Middle Cluneal Neuralgia: What It Is and Why It Gets Missed
Short Answer
- Middle cluneal neuralgia is low back pain caused by a small sensory nerve getting compressed or irritated where it crosses a ligament along the back of the pelvis.
- It is frequently mistaken for SI joint dysfunction, sciatica, or superior cluneal neuralgia, a neighboring nerve people confuse it with, and standard imaging like MRI does not show it, because MRI is built to look at the larger structures of the spine, not a small peripheral nerve crossing a ligament.
- In our practice the diagnosis is confirmed with a thorough hands-on exam and diagnostic ultrasound and, in more complex cases, a selective diagnostic nerve block, and many patients improve with ultrasound-guided nerve hydrodissection without surgery.
Confirming the nerve as the source and treating it directly, instead of continuing to chase the spine or the SI joint, is usually what finally resolves the pain.
If your low back pain has been blamed on your spine or your SI joint, you may have already worked through physical therapy that helped a little, chiropractic adjustments that gave you short bursts of relief, and maybe a cortisone injection that barely touched it. When an MRI comes back essentially normal, the usual next step is another round of physical therapy or a referral to pain management. When it shows a structural finding such as a disc bulge or herniation, the conversation can turn to surgery, especially after conservative care has failed. If the true source is the middle cluneal nerves, neither path addresses it, and spine surgery would not fix it. When we test whether the middle cluneal nerves are compressed or irritated where they cross the main ligament of the SI joint, the source of your pain can become clear for the first time, often with ultrasound-guided nerve hydrodissection as the next step instead of another round of spine-focused care.
Middle cluneal neuralgia is low back and sacral pain that comes from a compressed or irritated middle cluneal nerve, a small sensory nerve that crosses the posterior sacroiliac ligament along the back of the pelvis. At Regenerative Performance in Gilbert, AZ, we confirm this diagnosis with a hands-on exam and diagnostic ultrasound and treat it with ultrasound-guided nerve hydrodissection. This is a nerve problem rather than a spine problem, and imaging alone will not confirm it, so an honest workup has to reproduce the pain at the nerve's location by hand rather than rely on a scan.
Schedule a 2-hour evaluation for your low back pain at our Gilbert, AZ clinic.
We limit how many new regenerative patients we accept each month to devote sufficient time and attention to each case.
In our Gilbert clinic, we most often see active adults 40 and older with low back pain who have tried PT and cortisone without lasting relief and want to avoid surgery. Many arrive with a normal or near-normal MRI and a diagnosis that has shifted between the spine and the SI joint, and what they want most is a clear answer about where the pain is actually coming from before they consider anything more invasive.
Key Facts About Middle Cluneal Neuralgia
Here is what you need to know about middle cluneal neuralgia before your evaluation.
- What it is: Middle cluneal neuralgia is pain caused by compression or irritation of the middle cluneal nerves, a group of up to three small sensory nerve branches that cross the long posterior sacroiliac ligament, the main ligament along the back of the SI joint, on their way to the skin.
- Who it affects: People with chronic low back pain over the sacrum or buttock that has been attributed to the spine or the SI joint, particularly when the MRI shows nothing that explains the pain, or only age-related changes, and spine-focused or joint-focused care has not helped.
- How it is diagnosed: A hands-on physical exam combined with diagnostic musculoskeletal ultrasound. As part of the workup, we press on the middle cluneal nerves under ultrasound guidance, in addition to the other nearby structures, to help us understand whether these small nerves are contributing to your pain. A diagnostic nerve block is a selective adjunct reserved for complex or ambiguous cases, not a routine step.
- Treatment options: Activity modification and nerve-informed physical therapy for some patients, ultrasound-guided nerve hydrodissection when conservative care has not resolved it, and surgical release as a last resort in the uncommon case where appropriate non-surgical care has failed.
- Timeline: After nerve hydrodissection, most patients have little or no soreness, and mild soreness, when it happens, usually lasts 1 to 2 days. Most notice improvement within the first 2 weeks of nerve hydrodissection, and the response typically plateaus by 8 to 12 weeks with a platelet-based solution. Individual results may vary.
- Where: Regenerative Performance, a regenerative and orthobiologic clinic in Gilbert, AZ.
