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L i s te n to T h e A B M P Po d c a s t a t a b m m /p o d c a s t s o r w h e reve r yo u a cce s s yo u r favo r i te p o d c a s t s 83 In about 39 percent of the population, the superior cluneal nerves pass through a fibro-osseous tunnel in the upper iliac crest. 1 This tunnel is created by the thoracolumbar fascia and a bony groove in the iliac crest. Compression and irritation of these nerves in the region of this tunnel are often mistaken for sciatica or other causes of low-back pain. 2 Middle Cluneal Nerves The next group is the middle cluneal nerves, which originate from the dorsal rami of the upper sacral nerves, including S1, S2, and S3. These nerves course through the sacral foramina and then pass adjacent to the long posterior sacroiliac ligament (Image 2). Anatomical studies have shown some variation between individuals regarding whether the middle cluneal nerves pass above or below the long sacroiliac ligament. When compression pathology affects the middle cluneal nerves, they are most likely passing under that ligament. The middle cluneal nerves innervate the skin overlying the middle portion of the gluteus maximus. Inferior Cluneal Nerves The final group are the inferior cluneal nerves, which are sensory fibers that branch off the posterior femoral cutaneous nerve near the ischial tuberosity. They course from inferior to superior and wrap around the lower margin of the gluteus maximus (Image 3). The inferior cluneal nerves provide sensory innervation to the skin overlying the lower portion of the gluteus maximus muscle, as well as the region lateral to the anus and some aspects of the pelvic floor. 2 Branches of the inferior cluneal nerves. Image from 3D4Medical's Complete Anatomy application. 3 Branches of middle cluneal nerves Branches of the middle cluneal nerves. Image from 3D4Medical's Complete Anatomy application. Sciatic nerve Posterior femoral cutaneous nerve Inferior cluneal nerves

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