13. Maignes Syndrome

Question 1

What nerve irritation is thoracolumbar (Maigne’s) Syndrome associated with?

Answer 1

Superior cluneal (gluteal) nerve

Question 2

Where does Maigne’s syndrome refer to?

Answer 2

Iliac crest/buttock, sciatic notch, greater trochanter area, groin

Question 3

What is the location of pain for Maigne’s syndrome?

Answer 3

Unilateral - bilateral LBP with non-dermatomal pain referral at iliac crest about 7cm from midline. Pressure here can cause a sharp excruciating pain similar to patient’s complaint.

Question 4

What changes in the skin might be noted in Maigne’s syndrome?

Answer 4

Trophies changes of the skin (cellulalgia) consisting of thickening or nodularity of the skin and hair loss or swollen puffy appearance

Question 5

What test is usually positive in Maigne’s?

Answer 5

Pinch-roll test

Question 6

Describe the pinch-roll test? and what is a finding?

Answer 6

Grasp a fold of skin over the iliac crest between the thumbs and forefingers, lift it away from the trunk, and roll the subcutaneous surfaces against one another in a pinch and roll fashion.

Hyperalgesia is a finding with the pinch-roll test.

Question 7

What is the etiology of Maigne’s syndrome?

Answer 7

• Intervertebral joint dysfunction at TLJ

- may progress to include facet syndrome or disc derangement

Question 8

What is a medical Tx for Maigne’s syndrome?

Answer 8

Nerve block to TLJ facet

Question 9

What is a diagnostic criteria for superior cluneal nerve entrapment (SCN)?

Answer 9

Unilateral or bilateral LBP around iliac crest and buttock

Tender point over posterior iliac crest 7 cm from midline

Numbness and radiating pain in territory (Tinel’s sign) when tender point compressed

Question 10

What exercise mobilizes cluneal nerve?

Answer 10

A chair pigeon pose with flexion plus rotation to symptomatic side (e.g. if left cluneal nerve entrapped, then left foot crosses/makes figure 4 over the right knee and patient bends over the right knee)

Question 11

Where is pain felt with a TLJ compression fracture?

Answer 11

Iliac crest — referral is the same but don’t Dx this as Maigne’s syndrome

Question 12

What is psoas syndrome?

Answer 12

TLJ dysfunction + tight usually painless psoas

Question 13

What is the pain generator in psoas syndrome?

Answer 13

TLJ dysfunction

Not to be confused with psoas myofasical pain syndrome where psoas is pain generator

Question 14

What is the in office and home Tx for psoas syndrome?

Answer 14

In office: adjust TLJ, stretch/relax psoas

Home: psoas stretch, TLJ self mobilizations

Also, assess for lower cross syndrome