- Next step: Call 480-508-4226 to schedule a 2-hour evaluation for low back pain in Gilbert, AZ.
What Is Middle Cluneal Neuralgia?
Middle cluneal neuralgia is pain that comes from irritation of the middle cluneal nerves, a group of up to three small sensory nerve branches that cross a ligament along the back of the pelvis, just below the belt line, on their way to give feeling to the skin over the buttock.
This is a case of a nerve being compressed and repeatedly rubbed as it crosses that ligament, what most people would call a pinched nerve, and it belongs to the same friction-and-irritation family of nerve problem that affects other small sensory nerves in this part of the body. Dissecting cadaver specimens, researchers identified the nerve compressed under this ligament in roughly one out of every eight cases, a rate high enough to argue against treating this as a rare anatomic curiosity (Konno et al., J Pain Res, 2017). A clinical case series evaluating patients for low back pain suggests a similar picture: about 1 in 8 (13%) had middle cluneal nerve entrapment once properly assessed, which suggests the condition is underdiagnosed rather than rare (Fujihara et al., Acta Neurochir, 2021).
"Neuralgia" simply means nerve-generated pain, which is a meaningfully different diagnosis from a disc bulge or a joint problem, even though the pain can feel similar and land in a similar location. The middle cluneal nerve and its neighbor, the superior cluneal nerve, are both recognized, published causes of otherwise-unexplained low back pain, not a fringe or speculative diagnosis (Isu et al., Neurospine, 2018).
Middle Cluneal Nerve Anatomy: Where the Nerves Cross the Posterior Sacroiliac Ligament
The middle cluneal nerves run from the sacrum out to the skin of the buttock, crossing the long posterior sacroiliac ligament, the main ligament along the back of the SI joint, just below the belt line, where the base of the spine meets the pelvis. Where a branch passes under or through that ligament, it can become compressed or irritated, and every time you bend, sit for long stretches, or walk, friction and tension on the nerve can cause pain.
In one anatomical study, the point where the nerve passes through that ligament sat just under an inch below the posterior superior iliac spine, the bony bump you can feel at the top of each buttock dimple, a fairly consistent, reproducible location (Konno et al., J Pain Res, 2017), and a separate case report placed the nerve's tender point within about an inch and a half below that same bump, along the ligament (Aota, World J Orthop, 2016). Reproducibility like this is part of why a targeted, ultrasound-guided approach is practical for both diagnosis and treatment.
The middle cluneal nerves also have a close neighbor, the superior cluneal nerve, which crosses a different landmark entirely, the bony ridge of the pelvis higher up. Both can produce a similar pattern of low back and buttock pain, but they are compressed at different points, which is why telling them apart matters for treatment.
In our clinical experience, a nerve this small cannot be located reliably by feel alone, which is why ultrasound guidance matters so much for finding it accurately. In a dissection study of the cluneal nerve family, the middle cluneal nerve measured about 0.8 mm in average diameter, thinner than its neighbor the superior cluneal nerve at about 1.1 mm (Tubbs et al., J Neurosurg Spine, 2010).
Schedule a 2-hour evaluation for your low back pain at our Gilbert, AZ clinic.
How Is Middle Cluneal Neuralgia Diagnosed?
Middle cluneal neuralgia is diagnosed by starting with a thorough history and a hands-on physical exam that reproduces your pain at the spot where the nerves cross the ligament along the back of your pelvis, and then confirming that finding with diagnostic musculoskeletal ultrasound.
We lead with the workup because low back pain can come from several different structures, and imaging on its own only shows what structures might be involved, not what is actually generating your pain. Diagnostic ultrasound is what makes this diagnosis practical, but not because it shows us the nerves. Nerves this small and this deep are very difficult to see on ultrasound, so we do not rely on seeing them. Instead, we use the ultrasound to identify the ligament, the SI joint, and the other structures in that area, then press on the middle cluneal nerves at their crossing point and on each nearby structure under guidance, a technique called sonopalpation, to find which one reproduces the exact pain you came in with. In the literature, the tender point used to identify middle cluneal nerve entrapment sits about two finger-widths below the posterior superior iliac spine, the bony bump at the top of each buttock dimple, and slightly toward the outside of it (Fujihara et al., Acta Neurochir, 2021). If pressing there reproduces your familiar low back or buttock pain, that is one clue that the middle cluneal nerves may be involved, though only a hands-on exam can confirm it.
