SCN-E. The article acknowledges that there are surgical ways of

treatment, but states that it is rarely needed. The article from the Journal of Prolotherapy

states similar information. Inklebarger and Galanis write that regional massages, soft tissue

mobilization, and other methods that involve manipulating the muscle and fascia are successful

ways of treatment(1). The last source agrees more with the first two from the National Library

of Medicine. “Surgery was indicated only when temporal pain relief was obtained after SCN

blocks..”(Hiroshi et al.). Sources from the same title of doctors agree on the same methods of

treatment, while chiropractic doctors seem to have their own set of solutions to treat superior

cluneal nerve entrapment.

Superior cluneal nerve entrapment is becoming more and more common, and is being

seen more by doctors. Although, it is a common misunderstanding that all lower back pain is

caused by superior cluneal nerve entrapment. There are many other causes and reasons for

lower back pain and SCN-E specifically focuses on the thoraco-lumbar fascia and the nerves

above and below the fascia. Furthermore, many believe that you have to be older to suffer

from SCN-E, although it is becoming more common for young athletes to have it too. Lastly,

many people say that going to a chiropractor is a 100% guaranteed solution for nerve

entrapment. There are misconceptions that surgery or nerve block injections are not needed to

treat pain. “While there is little evidence to validate this treatment as being effective in

treatment of this condition, there is not evidence that it is not effective”(Morgan). This is

information from a chiropractic doctor, admitting that the ways of treatment are not 100%
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effective and it does not guarantee pain relief. I might use this source to show the ways of

treatment used by practitioners that are not reliable and have no facts or statistics to back

them up.

After reviewing these sources, I have a pretty good idea on how superior cluneal nerve

entrapment is treated and diagnosed. Most of the sources say the same thing about diagnosing

SCN-E by doing a nerve block injection and seeing if the pain subsides after receiving the shot. If

after 1-3 of the nerve block shots do not relieve the pain, then the next step is most likely

surgery to release the nerve from the fascia surrounding it. Although, chiropractors believe

there are less invasive methods that work better that deal with manipulating the muscle and

fascia around the nerve externally. I think I need to do some more research on what the steps

of the surgery are and what exactly happens during the surgery to release the nerve. I think

having a more in depth understanding of the surgery will help me write the final draft. I also

need to do a bit more research on how superior cluneal nerve entrapment actually causes pain

to that area, which then can spread to your legs and iliac crest.
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Works Cited

Hiroshi Kuniya, et al. “Prospective Study of Superior Cluneal Nerve Disorder as a Potential

Cause of Low Back Pain and Leg Symptoms.” Journal of Orthopaedic Surgery &

Research, vol. 9, no. 1, Dec. 2014, pp. 37–61. EBSCOhost, doi:10.1186/s13018-014-

0139-7.

Inklebarger, James, and Nikforos Galanis. “The Management of Cluneal Nerve Referred Pain

with Prolotherapy.” Journal of Prolotherapy, 31 Aug. 2018,

journalofprolotherapy.com/management-cluneal-nerve-referred-pain-prolotherapy/.

Isu, Toyohiko et al. “Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back

Pain.” Neurospine vol. 15,1 (2018): 25-32. doi:10.14245/ns.1836024.012

Miki, Koichi et al. “Characteristics of Low Back Pain due to Superior Cluneal Nerve Entrapment

Neuropathy.” Asian spine journal vol. 13,5 772-778. 14 May. 2019,

doi:10.31616/asj.2018.0324

Morgan , William E. “Cluneal Nerve Entrapment.” Cluneal Nerve Entrapment - Dr. William E.

Morgan, 2013, drmorgan.info/clinicians-corner/cluneal-nerve-entrapment/.