Buttock pain is a common complaint. While we attribute many cases to tendonitis, sciatica, or sacroiliac joint degeneration, one under-recognised cause is cluneal nerve entrapment. In patients with persistent or atypical symptoms that do not fit other causes, we should consider cluneal nerve pain. So, what is cluneal nerve entrapment, and how do we treat it?
What Is Cluneal Nerve Entrapment?
The cluneal nerves are small sensory nerves that come from the large nerves in the lower back. These nerves provide sensation to the skin over the buttocks. Cluneal nerve entrapment occurs when one or more of these nerves—especially the superior cluneal nerves—are compressed or irritated as they pass through fascial layers or over bony prominences.
Doctors often misdiagnose this condition as sciatica, proximal hamstring tendinopathy, deep gluteal syndrome or sacroiliac joint pain due to overlapping symptoms. Accurate diagnosis requires a careful assessment and, in some cases, diagnostic blocks.
Symptoms of Cluneal Nerve Pain
Patients with cluneal nerve entrapment typically report:
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Localised or diffuse buttock pain, often near the top of the iliac crest, but it can move to the lower buttock or upper hamstring.
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Burning, tingling, or sharp sensations radiating across the upper buttocks
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Pain aggravated by prolonged sitting, bending, or direct pressure
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No significant neurological symptoms
Pain is usually on one side only, although it can be bilateral.
Clinical Assessment
Assessment begins with a detailed history to rule out more common causes of buttock pain.
On examination:
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Tenderness is often localised approximately 7–8 cm lateral to the midline at the level of the posterior iliac crest.
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We reproduce pain by touching the area. Tapping the nerve in this area often reproduces pain.
- Movement of the lumbar spine into extension, lateral flexion and rotation often reproduces pain.
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There is typically no neurological deficit in the lower limb.
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Examination of other structures, such as the lumbar spine, sacroiliac joint, piriformis muscle, hamstring origin tendon and hip joint, is normal.
A positive response to nerve block or local anaesthetic infiltration over the suspected nerve site strongly supports the diagnosis.
Diagnostic Tests
Overall, there is no specific imaging test to confirm cluneal nerve entrapment, but investigations can help rule out other causes.
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MRI Lumbar Spine to exclude disc herniation, facet joint arthritis or spinal stenosis
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Hip MRI or ultrasound to assess gluteal tendons, bursae, or sacroiliac joint pathology
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In some cases, ultrasound may identify fascial thickening or nerve compression near the iliac crest.
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Diagnostic injection of local anaesthetic over the cluneal nerve can provide both confirmation and temporary relief. Generally, we perform these injections under ultrasound guidance.
Treatment Options for Cluneal Nerve Entrapment
Management of cluneal nerve pain includes both conservative and interventional options:
Conservative options:
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Activity modification – avoiding prolonged sitting or pressure over the iliac crest
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Physiotherapy – targeted stretching and nerve mobilisations
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Medications – such as neuropathic pain agents (e.g. duloxetine or amitriptyline)
Interventional options:
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Ultrasound-guided nerve block involving injection of local anaesthetic with steroid for diagnostic and therapeutic effects
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Nerve Hydrodissection using ultrasound to release fascial entrapment of the nerve
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Radiofrequency ablation, which consists of burning or stunning the nerves
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Surgical decompression is rarely required, but it is an option in refractory cases
Final Word from Sportdoctorlondon regarding Cluneal Nerve Entrapment
Cluneal nerve pain is a rare cause of chronic buttock discomfort. Awareness of this condition is crucial, particularly when treatments for other conditions fail. With careful assessment and targeted treatment—often involving ultrasound-guided nerve block—many patients experience significant relief and return to normal function.
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