That same study describes a diagnostic convention used in the research literature: confirming the diagnosis with a local nerve block and requiring more than 50% pain relief within two hours to count as a positive result. That is how a study establishes who gets enrolled, and it is a legitimate research methodology, but it is not how we typically confirm a middle cluneal nerve diagnosis in our practice. Our routine confirmation pathway is the exam plus diagnostic ultrasound described above. A diagnostic nerve block is a selective adjunct we reach for in more complex or ambiguous cases, where several structures could plausibly be contributing and the exam and ultrasound have not fully settled the question, not a routine step every patient goes through.
An MRI that is normal, or that shows only the age-related disc and joint changes most adults have, does not rule out the diagnosis.
Why Is Middle Cluneal Neuralgia Missed on MRI?
Middle cluneal neuralgia is missed on MRI because MRI is built to evaluate the larger structures of the back, including the discs, bone, facet joints, and the spinal canal, and the standard views are not angled to follow a peripheral nerve where it crosses a ligament along the back of the pelvis. Your scan can come back normal, or show only the age-related disc and joint changes that most adults have, and still miss the actual source of your pain entirely.
The nerves themselves are also small enough to escape imaging. One dissection study measured the middle cluneal nerve at about 0.8 mm in average diameter (Tubbs et al., J Neurosurg Spine, 2010), and in our experience a structure that size is not reliably visualized even when a radiologist is specifically looking for nerve pathology. That combination, a peripheral nerve that imaging is not designed to evaluate and is too small to see reliably even when it is, is a large part of why this diagnosis gets missed or mistaken for something else for so long.
In practice, we frequently see these nerves contributing alongside other findings on a scan, such as age-related disc changes. Both can be present at once, so a finding on the MRI does not settle where the pain is coming from. When the scan shows a disc bulge or herniation and conservative care has failed, the conversation in the conventional medical system often turns to surgery, but if the middle cluneal nerves are the true source, spine surgery will not address them. A normal and an abnormal MRI both deserve the same next step, an exam with ultrasound-guided palpation that tests the nerves' crossing point directly, instead of relying on the scan to answer a question it was never built to answer.
Middle Cluneal Neuralgia vs. SI Joint Pain vs. Superior Cluneal Neuralgia vs. Lumbar Radiculopathy: How to Tell Them Apart
Middle cluneal neuralgia, SI joint pain, superior cluneal neuralgia, and lumbar radiculopathy can all produce chronic pain over the low back, sacrum, and buttock. Telling them apart from history and symptoms alone is difficult, which is exactly why a hands-on evaluation matters more than a symptom checklist.
During the physical exam, the diagnosis of middle cluneal neuralgia rests on two findings together. The first is pain reproduced exactly over the middle cluneal nerves' territory at the outer edge of the sacrum, where the nerves cross the ligament. The second is the absence of other positive findings pointing to a nearby structure. If SI joint provocation testing is negative, the SI joint becomes less likely. Superior cluneal pain tends to sit further out to the side, with tenderness over the iliac crest where that nerve crosses the bone, rather than over the outer sacrum. An S1 nerve root problem very commonly sends pain down the back of the leg and shows positive nerve-tension tests that reproduce that same pain; middle cluneal neuralgia does not radiate down the leg.
Middle cluneal neuralgia and superior cluneal neuralgia are genuinely different conditions involving different nerves. The superior cluneal nerve crosses the bony ridge of the pelvis, while the middle cluneal nerve crosses the ligament along the back of the pelvis further down, a different landmark and a different mechanism of compression entirely. Because both nerves can produce a similar pattern of low back and buttock pain, we test for both during your evaluation instead of assuming one or the other based on symptoms alone. If you suspect the superior cluneal nerve is more likely your issue, our guide to superior cluneal neuralgia covers that nerve's specific crossing point and treatment approach in depth.
Middle cluneal neuralgia and SI joint pain can also look alike, since both produce pain over the sacrum and buttock that gets blamed on the low back. The SI joint problem comes from lax or irritated ligaments allowing abnormal motion in that joint, not a compressed nerve, so the physical exam and diagnostic ultrasound findings are different even though the pain pattern can overlap. If SI joint dysfunction seems more likely in your case, our guide to SI joint pain covers how that diagnosis is made and treated.
