Home › Body Atlas › Nerves › Middle Cluneal Nerves

Middle Cluneal Nerves

nervi clunium medii

The middle cluneal nerves are the posterior primary rami of S1-S3 that exit through the posterior sacral foramina and pierce the posterior sacroiliac and long posterior sacroiliac ligaments to supply the skin over the posterior iliac crest, the upper gluteal region, and the posterior sacrum. They run obliquely from medial to lateral across the posterior iliac crest region.

Anatomical Data

Course & Distribution

Origin	Lateral branches of the posterior rami of S1, S2, S3
Course	Emerge through the posterior sacral foramina, run laterally under or through the long posterior sacroiliac ligament, and pierce gluteus maximus to reach the skin
Sensory	Skin over the sacrum and the medial buttock

Clinical Relevance

Clinical Notes

Middle cluneal nerve entrapment occurs where the nerves pierce the long posterior sacroiliac ligament or the posterior thoracolumbar fascia near the posterior iliac crest, producing posterior pelvic and buttock pain that mimics sacroiliac joint dysfunction or lumbar radiculopathy. The pain is reproduced by direct pressure over the posterior superior iliac spine and may be relieved by local anaesthetic injection. It is increasingly recognised as an underdiagnosed cause of chronic low back pain, treatable by injection or surgical nerve decompression at the ligament.

Pathology

Common Injuries & Conditions

Middle Cluneal Nerve Entrapment

Compression of the middle cluneal nerves where they pierce the long posterior sacroiliac ligament near the PSIS produces posterior pelvic and upper buttock pain mimicking sacroiliac joint dysfunction, with a positive tenderness point at the posterior PSIS and pain relief from targeted nerve block, treated by conservative injection or surgical decompression of the nerve at the ligament.

Explore

More in Pelvis & Hip

Browse all of Pelvis & Hip →