The perforating cutaneous nerve arises from the posterior divisions of S2-S3, piercing the sacrotuberous ligament and the lower gluteus maximus to supply the medial inferomedial buttock skin. It is the smallest of the posterior cutaneous nerves of the buttock.
| Origin | Posterior aspect of the anterior rami of S2, S3 |
|---|---|
| Course | Pierces the sacrotuberous ligament and curves around the lower border of gluteus maximus to reach the skin |
| Sensory |
|
The perforating cutaneous nerve is compressed as it pierces the sacrotuberous ligament, producing buttock pain and cutaneous dysaesthesiae in the lower medial buttock. This entrapment is underdiagnosed and may be mistaken for piriformis syndrome or sacroiliac joint pain. It is injured during hamstring origin repair and gluteus maximus flap elevation.
Compression of the nerve at the sacrotuberous ligament producing medial buttock pain and numbness, reproduced by deep pressure over the nerve's piercing point at the lower gluteus maximus.
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