The table below outlines the features that tend to separate these four, though any one of them can coexist with another, and only a physical exam and diagnostic ultrasound can confirm which is actually driving your pain.
| Factor | Middle Cluneal Neuralgia | SI Joint Pain | Superior Cluneal Neuralgia | Lumbar Radiculopathy |
|---|---|---|---|---|
| Most tender location | Where the nerves cross the ligament at the back of the pelvis, just below the belt line | Over the joint itself, in the dimple area at the back of the pelvis | Over the bony ridge of the pelvis, higher and further out than the middle cluneal point | Often none in the low back itself; when there is tenderness, it usually comes from a neighboring structure such as guarded muscle or an arthritic facet joint rather than the nerve root |
| What the exam shows | Pressing over the nerves at the outer edge of the sacrum reproduces your exact pain; tests for the SI joint, the superior cluneal nerve, and the nerve roots are negative | SI joint provocation tests are positive; when they are negative, the joint is less likely to be the source | Tenderness over the iliac crest, the bony ridge where that nerve crosses, further out to the side than the middle cluneal point | Nerve-tension tests for the affected nerve root are positive and reproduce your familiar pain |
| What provokes it | Direct pressure over the nerve; walking, standing, bending forward, and prolonged sitting | Sit-to-stand, getting in and out of a car, rolling over in bed | Sitting, bending forward, twisting at the waist | Bending, coughing, sneezing, prolonged standing |
| Travels below the knee? | No; the pain stays over the low back and buttock rather than running down the leg | Rarely, though it can travel down the leg into the calf or foot | Rarely | Often, following a specific nerve root pattern |
How Is Middle Cluneal Neuralgia Treated?
Treatment for middle cluneal neuralgia usually starts with activity modification and, for some patients, nerve-informed physical therapy. Physical therapy for a nerve problem is only as good as the therapist's understanding of nerve behavior, so we prefer therapists trained in clinical neurodynamics, because therapy aimed only at muscles and joints can aggravate a nerve condition rather than calm it.
For pain that persists, ultrasound-guided nerve hydrodissection treats the nerve at the location of compression or irritation instead of masking the pain, once the middle cluneal nerves have been confirmed as the source. In more complex or ambiguous cases, a selective diagnostic nerve block can add useful confirmation before proceeding. A cortisone injection can suppress inflammation temporarily, but it does not hydrodissect the nerve, which is why it is rarely the right choice for a nerve entrapment like this one.
Surgery is considered only when a well-supported diagnosis is paired with a genuine failure of appropriate non-surgical care, including nerve hydrodissection, and that combination is uncommon. In one reported case, a revision surgery that specifically released the middle cluneal nerve brought the patient's pain score to zero and disability score to near-normal at eight months (Aota, World J Orthop, 2016). That is illustrative of what surgical release can achieve in the right case, not a proven or typical outcome rate.
Middle Cluneal Nerve Hydrodissection at Regenerative Performance
Once the middle cluneal nerves are determined to be contributing to your pain, our approach is ultrasound-guided nerve hydrodissection, injecting solution around the nerve at the location of compression or irritation, where it crosses the posterior sacroiliac ligament, to separate it from the ligament and the surrounding fascia and create space around it. Our goal is to resolve your pain without surgery, and for the great majority of the people we see with this problem, treating the nerve with hydrodissection instead of an incision is enough.
Several different solutions can be used for nerve hydrodissection, including saline, 5% dextrose in water (D5W), platelet-rich plasma (PRP), protein concentrate, and, in select cases, stem cell therapy. At Regenerative Performance, the starting solution is typically properly dosed platelet-rich plasma, protein concentrate, or both, depending on your diagnosis, usually with 5% dextrose added. In our experience, PRP and protein concentrate typically require fewer treatments than 5% dextrose alone, which is why they are what we reach for first.
Please note: Platelet-rich plasma and protein concentrate are autologous blood-derived preparations; in their minimally manipulated autologous form they are exempt from the FDA's 351 and 361 biologics pathways. Dextrose solutions are approved for other uses and administered off-label for nerve hydrodissection. None of these injectates is FDA-approved as a cure for nerve conditions, and individual results may vary.
