Health Organization for Pudendal Education

I do not know much about the cluneal nerve, but from what I've read it is a more cutaneous (closer to the surface) nerve. It it just a sensory nerve or does it have motor function? Can it be removed and/or cut to remove the pain? Who does this surgery other than Aszmann and Dellon? I am wondering about this more as the area over my TG scar sends off shocks and neuralgia. I would hate to find out that not only was my TG barely worth it, but that the cluneal nerves were damaged as well. I still think Dr Hibner is a fine man and surgeon, and I am so grateful for people he has cured. Unfortunately, I am not one of them. I think he is a great choice if you are entrapped in the ligaments and you are certain of your pathology. I also believe that he will continue to evolve his surgery, making it better and better. In the meantime though, I need relief.

Any advice or knowledge about the cluneal nerves and treatment would be appreciated.

Warm regards,

AM

There is a group in France that developed a surgery for the cluneal nerve, describes anatomical variations of the inferior cluneal nerve and symptomology. See abstract below

Surg Radiol Anat. 2008 May;30(3):177-83. Epub 2008 Feb 28.

Perineal pain and inferior cluneal nerves: anatomy and surgery.

Darnis B, Robert R, Labat JJ, Riant T, Gaudin C, Hamel A, Hamel O.

Source

Laboratoire d'anatomie, Faculté de Médecine, Nantes, France. Labo-Anatomie@univ-nantes.fr


Abstract

Neuropathic perineal pains are generally linked to suffering of the pudendal nerve. But some patients present pains described as a type of burning sensation located more laterally on the anal margin and on areas including the scrotum or the labiae majorae, the caudal and medial parts of the buttock and the upper part of the thigh. These pains extend beyond the territory of the pudendal nerve. It is interesting to note that the inferior cluneal nerves are responsible for the cutaneous sensitivity in the inferior part of the buttock. We wanted to check if these nerves, or some of their branches, could be responsible for such pains. An anatomic study, containing six dissections on corpse, has been conducted. The inferior cluneal nerves, emerging from the posterior femoral cutaneous nerve have some branches joining the perineum, especially by a perineal ramus. However, two conflict areas have been identified on the path of these nerves and on the perineal ramus: one at the level of the sacrotuberal ligament, and the other being the passage under the ischium. Two surgical approaches have been established from these observations with the aim of suppressing the conflicts.

nyt wrote:There is a group in France that developed a surgery for the cluneal nerve, describes anatomical variations of the inferior cluneal nerve and symptomology. See abstract below

Surg Radiol Anat. 2008 May;30(3):177-83. Epub 2008 Feb 28.

Perineal pain and inferior cluneal nerves: anatomy and surgery.

Darnis B, Robert R, Labat JJ, Riant T, Gaudin C, Hamel A, Hamel O.

Source

Laboratoire d'anatomie, Faculté de Médecine, Nantes, France. Labo-Anatomie@univ-nantes.fr


Abstract

Neuropathic perineal pains are generally linked to suffering of the pudendal nerve. But some patients present pains described as a type of burning sensation located more laterally on the anal margin and on areas including the scrotum or the labiae majorae, the caudal and medial parts of the buttock and the upper part of the thigh. These pains extend beyond the territory of the pudendal nerve. It is interesting to note that the inferior cluneal nerves are responsible for the cutaneous sensitivity in the inferior part of the buttock. We wanted to check if these nerves, or some of their branches, could be responsible for such pains. An anatomic study, containing six dissections on corpse, has been conducted. The inferior cluneal nerves, emerging from the posterior femoral cutaneous nerve have some branches joining the perineum, especially by a perineal ramus. However, two conflict areas have been identified on the path of these nerves and on the perineal ramus: one at the level of the sacrotuberal ligament, and the other being the passage under the ischium. Two surgical approaches have been established from these observations with the aim of suppressing the conflicts.

Very interesting.

Here's a picuture of the cluneal nerves. http://tinyurl.com/3vg8mkb

Does Hibner's TG incison come down this far below the ischial tuberosities? It looks like the pain you describe might be coming from the posterior femoral cutaneous nerve, but I don't think it would be the cluneal unless you have a lot of ischial tuberosity area pain. I do not believe there is motor function with this nerve.

AM,

I'm sorry to hear about your continuing pain. I'm sending lots of hugs and well wishes.

Faith,

Don't you have ischial tuberosity pain? So are you thinking that your cluneal nerves are involved?

