J Rheumatol
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Case Reports
A potentially underrecognized and treatable cause of chronic back pain: entrapment neuropathy of the cluneal nerves.
We describe a case of longstanding low back pain related to entrapment neuropathy of the L1-L2 dorsal ramus over the iliac crest. As 3 local anesthetic pain blocks (at the trigger point, 7 cm left of the L5 spine process and just above the iliac crest) were successful for 3 weeks each, a surgical procedure was performed. This corrected patient stricture of a voluminous dorsal ramus within a rigid osteofibrous orifice between the upper rim of the iliac crest and the thoracolumbar fascia. Pain decreased dramatically the same day and disappeared completely within less than a week.
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To define differences in digital vascular responses to cooling and to determine their usefulness for the differential diagnosis of 4 groups of subjects: patients with primary Raynaud's phenomenon (RP) (n = 96), patients with RP associated with scleroderma (systemic sclerosis, SSc) spectrum disorders (SSc spectrum RP) (n = 108), subjects complaining of cold sensitivity of the fingers (n = 88), and RP negative controls (n = 120). ⋯ The digital pressure response to cooling is a useful test for RP and cold sensitive subjects. It has high sensitivity and specificity to differentiate between SSc spectrum RP and primary RP and between primary RP and cold sensitive subjects. Our preliminary data on vasodilator use suggest that the digital pressure response to cooling may also be useful in RP treatment studies.