We treat the middle cluneal nerves under continuous ultrasound guidance because nerves this small cannot be reliably reached blind, and precision is what separates a treatment from a guess. We use the ultrasound to identify the ligament and the point where the nerves cross it, the same spot your exam already pointed to, and deliver the solution to that exact location rather than the general area of your low back.
In our practice we almost never use cortisone for middle cluneal nerve hydrodissection. We reserve it for the rare, genuinely indicated flare rather than using it as a routine or repeated approach. A corticosteroid injection can suppress inflammation temporarily, but it does nothing to hydrodissect the nerve itself, and repeated steroid exposure carries real downsides for the surrounding tissue. When an injection procedure is warranted for the middle cluneal nerves, the orthobiologic solutions we prepare from your own blood support the tissue instead of suppressing it.
We treat once and then track your response over 4 to 12 weeks, depending on the solution used. There is no fixed number of sessions. If there is no response after one treatment, that usually means either the diagnosis was wrong or a true mechanical compression was not adequately released. In either case we re-evaluate rather than simply repeat the same injection. We go back through your history, repeat the exam, and consider additional imaging to adjust the diagnosis. Some patients come to us with hydrodissection as a last step before surgery, and for them a genuine non-response is the point at which we may recommend surgery.
Many patients who come to us for middle cluneal neuralgia have already been through disc-focused or SI-joint-focused treatment that did not resolve the pain, because the actual source was never tested directly. Once the nerves themselves are identified as the pain generator and treated with hydrodissection, the underlying problem is finally being addressed, not just worked around. You can read more about the technique itself in our full guide to nerve hydrodissection or on our nerve hydrodissection service page.
What to Expect at Our Gilbert, AZ Clinic for Middle Cluneal Neuralgia
Every patient with suspected middle cluneal neuralgia moves through the same four steps.
The 2-Hour Evaluation
Every new patient starts with a detailed 2-hour evaluation that includes a thorough history, a hands-on physical examination, plus diagnostic ultrasound when indicated. We test the middle cluneal nerves' crossing point and the structures around it directly, pressing on each one under ultrasound guidance to find what reproduces your pain, rather than relying on imaging alone.
The primary purpose of this evaluation is to identify the specific tissue causing your pain. This step matters because, in our experience, an accurate diagnosis is one of the most important factors in regenerative treatment success, and a missed or incomplete diagnosis is the most common reason we see regenerative treatment fall short.
Individualized Treatment Plan
Based on the evaluation, we determine whether you are a candidate for nerve hydrodissection, a diagnostic nerve block first in a more complex case, or another regenerative approach. From there, we develop a plan specific to your case, including which nerve and surrounding tissue will be treated, the expected timeline, and your role in recovery.
Because the first three months after treatment are the window where most of the response occurs, we typically recommend supplements and peptides during that period to give your body every advantage while it heals.
Ultrasound-Guided Nerve Hydrodissection
On your treatment day, we draw your blood and prepare the solution while you relax in our IV lounge. Fluid is then injected under continuous ultrasound guidance circumferentially around the middle cluneal nerves at the point where they cross the ligament along the back of your pelvis, separating them from the surrounding tissue. The solution is typically properly dosed platelet-rich plasma, protein concentrate, or both, depending on your diagnosis, often with 5% dextrose added.
We treat the specific crossing point identified during your evaluation rather than injecting blindly into the general area of your low back.
Recovery and Follow-Up
After your procedure, we recommend resting for the remainder of that day so your body can begin to respond. Because nerve hydrodissection on its own is gentler on the surrounding tissue than treating a joint, tendon, or ligament, activity restrictions typically last less than 1 week, with a gradual return to full activity guided by your response, and when it helps we refer you to a physical therapist trained in nerve-informed rehabilitation.
Most patients have no soreness afterward. If there is mild soreness from the injection, it usually lasts 1 to 2 days, and very rarely a patient has a pain flare that lasts 3 to 7 days. Most people notice improvement within the first 2 weeks, though some take longer. With platelet-rich plasma, protein concentrate, or platelet lysate, the response typically plateaus by 8 to 12 weeks, and with dextrose alone, it usually plateaus by 4 to 6 weeks. Individual results may vary.
We treat once and then track your response over that window before deciding anything further. We schedule follow-up assessments to track your progress, giving both you and our team objective information on how your treatment is working.
