1990 Grieve – sacroiliac sulcus lipoma

This is a very short article published in 1990 by G. P. Grieve about sacroiliac sulcus lipoma or back mice.

Grieve provides a long list of articles related to episacroiliac lipoma (sacroiliac sulcus lipoma) or back mice. But he just explains about it briefly.

Some Greive’s referred articles:

He insists about the fact that the physiotherapists are sometimes so absorbed in their techniques of “handling” that they may be missing this pathology, which clearly presents as a masquerade if it is not known.

He warns that however careful spinal mobilization techniques of various types can be, there are occasions where the therapist is shooting at the wrong target, then results can be disappointing and puzzling, and blame may be shifted to the patient. An awareness of how misleading these lipomas can be, and how quickly a single injection can resolve the problem, might reduce the frequency of these misleading cases.

Grieve DOES NOT discuss about etiological factors or about why a single injection of anesthetic should solve the problem of the painful lipomas.

Personal notes on the article:

Episacroiliac lipoma

(Sacroiliac sulcus lipoma)

Published in Physiotherapy in June 1990, vol 76 no 6

By Gregory P. Grieve FCSP DipTP

In the introduction, Grieve mentions “sacroiliac joint problems” associated with unilateral (occasionally bilateral) benign aggregations of fat in the soft tissues overlying the sacroiliac sulcus (sacroiliac sulcus lipoma or back mice) as a masquerade for certain low back pains.

Several authors have drawn attention to this common clinical presentation: Ries (1937), Copeman and Ackerman (1944), Herz (1945), Hucherson and Gandy (1948), Hittner (1949), Bonner and Kadson (1954), Ficarra (1954), Wollgast and Afeman (1961), Singewald (1966), Pace and Henning (1972), Faille (1978).

Sometimes a single injection clarifies the problem and often deals with it for good; in certain other cases, excision of the nodule is advised under local anesthesia. Alternatively, a radio frequency heat lesion may be sufficient.

Copeman and Ackerman noticed that the cutaneous branches of the dorsal rami (also known as CLUNEAL NERVES) cross the thoracolumbar fascia through foramina, sometimes also these foramina present herniation of underlying fat.

sacroiliac sulcus lipoma

Case history 1

A 53-year-old man with ankylosing spondylitis for some ten years. Presented with a 2 year history of LEFT LOW BACK and bilateral posterior thigh pain, ‘stinging’ of the buttocks which “waxed and waned” with the lumbosacral pain, and also tender ischial tuberosities. No neurological signs and mildly restricted straight leg rising was 80º/80º. Two years before he had fallen, since then he presented lumbar pain.

Sitting provoked the symptoms. They noticed a tender left sacroiliac sulcus lipoma. After local anesthetic injections, he improved.

Case history 2

A 50-year-old active woman. She reported grumbling low back pain for ten years. No neurological symptoms. Leg rising test normal. She presented a very tender left sacroiliac sulcus lipoma. The doctor injected local anesthetic. Her comment was ‘the injection worked wonders’, and she remained pain free.

Published in September 2018 by Marta Cañis Parera   ORCID iD icon