‘Back mice’, also known as ‘episacroiliac lipomas’ or ‘lumbar fat herniation’, can contribute to superior cluneal neuropathyby compressing or irritating the tiny nerves. Both entities are quiet UNDER-DIAGNOSED by the medical community. These nerves are the peripheral nerves of the lumbar region and cross the deep fascia at specific locations where they may be more vulnerable to compression. The presence of ‘back mice’ can lead to symptoms of superior cluneal neuropathy, including low back pain radiating to the gluteal region. Identifying and addressing these nodules may be necessary to relieve the compression on the nerves and alleviate symptoms.
This chapter 2 of the website exploresperipheral nerve entrapments, with a focus on superior cluneal nerve entrapment and its relationship to low back pain. It also discusses the potential connection between ‘back mice’ or subfascial fat herniation and superior cluneal nerve neuropathy. Additionally, it emphasizes the importance of studying other peripheral nerve entrapments beyond the cluneal nerves to enhance our understanding of these conditions.
This webpage structure:
Part 1: Introduction by Andrea Trescot emphasizing the significance of being aware of all peripheral nerve entrapments, not just superior cluneal nerve entrapment, which are often overlooked. (Based on book preface)
Part 2: Tim Tollestrup’s perspective on the relationship between superior cluneal nerve entrapment and back mice, as shared in a personal email.
Part 3: Video presentation aimed at explaining why superior cluneal neuropathy can manifest as low back pain that radiates to the leg.
Part 4: Exploration of the importance of studying other overlooked peripheral nerve entrapments and their significance.
Part 1 – Introduction by Andrea Trescot emphasizing the significance of being aware of all peripheral nerve entrapments, not just superior cluneal nerve entrapment which are often overlooked. (Based on book preface)
“Peripheral nerve entrapments are a commonly overlooked cause of painful conditions, resulting in pain literally from the head to the toe. Even the astute clinician may not be aware of these syndromes, and entrapment of these often small nerves can lead to debilitating pain, mimicking “migraines,” cardiac disease, intra-abdominal pathology, “endometriosis,” complex regional pain syndrome (CRPS), and “plantar fasciitis.” Knowledge of these entrapments can prevent expensive ineffective testing and treatment and can ideally avoid unnecessary pain and suffering. This book is a culmination of many years of my personal clinical observations as well as collaboration between many providers. Over the years, when I would lecture on peripheral nerve entrapments, I would be met with blank stares, or worse, derision. However, this lack of knowledge is slowly changing. Fifteen years ago, when I would ask the audience to raise their hand if they had ever even heard of the cluneal nerve, perhaps two or three hands would go up. Now, with the same question, sometimes a majority of the room will raise their hands.” By Andrea Trescot 2016.
Nerve entrapments can occur throughout the body and cause headaches, chest pain, abdominal pain, pelvic pain, low back pain, and upper and lower extremity pain.
Part 2: Tim Tollestrup’s perspective on the relationship between superior cluneal nerve entrapment and back mice, as shared in a personal email.
Comments about Tim Tollestrup related to superior cluneal nerve entrapment:
“The reason why science is close to cloning a human being but still struggling with effectively treating low back pain is because the medical community has largely overlooked the peripheral nervous system.
The fatty nodules, commonly known as “back mice,” are not the true source of pain in these cases. They can be seen as irritants rather than the direct cause of the pain. In some instances, these nodules can lead to the entrapment of small nerve branches within the surrounding fascial septae. The technique developed by Copeman for treating symptomatic back mice was successful because it effectively released the pressure on these entrapped nerves.
However, the presence of these nodules does not always indicate pathology. Dr. Hench noted that he often couldn’t find any fatty nodules in cases of unexplained low back pain with negative radiographs. In other cases, he found and palpated them, but they were not always tender. Thus, the nodules themselves are not necessarily pathological.
To solve the mystery of “mysterious” back pain when musculoskeletal causes have been ruled out, it is crucial to focus on the peripheral nerves. While ‘back mice’ can compress and irritate terminal nerve branches, leading to pain, there are cases where patients don’t improve after nodule removal or experience similar low back pain without any nodules. Therefore, the key lies in considering all these peripheral nerves mentioned earlier.
The solution to the “unsolvable” low back pain and the large number of patients diagnosed with “failed spine surgery syndrome” lies in understanding and addressing peripheral nerve pathology. Currently, low back pain and sciatica pain are often seen as mysterious, resulting in many patients undergoing spine surgery without proper consideration of peripheral nerve issues. By focusing on peripheral nerve anatomy and its role in chronic pain, we can potentially solve over 95% of back surgeries.
Unfortunately, peripheral nerves remain largely invisible despite advancements in medical imaging. A lack of understanding of peripheral nerve anatomy hinders our ability to diagnose and treat chronic pain effectively.
Peripheral nerve anatomy is crucial in unraveling the mysteries of chronic and acute pain in our patients, much like the discovery of the Rosetta Stone enabled us to read Egyptian hieroglyphs. Unless this knowledge becomes widespread in the medical community, chronic pain will remain a mystery”. By Tim Tollestrup 2021
In this video blog, Dr. Tollestrup explains how low back pain is not always caused by a spine problem. Patients with a clear MRI and pain on the side of their spine may suffer from Superior Cluneal Nerve entrapment. Luckily Dr. Tollestrup has developed a surgical solution.
Part 3: Video presentation aimed at explaining why superior cluneal neuropathy can manifest as low back pain that radiates to the leg.
→Link to the YouTube video where we attempt to explain, in an easy and humorous manner, why superior cluneal nerve entrapment causes pain that can radiate to the leg, as well as the specific patterns it follows.
Part 4: Exploration of the importance of studying other overlooked peripheral nerve entrapments and their significance.
We strongly believe in the importance of exploring peripheral nerve entrapments beyond the scope of cluneal nerves to enhance our understanding of these conditions.