Schedule a 2-hour evaluation for your low back pain at our Gilbert, AZ clinic.
Who Is a Good Candidate for Middle Cluneal Neuralgia Treatment
Middle cluneal neuralgia is worth exploring if any of the following describe your situation:
- Chronic low back pain over the sacrum or buttock lasting 3 months or longer that has not responded to conservative care
- Pain that gets worse with walking, standing, prolonged sitting, or direct pressure at the back of the pelvis
- An MRI that is normal, or that shows only age-related changes that do not explain your pain
- You have been told the pain is coming from the SI joint or a disc, and treatment aimed at those has not helped
- You are looking for a non-surgical option before considering surgery
During your evaluation we determine whether nerve hydrodissection, a different regenerative approach, or an entirely different diagnosis and treatment plan is the right answer for you. Our clinic is in Gilbert, AZ, and we see patients from across the greater Phoenix area as well as those traveling from out of state, with the evaluation and, when appropriate, the procedure scheduled in a single trip for traveling patients.
If you are unsure whether orthobiologic injections like PRP or stem cell therapy are appropriate, or you are traveling from outside the Phoenix area, you can also call and ask about a brief 15 minute discovery call.
Frequently Asked Questions About Middle Cluneal Neuralgia
What exactly is middle cluneal neuralgia?
Middle cluneal neuralgia is low back and buttock pain caused by compression or irritation of the middle cluneal nerve, a small sensory nerve that crosses the long posterior sacroiliac ligament, the ligament along the back of the pelvis. It is a peripheral nerve problem rather than a spine or disc problem, and it is a recognized, published cause of otherwise-unexplained low back pain, not a fringe diagnosis.
How is middle cluneal neuralgia different from SI joint pain?
Middle cluneal neuralgia comes from a compressed nerve crossing a ligament at the back of the pelvis, while SI joint pain comes from instability or irritation in the joint itself and its stabilizing ligaments. Both can produce similar low back and buttock pain, and pain from the SI joint is often provoked by transitions like sitting to standing or rolling over in bed, while middle cluneal nerve pain is more directly reproduced by pressure at the nerves' crossing point and tends to flare with walking and standing. On exam, negative SI joint provocation tests make the joint less likely, while tenderness over the outer edge of the sacrum, where the nerves cross the ligament, points to the middle cluneal nerves.
Why does my MRI look normal if I have middle cluneal neuralgia?
Your MRI can look normal, or show only age-related changes that do not explain your pain, because middle cluneal neuralgia is a problem with a peripheral nerve crossing a ligament at the back of the pelvis, not with your spine, discs, or joints, which is what MRI is designed to evaluate. These nerves are also small enough that MRI does not visualize them reliably. Many adults have incidental degenerative findings on a low back MRI, so neither a normal scan nor an abnormal one rules this condition in or out, which is one reason the diagnosis is so often missed.
What does a diagnostic nerve block tell you about middle cluneal neuralgia?
A diagnostic nerve block for middle cluneal neuralgia, which is an anesthetic injection placed around the suspected nerve, tells you whether that specific nerve is a source of your pain based on how much your symptoms improve afterward. It does not tell you whether other structures, like the SI joint or a disc, are also contributing, because relief from a block only rules that one nerve in rather than ruling everything else out. A hands-on exam and diagnostic ultrasound are the routine way a middle cluneal nerve diagnosis is confirmed, and a diagnostic block is a selective adjunct reserved for complex or ambiguous cases rather than a routine step.
What is middle cluneal neuralgia's relationship to superior cluneal neuralgia?
Middle cluneal neuralgia and superior cluneal neuralgia involve two different, neighboring nerves that can produce a similar pattern of low back and buttock pain but are compressed at different locations. The middle cluneal nerve crosses the main SI ligament along the back of the pelvis, the posterior sacroiliac ligament, while the superior cluneal nerve crosses the bony ridge of the pelvis higher up. Because they can look alike on history alone, both nerves should be tested during an evaluation rather than assuming one over the other.
What can I expect after nerve hydrodissection for middle cluneal neuralgia?
