Painful bursa like spot above the iliac crest

Hi everybody,

I wanted to ask you a clinical question.

It's not the first patient I see that complains about an acute and irradiating pain at the pressure of a precise spot that I could indicate between the sacro-iliac joint and above the iliac crest. At the touch this spot appears to be like a quite mobile bursae. I already found this kind of painful "tissue" in many patients but I didn't find anything about it... Is there a bursae up the iliac crest?
The peculiarity of the point is that it doesn't seems like a miofascial tissue and it doesn't respond very well as trigger point either..

Thank you very much
Phil

I have come across this with a couple of people and on ultrasound it is a localised deposit of adipose tissue. Are there multiple 'lumps' or just one?

do you know the reason why it creates and why it is painful ?

Thank you so much

I suspect it is due to the fact that adipose tissue is quite highly neural? I don't know the specifics of why it generates in certain areas though?

I have recently had a patient with this area and I understand there is a limited descriptive literature called "back mice". I wouldn't have described it as a bursa - not that large so not sure if this is the same as your patient. In my patient's case these were exquisitely tender nodules that are quite small and highly localised. and gave rise to frequent severe episodes of severe pain that would then settle. They are relatively superficial and are associated with the posterior ligament of the SIJ and the caudal thoracolumbar fascia. Have a look at this and see what you think:
Treatment for Back Mice - Painful Lumps in Low Back - Back Pain Forum - eHealthForum
Treatment of Low Back Pain Associated with "Back Mice" A Cas... : JCR: Journal of Clinical Rheumatology


My patient responded to localised massage - I used neuro-dermal modulation which is a relatively comfortable manual therapy for symptomatic relief and stability exercises seemed to reduce recurrence of episodes.

Quote:

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Originally Posted by gcoe

I have recently had a patient with this area and I understand there is a limited descriptive literature called "back mice". I wouldn't have described it as a bursa - not that large so not sure if this is the same as your patient. In my patient's case these were exquisitely tender nodules that are quite small and highly localised. and gave rise to frequent severe episodes of severe pain that would then settle. They are relatively superficial and are associated with the posterior ligament of the SIJ and the caudal thoracolumbar fascia. Have a look at this and see what you think:
Treatment for Back Mice - Painful Lumps in Low Back - Back Pain Forum - eHealthForum
Treatment of Low Back Pain Associated with "Back Mice" A Cas... : JCR: Journal of Clinical Rheumatology


My patient responded to localised massage - I used neuro-dermal modulation which is a relatively comfortable manual therapy for symptomatic relief and stability exercises seemed to reduce recurrence of episodes.

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Thank you so much gcoe! I noticed in my patients that this "back mice" did respond quite well working "around it" (not on it).