Lower back pain above buttocks
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Understanding Lower Back Pain Above the Buttocks
Lower back pain above the buttocks is a common complaint that can stem from various underlying conditions. This article synthesizes research findings to provide a comprehensive overview of potential causes, diagnostic approaches, and treatment options.
Common Causes of Lower Back Pain Above the Buttocks
Sacroiliac Joint Dysfunction
Sacroiliac (SI) joint dysfunction is a significant cause of lower back pain localized above the buttocks. This condition arises from biomechanical disorders of the SI joint, which can lead to pain in the lower back and buttocks region4 6 8. The SI joint transmits forces from the spine to the lower extremities, and its dysfunction can result from trauma, pregnancy, or certain athletic activities8.
Lumbar Spinal Disorders
Lumbar spinal disorders, including herniated discs, spinal stenosis, and nerve entrapment, are also common sources of lower back pain that can radiate to the buttocks. These conditions can cause both nociceptive and neuropathic pain, with neuropathic pain being more prevalent when buttock pain is present2 3 10.
Osteochondromas
In rare cases, lower back pain extending into the buttocks can be caused by osteochondromas, which are benign bone tumors. These can be identified through physical examination and radiographic imaging1.
Sacral Stress Fractures
Sacral stress fractures, though uncommon, can occur postpartum or due to other factors such as osteoporosis. These fractures can cause significant pain in the lower back and buttocks and should be considered in differential diagnoses7 9.
Diagnostic Approaches
Clinical Examination and Imaging
A thorough clinical history and physical examination are crucial for diagnosing the cause of lower back pain. Specific tests, such as the buttock applied strain (BUAS) test, can help identify radicular pain originating from lumbar nerves5. Imaging techniques like radiographs, MRI, CT scans, and bone scans are essential for identifying structural abnormalities such as osteochondromas or sacral fractures1 7 9.
Diagnostic Injections
For conditions like SI joint dysfunction, diagnostic injections can be particularly useful. Fluoroscopically guided injections into the SI joint can help confirm the source of pain and provide temporary relief6 8.
Treatment Options
Conservative Treatments
Conservative treatment options include physical therapy, anti-inflammatory medications, and the use of SI joint belts. These methods are generally effective for managing pain and improving function6 8.
Invasive Procedures
In cases where conservative treatments fail, more invasive procedures such as radiofrequency denervation or surgical arthrodesis may be considered. However, these should be viewed as last-resort options due to their higher risk and complexity6 8.
Addressing Underlying Conditions
For specific conditions like osteomalacia, addressing the underlying cause, such as correcting hypophosphatemia, can lead to significant improvement in symptoms9.
Conclusion
Lower back pain above the buttocks can result from various conditions, including sacroiliac joint dysfunction, lumbar spinal disorders, osteochondromas, and sacral stress fractures. Accurate diagnosis through clinical examination and imaging, combined with appropriate treatment, can effectively manage and alleviate this type of pain. Understanding the underlying cause is crucial for selecting the most effective treatment strategy.
Sources and full results
Most relevant research papers on this topic
Buttock Pain and Sciatica Caused by a Femoral Osteochondroma.
Multiple osteochondromas in the femur can cause buttock pain and sciatica, and physical therapy can help manage these symptoms.
Case ReportA more precise diagnosis for low-back pain.
This paper presents five common syndromes for low-back and leg pain, highlighting the importance of early diagnosis and utilizing diagnostic tools like CT, MRI, and injections.
Highly CitedA More Precise Diagnosis for Low-Back Pain
This paper presents five common syndromes for low-back and leg pain, highlighting the importance of early diagnosis and utilizing diagnostic tools like injections, CT scans, and MRIs.
Highly CitedLow back pain with sacroiliac joint dysfunction: A systematic review
Low back pain with sacroiliac joint dysfunction is a common health issue affecting all age groups except children due to changing lifestyle, occupational load, and so on.
Systematic ReviewReliability of the Buttock Applied Strain Test to Diagnose Radicular Pain in Patients With Low Back Pain
The buttock applied strain test is a reliable method for diagnosing radicular pain in patients with low back pain, aiding in differential diagnosis.
Sacroiliac Joint Pain
Sacroiliac joint pain is difficult to diagnose, and controlled analgesic injections are the most important tool for diagnosis and treatment.
Highly CitedPostpartum sacral stress fracture: an unusual case of low-back and buttock pain.
Postpartum sacral stress fractures are an unusual cause of low-back and buttock pain in women, and should be considered in differential diagnosis for these symptoms.
Case ReportSacroiliac joint pain: anatomy, biomechanics, diagnosis, and treatment.
Sacroiliac joint pain contributes to at least 15% of low back pain and can be effectively treated with conservative methods like joint mobilization, antiinflammatory medicines, and sacroiliac joint belts.
Highly CitedOsteomalacia as a Cause of Chronic Low Back and Buttock Pain.
Osteomalacia secondary to adefovir dipivoxil use can cause chronic low back and buttock pain, but pain and waddling gait significantly improved after correcting hypophosphatemia using oral phosphorus supplementation.
Case ReportPrevalence and Location of Neuropathic Pain in Lumbar Spinal Disorders: Analysis of 1804 Consecutive Patients With Primary Lower Back Pain
Low back pain alone can induce physiological nociceptive pain, while buttock pain is significantly associated with neuropathic pain, and leg pain can increase the prevalence of neuropathic pain, especially when involving peripheral elements.
Observational Study
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