After nerve hydrodissection for middle cluneal neuralgia, rest for the remainder of that day, with activity restrictions typically lasting less than 1 week and a gradual return guided by how you respond. Most patients have little or no soreness; when mild soreness occurs it usually lasts 1 to 2 days, and a flare lasting 3 to 7 days is rare. Most patients notice improvement within the first 2 weeks, and the response typically plateaus by 8 to 12 weeks with a platelet-based solution. Individual results may vary.
Is surgery ever needed for middle cluneal nerve entrapment?
Surgery is occasionally needed for middle cluneal nerve entrapment, but only when a well-supported diagnosis is paired with a genuine failure of appropriate non-surgical care, including nerve hydrodissection, and that combination is uncommon. In one reported case, surgical release of the entrapped nerve brought the patient's pain score to zero and disability score to near-normal at eight months (Aota, World J Orthop, 2016), which is illustrative of a good surgical outcome rather than a typical or guaranteed one. The goal is to resolve the pain without surgery whenever the diagnosis and response to conservative care allow it.
Is nerve hydrodissection covered by insurance in Arizona?
Nerve hydrodissection with platelet-rich plasma or protein concentrate is typically not covered by insurance as it is deemed experimental. Regenerative Performance operates on a cash-pay, out-of-network model. Cost depends on the number and complexity of structures treated, and the specifics are reviewed during your 2-hour evaluation once the diagnosis is clear.
Still have questions? The best way to get answers is a conversation. Call 480-508-4226.
About Dr. Timmermans
Dr. Drew Timmermans, ND, RMSK
Dr. Drew Timmermans, ND, RMSK, is a naturopathic physician and registered musculoskeletal sonographer (RMSK) practicing at Regenerative Performance in Gilbert, AZ. He specializes in orthobiologic injections, including platelet-rich plasma, bone marrow concentrate, prolotherapy, perineural injection therapy, and nerve hydrodissection, using ultrasound and fluoroscopic guidance to treat the specific structures causing chronic pain rather than suppressing symptoms.
Dr. Timmermans has performed close to 10,000 orthobiologic injections, and tracks patient outcomes to refine diagnosis and treatment across thousands of cases.
References
- Konno T, Aota Y, Saito M, Qu N, Hayashi S, Kawata S, Itoh M. Anatomical study of middle cluneal nerve entrapment. Journal of Pain Research. 2017;Volume 10:1431-1435. DOI: 10.2147/jpr.s135382.
- Tubbs RS, Levin MR, Loukas M, Potts EA, Cohen-Gadol AA. Anatomy and landmarks for the superior and middle cluneal nerves: application to posterior iliac crest harvest and entrapment syndromes. Journal of Neurosurgery: Spine. 2010;13(3):356-359. DOI: 10.3171/2010.3.spine09747.
- Fujihara F, Isu T, Kim K, Sakamoto Y, Matsumoto R, Miki K, Ito K, Isobe M, Inoue T. Clinical features of middle cluneal nerve entrapment neuropathy. Acta Neurochirurgica. 2021;163(3):817-822. DOI: 10.1007/s00701-020-04676-0.
- Aota Y. Entrapment of middle cluneal nerves as an unknown cause of low back pain. World Journal of Orthopedics. 2016;7(3):167. DOI: 10.5312/wjo.v7.i3.167.
- Isu T, Kim K, Morimoto D, Iwamoto N. Superior and Middle Cluneal Nerve Entrapment as a Cause of Low Back Pain. Neurospine. 2018;15(1):25-32. DOI: 10.14245/ns.1836024.012.
NOTE: This article provides general information to help the reader better understand regenerative medicine, nerve and musculoskeletal conditions, naturopathic approaches to pain, and related subjects. All content provided in this article, website, or any linked materials, including text, graphics, images, research, and outcomes, are not intended, and should not be used, as a substitute for direct medical advice, diagnosis, or treatment. Please always consult with a professional and licensed healthcare provider to discuss if any treatment is right for you.
Please note: None of the injectates described here is an FDA-approved treatment for nerve conditions, and none is offered as a cure. Platelet-rich plasma and protein concentrate are autologous blood-derived preparations; in their minimally manipulated autologous form they are exempt from the FDA's 351 and 361 biologics pathways and are prepared using cleared devices, so FDA approval is not a pathway that applies to them. Dextrose solutions are approved for other uses and administered off-label for nerve hydrodissection.