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Maigne Syndrome Cheat Sheet (DRAFT) by

Presentation, management etc

This is a draft cheat sheet. It is a work in progress and is not finished yet.

Maignes Syndrome

- Irritation of thorac­olumbar posterior ramus - T9-L2
- Due to facet joint dysfun­ction & degene­ration
- Superior cluneal nerve divided into medial, interm­edi­ate­/mi­ddle, and lateral)
- Occurs at ostefi­brous orifice - nerves penetrate thorac­olumbar fascia before innerv­ating cutaneous regions of iliac crest and buttock
- Increases neurod­ynamic tension on dorsal nerve root - ischemia and hypere­xci­tab­ility
- Can co-exist with double crush
- Common in 55-68 yo population - slightly higher prevalence in females


- Pain, numbne­ss/­pae­stehsia to lumbos­acral, iliac crest or groin
- Chronic, constant , unilateral (can be both sides)
- Can cause pseudo­vis­ceral pain (testi­cles)
- Aggravated by activities that stress the TL junction (slouc­hing, prolonged walking, repeat­ed/­sus­tained extension) + transi­tional movements (arising from a seated position, squatting, rolling in bed)
- TTP of TL junction and site of entrapment
posterior iliac crest 3-4cm (medial branch)
7-8cm (middle branch) from the midline
- Side to side shear + PA shear painful
- Contra­lateral LF relieves
- Hypere­xtesion movements (slump)
- SKin rollin­g/p­inching over iliac crest can cause hypera­lgesia over flank and iliac crest
- Tapping over entrapped nerve may produce shock like symptoms
- Assess for dysfun­ctional breathing - contri­butes to TL stress
- Assess for gait dysfun­ction (dimin­ish­ed/­asy­mme­trical arm swing (loss of GH motion) , loss of hip extension, short stride length)
- MP can reveal hyper/­hyp­omobile of spine


Not usually needed unless red flags are present


- Mechanical pathology of SI/LS (joint dysfun­ction, facet syndrome, disc lesion, spondy­lol­ysis, spondy­lol­ist­hesis, degene­ration, stenosis)
- Myofascial pain
- F#
- Infection
- Neoplasm
- Viscer­o-s­omatic referral - GU system (UTC, kidney stone)
As the TL junction pain is a red flag, caution should be advised


- Electrical stimul­ation
- Ice
- If hyperm­obile - build stability - if hypomobile , open interv­ert­ebral foramen
- Myofascial release of TL aponeu­rosis + distri­bution of cluneal nerve
- Nerve mobili­sation of dorsal rami and cluneal nerve
- Early rehab - flexab­ility exercises of erectors and iliopsoas
- Standing hip flexor stretch
- Half kneeling psoas stretch
- Lats stretches
- Pelvic tilt exercises
- Prone plank
- Core stability
- Dysfun­ctional breathing
- SMT/EMT of Lx, Tx, costov­ert­ebral regions
- Mulligan's NAGs/SNAGs
- Anesthetic nerve blocks and steroid injections if no improv­ement
- If no improv­ement with inject­ions, surgery may be considered