Does the Middle Cluneal Nerve Cause Coccyx Pain, Tailbone Pain?

I recently watched a video about the middle cluneal nerve as a possible cause of coccyx pain, tailbone pain, coccydynia.

I think that this is possible, but probably very uncommon.

  1. I sometimes treat cluneal nerve pain. It is relatively common to have pain from the SUPERIOR cluneal nerve after bone is harvested from the iliac crest for a bone graft to use in a spinal fusion surgery. But the SUPERIOR cluneal nerve does not involve the coccyx.
  2. The standard medical understanding is that cluneal nerves are mainly known as a source of buttock pain, rather than midline pain at the coccyx.
  3. However, it is true that the MIDDLE cluneal nerve is more midline than the distribution of the SUPERIOR cluneal nerve.
  4. See image, where MCN is the middle cluneal nerve:
  5. Middle Cluneal Nerve is mainly NOT in the area of Tailbone Pain, Coccyx Pain, Coccydynia

    Middle Cluneal Nerve is mainly NOT in the area of Tailbone Pain, Coccyx Pain, Coccydynia. Source:

    Image source: https://musculoskeletalkey.com/complications-of-iliac-crest-bone-graft-harvesting/ (From: Kim, K., Isu, T., Matsumoto, J. et al. Low back pain due to middle cluneal nerve entrapment neuropathy. Eur Spine J 27, 309–313 (2018). https://doi.org/10.1007/s00586-017-5208-2 )

  6. But… even though the MIDDLE cluneal nerve is more midline than the distribution of the SUPERIOR cluneal nerve, most of MIDDLE cluneal nerve distribution is at the BUTTOCK, rather than midline at the coccyx.
  7. The video about the middle cluneal nerve (MCN) shows only one image of nerves, and in that image it does NOT show MCN innervation of the coccyx (actually, none of the images in the video label the MCN). See screenshot from that video:
  8. Screenshot from Video about the Middle Cluneal Nerve and Coccyx Pain

    Screenshot from Video about the Middle Cluneal Nerve and Coccyx Pain

  9. In the video, the surgeon mentions that to test for whether pain is coming from the MCN they do a local anesthetic nerve block of the MCN … AND ALSO of the coccygeal nerves. To me, it seems likely that any relief of coccyx pain from such a COMBINED block of BOTH groups of nerves would be far more likely to be relief from the block of the COCCYGEAL nerves (which definitely do carry pain sensation from the coccyx) rather than being from the cluneal nerve block (which is proportionally less likely to carry sensation from the coccyx). (Admittedly, it was short video, so perhaps he meant that they do two separate blocks on separate dates for those separate nerves?)
  10. Some fibers from the middle cluneal nerve may innervate the SKIN that is OVER the coccyx region. But I think that for most people with coccyx pain they have a problem with the coccyx itself, rather than the SKIN that is over the coccyx.
  11. Still, it is POSSIBLE that the middle cluneal nerve MIGHT be involved in the uncommon instances where someone presents with tailbone region pain that is: A) unusual in that is is NOT tender when the doctor presses on the bones of the coccyx, B) is associated with altered sensation of the SKIN over the coccyx region, C) the symptoms are worse mainly to one SIDE of the coccyx, rather than at the midline, and D) the patient gets relief with a local anesthetic nerve block of the MCN but does NOT get relief with a similar local anesthetic nerve block of the coccygeal nerves.

COME FOR RELIEF: For more information on coccyx pain, or to be evaluated in-person by Dr. Foye’s Coccyx Pain Center in the United States, go to: www.TailboneDoctor.com

– Patrick Foye, M.D., Director of the Tailbone Pain Center, New Jersey, United States.

Patrick Foye, M.D.
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