Beyond the Fascia: Could Dorsal Rami Injury Mimic Osteofascial Tunnel Entrapment?
Description
Introduction: The superior cluneal nerve (SCN) is a well-documented source of hip and buttock neuralgia. Entrapment can occur at multiple locations along the pathway. The most common is the osteofibrous tunnel that forms between the thoracolumbar fascia and iliac crest.
Case Description: A 44-year-old female presented with persistent burning pain over the lumbar musculature, iliac crest, and sacrum. Imaging revealed transverse process fractures at L2-L4. She denied any pain prior to the injury. Given the lack of physical exam findings to support an articular source of pain and a history of transverse process fracture, cluneal neuralgia was suspected. Diagnostic nerve block resulted in significant symptom resolution. A peripheral nerve stimulator was subsequently placed, providing sustained relief.
Discussion: The SCN arises from the lateral branches of the dorsal rami of T11-L3 and traverses the paraspinal musculature, passing near the transverse processes of L2-L4 before piercing through the thoracolumbar fascia. While entrapment at the iliac crest is well documented, SCN trauma-induced neuropathy from transverse process fracture is rarely reported. This case presents a potential alternate source of SCN neuralgia and highlights the importance of anatomical awareness in back pain.
Conclusion: While superior cluneal neuralgia is a less common form of lower back and gluteal pain, its anatomical course warrants attention in cases of post-traumatic neuralgia. In this case, the distribution and persistence of the symptoms raise the possibility of proximal nerve impingement following transverse process fractures, expanding the differential for post-traumatic neuropathy.
Citation Information
McKay, Brigham; Slade, T. Brock; and Maldonado, Robert, "Beyond the Fascia: Could Dorsal Rami Injury Mimic Osteofascial Tunnel Entrapment?" (2026). Office of Research DMU Research Symposium. 50.
https://digitalcommons.dmu.edu/researchsymposium/2025rs/2025abstracts/50
Beyond the Fascia: Could Dorsal Rami Injury Mimic Osteofascial Tunnel Entrapment?
Introduction: The superior cluneal nerve (SCN) is a well-documented source of hip and buttock neuralgia. Entrapment can occur at multiple locations along the pathway. The most common is the osteofibrous tunnel that forms between the thoracolumbar fascia and iliac crest.
Case Description: A 44-year-old female presented with persistent burning pain over the lumbar musculature, iliac crest, and sacrum. Imaging revealed transverse process fractures at L2-L4. She denied any pain prior to the injury. Given the lack of physical exam findings to support an articular source of pain and a history of transverse process fracture, cluneal neuralgia was suspected. Diagnostic nerve block resulted in significant symptom resolution. A peripheral nerve stimulator was subsequently placed, providing sustained relief.
Discussion: The SCN arises from the lateral branches of the dorsal rami of T11-L3 and traverses the paraspinal musculature, passing near the transverse processes of L2-L4 before piercing through the thoracolumbar fascia. While entrapment at the iliac crest is well documented, SCN trauma-induced neuropathy from transverse process fracture is rarely reported. This case presents a potential alternate source of SCN neuralgia and highlights the importance of anatomical awareness in back pain.
Conclusion: While superior cluneal neuralgia is a less common form of lower back and gluteal pain, its anatomical course warrants attention in cases of post-traumatic neuralgia. In this case, the distribution and persistence of the symptoms raise the possibility of proximal nerve impingement following transverse process fractures, expanding the differential for post-traumatic neuropathy.