I also have similar, throbbing, pain there but I always thought it was just radiating from the severe, stabbing and burning in the perineum.

Lernica,

I do have ischial tuberosity pain mostly medial in what I believe is the region of alcock's. Sometimes I get some pain under the ischial tuberosity and burning in the uper hamstrings (this is new since my botox 2 months ago) but I really think this is from muscle compensation from the botox or CRPS/central sensitization/nerve crosstalk (whatever you want to call it ). I like this picture http://tinyurl.com/4yf2mbo (even though it is male anatomy) because it shows how close the PN runs to the ischial tuberosity. I know some doctors say PN can't cause ischial tuberosity pain, but I don't understand how they can say that (especially for people that are thin, like me) when the nerve runs right beside it. I mean that's where alcock's canal is located, right in the obturator fascia along the ishcial tuberosity?!

Hello AM,
I am also suspected to be entrapped on my inferior cluneal nerves . You should check out my posts about my visit with Dr Beco and previously with Dr de Bisschop.
Guessing if the inferior cluneal nerves are also involved together with PNE is very hard , though to several reasons:
The inferior cluneal nerves are branches of the posterior femoral cutaneus nerve which like the pudendal nerve starts from the sacral roots generated from S1 S2 S3. If there is a compression under the periformis muscle where both pudendal and posterior femoral cutaneus nerve pass , pain can be felt in the area innervated by those nerves and that includes also the ischeal toberosity and the back of the thigh. In the TG surgery is possible to decompress this nerve if conflict is in this level.
Another conflict may be found lower under the iscium, where there is a passage of nerves to the perineal ramus. Professor Robert describes that in many cases the most medial branch of the inferior cluneal nerves could stem directly from the ventral branch of S3 spinal nerve and go through the sacrotuberal ligaments, so in such anatomic variation, a real ligament pinch or pressure could be the reason to the pain.
When visiting Dr beco he told me that he had some cases where he had found a branch from the pudendal nerve stemming out before the ligaments and going down to the thigh. Such an anatomy variation of the pudendal nerve was not ever described in any article or illustration of the nerve I have seen, but if exist it should innervate the same area of the posterior femoral cutaneus/ inferior cluneal nerve.
The surgery Professor Robert has sugessted to me, was a bileteral decomrssion srgury for both the pudendal and the inferior cluneal nerves. This is not the same surgery as described by Dr Dellon in his book. Prevusly he used this aproach of two separate dissections (two different sergurys to decompress the two nerves) , but I believe it is now 1.5 year that he decompress the two nerves in the same one TG surgery. he explained to me that the opening is bigger (7-8 CM, compering to his regular TG opening of 4 CM) he told me results are 70- 75% for population of my age.
I have forgot to ask him if ST ligament is also damaged more than tn the regular surgery where its only partly damaged.
I think in general he prefer to take all actions at once unlike other TG surgeons who prefer to do only one side at a time.
AM , I think you should ask Dr Hibner , What was the condition of the posterior femoral and inferior cluneal nerves as he saw them on the infra piriformis area, and if the pudendal nerve was also compressed at this same level.
It is also possible that those nerves are only irotated from the TG surgery and not compressed and you should let it some time to heel. I had many pain and electric shocks to my right foot and it has almost completely gone with time only by resting (it took almost 2 years)
Stay strong! You will get better.

Hi Zacho,

I did speak to Dr. Hibner and he said that he hasn't operated on inferior cluneal nerves or the posterior femoral Cutaneous nerves.He said that Professor Roger Robert has worked on them in the past,but he has no updates from him as of yet.

Maybe,Dr. Hibner needs to get in touch with Professor Roger Robert to be trained on them.I wish doctors in the US could help each other,but their egos are in the way and the poor patients are suffering.

Regards,
Ali

Zachco wrote:Hello AM,
I am also suspected to be entrapped on my inferior cluneal nerves . You should check out my posts about my visit with Dr Beco and previously with Dr de Bisschop.

Interesting post Zacho. Where are your posts exactly about your visit with Dr. Beco? What exactly are your symptoms of inferior cluneal nerve entrapment? Have you already had PN decompression or are you hoping to have all the nerves decompressed at once.

I agree it seems like doctors should be able to address both nerves at once (at least if they are entrapped by piriformis or ST ligament) maybe not if under the ischial tuberosity (the TG incision wouldn't be able to go that far I don't think).