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4 Anatomy of the buttocks and pelvis (Image by Springer)  

4 Anatomy of the buttocks and pelvis (Image by Springer)  

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The posterior femoral cutaneous nerve is an under-recognized cause of posterior thigh and buttocks pain. There are many overlapping pain patterns in this region, and the etiology of posterior femoral cutaneous nerve entrapment must be actively sought out in order to be diagnosed.

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... Presentation (Table 56.1) A patient with PFCN entrapment has posterior buttocks and thigh pain, from the gluteal fold to the back of the knee, and includes a variable amount of the posterior calf ( Fig. ...
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... can be sensory abnormalities in the lower buttock and posterior thigh ( Fig. 56.2). Through its perineal branch, the PFSN also innervates the perineal region ( Fig. 56.3). PFCN injury has been reported after intramuscular gluteal injec- tions [1]. This nerve is also traumatized by prolonged bicycle rides, pelvic tumors, venous malformation, and pressure on the nerve at the inferior margin of the gluteus maximus, due ...
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... can be sensory abnormalities in the lower buttock and posterior thigh ( Fig. 56.2). Through its perineal branch, the PFSN also innervates the perineal region ( Fig. 56.3). PFCN injury has been reported after intramuscular gluteal injec- tions [1]. This nerve is also traumatized by prolonged bicycle rides, pelvic tumors, venous malformation, and pressure on the nerve at the inferior margin of the gluteus maximus, due to sitting on hard surfaces (Table 56.1) [2][3][4]. It can also present as perineal ...
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... is very variable, and it may involve branches as high as L4 or as low as S4 [10]. The PFCN exits the pelvis beneath the gluteus maximus (Figs. 56.4 and 56.5), accompanied by the inferior gluteal artery, and passes through the sciatic fora- men, below the piriformis muscle, and down the buttock and thigh on the medial aspect of the sciatic nerve ( Fig. 56.6). It is sometimes referred to as the "lesser sciatic ...
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... to the gluteus maximus muscle, the PFCN gives off the inferior cluneal nerve (Chap. 63) (Fig. 56.7) and the peri- neal branch of the PFCN (PBPFCN). The inferior cluneal nerve provides the cutaneous innervation of the inferior but- tocks, while the perineal branch innervates the lateral perineum, proximal medial thigh, posterolateral scrotum/ labium majora, and part of the penis/clitoris (Fig. 56.3) [11]. The perineal branch courses ...
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... off the inferior cluneal nerve (Chap. 63) (Fig. 56.7) and the peri- neal branch of the PFCN (PBPFCN). The inferior cluneal nerve provides the cutaneous innervation of the inferior but- tocks, while the perineal branch innervates the lateral perineum, proximal medial thigh, posterolateral scrotum/ labium majora, and part of the penis/clitoris (Fig. 56.3) [11]. The perineal branch courses medially, staying about 4 cm inferior to the attachment of the sacrotuberous ligament onto the ischial tuberosity, parallel to the ischial ramus [11]. However, Bergman et al. [12] described the perineal branch piercing the sacrotuberous ligament, which would place it close to the pudendal nerve in ...
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... the PFCN lies deep in the thigh, it is relatively hard to examine it by palpation. At the level of the ischium, how- ever, the nerve can be palpated between the heads of the hamstring muscles (Fig. 56.8). Only two case reports men- tioned numbness in the region of the PFCN [4,7], and two patients had decreased sensation in the posterior thigh and lower buttock. This suggests that in a significant number of posterior femoral cutaneous neuropathies, the inferior clu- neal nerve is also ...
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... one study describes a landmark-guided injection of the PFCN. Hughes et al. [17] described blocking the nerve where its branches come from below the medial border of the glu- teus maximus. The site is in the gluteal fold, one quarter of the distance between the ischial tuberosity and the greater trochanter ( Fig. 56.9 Site A). The authors suggest trying to feel two distinct losses of resistance as superficial and deep fascia are penetrated with a short-beveled needle. The peri- neal branch of the PFCN is usually injected at the ischial tuberosity ( Fig. 56.9 Site B) ...
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... gluteal fold, one quarter of the distance between the ischial tuberosity and the greater trochanter ( Fig. 56.9 Site A). The authors suggest trying to feel two distinct losses of resistance as superficial and deep fascia are penetrated with a short-beveled needle. The peri- neal branch of the PFCN is usually injected at the ischial tuberosity ( Fig. 56.9 Site B) ...
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... the approach to the PFCN depends on the site of entrapment, Fritz et al. [18] recommended injecting the nerve 2 cm below the ischial tuberosity ( Fig. 56.9 Site C), proximal to the PBPFCN for patients with pain and paresthe- sia in the perineal area. In patients with inferior lateral but- tock area pain and numbness, target the cluneal nerves under the gluteus maximus muscle. For those with pain in the pos- terior thigh, the distal portion of the PFCN between the glu- teus maximus and the ...
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... of the PFCN between the glu- teus maximus and the long head of the biceps femoris should be considered for injection [18]. Based on cadaver studies, Tubbs et al. suggested that the PBPFCN is on average located 4 cm inferior to the ischial tuberosity; they recommend injecting this area with anesthetic if this nerve is the source of the pain (Fig. 56.9 Site D) ...
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... are no good fluoroscopic landmarks, other than the ischium (Fig. 56.10). Although there are no reported fluoro- scopic techniques, Trescot (personal communication) describes the injection of the PFCN at the ischium using a peripheral nerve stimulator (PNS). ...

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