Maigne Syndrome: The #1 Overlooked LBP Diagnosis?

Maigne syndrome and cluneal neuropathy are commonly overlooked causes of pain in the lumbosacral region, iliac crest, and buttock. (1-3) In fact, the pair are causative or contributory in up to 40% of LBP cases. (5,40,41) And that prospect increases as symptoms extend over the posterior iliac crest. (2)

Maigne syndrome typically results from irritation of a thoracolumbar dorsal ramus. (3) Facet joint dysfunction, degeneration, and instability are common culprits. Maigne syndrome is particularly elusive because the anatomical site of origin is often asymptomatic. (3)This blog will cover the essentials of management, including a 5-minute video tutorial detailing the top assessments, treatments, and exercises, plus our top 10 clinical pearls.

Maigne syndrome/ Cluneal neuropathy is the newest ChiroUp protocol, and we’re particularly excited because it’s the 100th ChiroUp protocol.

How are ChiroUp Protocols Developed?

• Our research team scours several online databases for the latest evidence-based data regarding a condition’s etiology and clinical presentation, plus the most appropriate assessment, imaging/tests, differential diagnosis, treatment, exercises, and ADL’s.

• Our writers summarize that data into a condition protocol draft.

• The draft is submitted to our board of advisors and invited expert guests for a 14-day comment & critique period.

• The protocol is updated to reflect the peer-review recommendations, then published to our website after final approval.

• The protocol is continually refined as new data emerges, and by surveying our top performers for their real-world advice.

Subscribers can visit the ChiroUp condition reference library to access the entire synopsis, but here are our top 10 clinical pearls for Maigne syndrome and cluneal neuropathy:

2. Distal entrapments of the cluneal nerve are thought to increase neurodynamic tension on the dorsal nerve root, thereby compounding ischemia and hyperexcitability. (7,8) Maigne syndrome and superior cluneal nerve entrapment frequently coexist as double crush partners.

3. The most common manifestation of Maigne syndrome is low back pain that mirrors the presentation of lumbosacral or sacroiliac joint dysfunction. (3,9) Complaints rarely affect the thoracolumbar junction itself. (3)

4. Symptoms of a peripheral cluneal nerve entrapment frequently mimic those of lumbar stenosis - in that both conditions are provoked by prolonged standing or walking. (8)

5. In cases of peripheral cluneal nerve entrapment, patients will often report palpatory tenderness at the primary site of entrapment on the posterior iliac crest, approximately  3–4 cm (medial branch) or 7–8 cm (intermediate/ middle branch) from the midline. (8,12,40)

6. Paradoxical dysfunctional breathing may contribute to thoracolumbar stress. Clinicians should look for classic signs of dysfunctional breathing, including elevation of the upper rib cage, inadequate or asymmetrical lateral rib cage expansion, excessive paraspinal muscle contraction, or initiation of breathing from the chest rather than the abdomen. (29)

7. Gait assessment may reveal contributory mechanics, including diminished or asymmetrical arm swing (loss of glenohumeral motion), loss of hip extension, or short stride length. (45)

8. Motion palpation and clinical assessment may demonstrate signs of thoracolumbar hypomobility or hypermobility; and differentiating between the two is essential. Loss of spinal stability is a common precipitating factor for Maigne syndrome. (18)

9. Specific treatment strategies will be chosen based on whether the primary problem involves hypermobility or hypomobility. Hypermobile joints require a focus on building stability, whereas hypomobile joints, particularly degenerated segments, prefer strategies that open the intravertebral foramen.

10. Stiff fascia reduces muscle contractility and can perpetuate a chronic ischemic compartment-like syndrome. Many providers advocate for using shock wave therapy or mechanical cupping before stretching for multi-dimensional release of the thoracolumbar fascia.

Ready to put this information to work?

Wouldn’t it be great to have all of this information in one concise protocol that you can access 24/7 and use to educate your patients in seconds?

Well, with ChiroUp, you can.

And not only will you have access to our protocol for Maigne Syndrome & Cluneal neuropathy, but you’ll also have access to 100+ other conditions.

For more information on Maigne Syndrome, check out this podcast episode!

• References

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