It has been reported that 15% to 25% of pain in patients with pain in the posterior iliac crest area results from injury of the posterior ramus of the T12 thoracic nerve due to fracture or degenerative changes and this pain is often confused with back pain originating in the sacral region.
Maigne (1996) described thoracolumbar junction syndrome as a condition with typical pain on the iliac crest and tenderness on palpation of the thoracolumbar junction, and it is accompanied by lesions in the spine in about 60% of patients. In most cases, symptoms generally appear when there are lesions in T12-L1, which is the thoracolumbar junction
Symptoms of thoracolumbar joint syndrome include:
- Back pain.
- Pseudo-visceral pain.
- Posterior iliac crest pain.
- Irritable bowel symptoms.
Clinical signs correlate with spinal nerve root innervations. The posterior ramus supplies subcutaneous tissue of the upper buttocks and lower waste, the anterior ramus supplies the lower abdomen and groin, and the lateral cutaneous branch supplies the trochanter. Therefore, patients may complain of pseudo-visceral pain in the lower abdomen, pseudo-sciatica, pubic tenderness, and irritable bowel symptoms besides low back pain, which can lead to misdiagnosis
Diagnostic tests for thoracolumbar joint syndrome include:
- Pain on applying pressure to the facet joints.
- Pain on applying pressure to the sides of the spinous processes.
When examining the thoracolumbar junction, one must always look carefully for tender points upon palpation of spinous processes and facet joints. Looking for the presence of a posterior iliac crestal point tenderness and performing a positive pinch-roll test can also be beneficial.
Thoracolumbar Junction Syndrome Causing Pain around Posterior Iliac Crest: A Case Report. (2013). Kim SR, Lee MJ, Lee SJ, Suh YS, Kim DH, Hong JH.
Diagnosis and treatment of pain of vertebral origin: a manual medicine approach. Baltimore: Williams & Wilkins (1996). Maigne R.