The Iliac Crest Syndrome

June 9, 1995 Peter B. J. Wu, M.D.

Livingston (1941): described a syndrome of recurrent attacks of acute low back pain, referred to the area involved as the "multifidus triangle". He stressed the attacks are often brought on by physical exercise involving bending and twisting of the lumbar spine.

Bauwens and Coyer (1955) coined the term "the multifidus triangle syndrome".

Hirschberg (1979): the iliolumbar syndrome. The patient complains of pain at the posterior portion of one iliac crest. Some patients complain of pain across the iliolumbar area bilaterally. Some complain of pain only after prolonged sitting or standing or for a brief period in the morning after getting out of bed.

Broudeur (1981) believed that the condition is produced by inflammation or irritation of the ilio-lumbar ligament, in the form of a ligamento-periostitis.

Fairbank (1983): the iliac crest syndrome.

Collee (1990): the iliac crest pain syndrome.

Clinical manifestations

History:

- aggravated by repetitive extension-flexion activity. Pain can be referred to the groin with an increase in discomfort after prolonged siting or standing.

Physical examination:

- One iliac crest is frequently lower than the other. Usually the painful iliac crest is the higher one. In the majority of cases, lateral bending away from the painful side produces or increases LBP. In a smaller number of cases, lateral bending toward the painful side, causes LBP. Forward bending sometimes is slightly limited.

- 1) Straight leg raising 2) hip flexion 3) the Patrick test.

- The most typical sign is tenderness on palpation of the iliac crest on the involved side. The tenderness is usually limited to the insertion of the iliolumbar ligament. At times, the whole length of the iliac crest from the anterior to the posterior iliac spine may be tender, with maximum tenderness of the posterior third.

X-ray: varied from a 'rose-thorn' spike of calcification at the insertion of the iliac crest to diffuse opacity of part or the whole of the ligament itself.

Pathogenesis/Pathology: unknown.

Treatment:

- Injection: local anesthetics with or without steroids/ prolotherapy.

- Brodeur: resected the ligament--- rapid and durable relief.

Prognosis: Who knows?

REFERENCES:

1. Hirschberg GG, Froetscher L, Naeim F: Iliolumbar syndrome as a common cause of low back pain: diagnosis and prognosis. Arch Phys Med Rehabil. 60 (9): 415-419, 1979.

2. Collee G, Dijkmans B, Vandenbroucke JP and Cats A: Iliac crest pain syndrome in low back pain. a double blind, randomized study of local injection therapy. J Rheumatol. 18:1060-3, 1991.

3. Naeim F, Froetscher L, Hirschberg GG: Treatment of the chronic iliolumbar syndrome by infiltration of the iliolumbar ligament. West J Med 136(4): 372-4, 1982.

4. Collee G, Dijkmans B, Vandenbroucke JP and Cats A: Iliac crest pain syndrome in low back pain: frequency and features. J Rheumatol. 18:1064-7, 1991.

5. Bauwens P, Coyer AC: The "multifidus triangle" syndrome as a cause of recurrent low-back pain. Br Med J 1306-7, 1955.

6. Collee G, Dijkmans B, Vandenbroucke JP, Rozing PM and Cats A: A clinical epidemiological study in low back pain. description of two clinical syndromes. Br J Rheumatol 29:354-7, 1990.

7. Cashman A: The ilio-lumbar ligament syndrome. Br J Rheumatol 25(2): 228-9.

8. Fairbank JCT, O'brien JP: The iliac crest syndrome. Spine 8: 220-4, 1983.

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