What is Maigne’s Syndrome?
Maigne’s syndrome refers to a pain syndrome arising from dysfunction (often subtle) at the the thoracolumbar junction (TLJ) (roughly T11–L2), with irritation or entrapment of the posterior rami (or their branches) resulting in referred pain to the lower back, pelvis, buttock, groin, or lower abdomen.
It is sometimes conceptualized as a “facet‑dysfunction / posterior ramus entrapment / cutaneous referral” syndrome rather than a classic lumbar disc or radicular pathology.
It may overlap with or mimic cluneal nerve entrapment or “posterior ramus syndrome”; some authors see it as part of that spectrum.
In a recent review, Maigne’s syndrome is described as an underappreciated cause of low back–dominant pain with mechanical origins and two “variants” (central vs peripheral) depending on whether the irritation is at the facet joint or the medial branch / cluneal nerve branch entrapment.
Proposed Mechanisms / Pathophysiology
Several mechanisms are hypothesized:
Facet joint / apophyseal dysfunction of the TLJ segments causing nociceptive input transmitted via the posterior rami.
Entrapment or compression of the cutaneous branches of the dorsal rami (e.g. superior cluneal nerve or intermediate cluneal nerve) as they traverse over/through the iliac crest or thoracolumbar fascia.
Mechanical stress and microtrauma at the TLJ due to the transitional kinematics of thoracic (rotational) to lumbar (less rotational) segments. Because the thoracic spine is more rotationally mobile and the lumbar is more restricted, the transition zone experiences shear, torsion, or compensatory stress.
Referral / central sensitization: Over time, the segmental irritation may lead to hypersensitivity, expanded referral zones, and perhaps nociplastic amplification.
The presence of osteofibrous tunnels or rigid passages as nerves pass over or through fascia/crest may predispose to entrapment in some individuals. For example, in anatomical dissections, dorsal rami crossing posterior iliac crest ~7–8 cm from midline may be subject to entrapment.
Thus, Maigne’s syndrome is often a diagnosis of exclusion / clinical diagnosis once more obvious sources (disc herniation, facetogenic lumbar pain, sacroiliac dysfunction, hip pathology) are ruled out.
Clinical Presentation: Signs & Symptoms
Common Symptoms / Clinical Clues
Patients with Maigne’s syndrome often present with:
Pain in the lower back / lumbosacral region, but often not directly at the TLJ itself (i.e. the symptomatic zone is remote).
Unilateral symptoms are more common than bilateral, though bilateral can occur.
Referred pain to:
Buttock / posterior iliac crest
Lateral hip / outer thigh
Groin, inguinal region
Lower abdomen, pubic region
Genitals / testicular or labial pain (in some reports)
Occasionally pseudo-visceral or pseudo-abdominal pain
The pain may be deep, aching, or burning, with hypersensitivity over cutaneous zones (allodynia, hyperalgesia) along the relevant dermatomal / cutaneous distribution.
The patient’s hip / lumbar ROM might be near normal (i.e. no gross hip joint pathology) and neurodynamic (nerve stretch) tests tend to be negative (because nerve roots are not involved).
There may be localized tenderness at specific “trigger” / tender points:
Over the posterior iliac crest (in the region ~7–8 cm from midline) corresponding to where dorsal rami cross.
Along the facet joints of the TLJ (e.g. on palpation or posterior-to-anterior (PA) pressure over T11–L2) reproducing symptoms.
A skin‐rolling / pinch‐roll test over the skin and subcutaneous tissue in the gluteal / iliac region may provoke or reproduce pain/hyperesthesia.
On physical exam, segmental dysfunction at the TLJ (e.g. hypomobility, palpatory restriction) is often detectable.
Importantly, imaging is often unremarkable or nonspecific. There is often no clear structural correlate (or findings may be coincidental) on X-ray or MRI.
Proposed Diagnostic Criteria / Clinical Prediction
Some clinicians use a cluster of findings (not universally validated) as a guide. For instance:
Deep pain with tenderness to palpation over the iliac crest at the distal cluneal nerve crossing point
Hypersensitivity / altered cutaneous sensation (pinch / roll) over the gluteal / iliac region
Localized pain reproduction with PA shear / pressure over the TLJ segment
Absence of nerve root tension signs (i.e. negative SLR, femoral stretch tests)
Relief of pain following local anesthetic infiltration into the suspected painful facet / posterior ramus structure
However, note that these criteria are not universally validated, and the reliability / sensitivity / specificity is not well established in the literature.
A 2022 review article specifically describes Maigne syndrome as “a potentially treatable yet underdiagnosed cause of low back pain,” emphasizing the need for clinical awareness and mechanical understanding.
A case series of pelvic pain in Maigne’s syndrome also underscores that symptoms may overlap with sacroiliac joint dysfunction, and that multi‐segmental assessment is sometimes required.
Evidence / Scientific Studies & Treatment Insights
Here are some key studies and relevant findings:
“A potentially treatable yet underdiagnosed cause of low back pain: A review” (Randhawa et al., 2022) — This review highlights the mechanical and referral basis of Maigne’s syndrome, suggests that it may be more common than appreciated, and emphasizes the need for clinicians to include it in differential diagnosis.
Alptekin et al. (2017), “Effectiveness of exercise and local steroid injections for the thoracolumbar junction syndrome (Maigne’s syndrome)” — In this non‑randomized comparative study, 30 patients were divided into three groups (exercise alone, local steroid injection alone, and combined injection + exercise). All groups improved on VAS and Oswestry, but the combination group showed the greatest improvement at 1 and 3 months.
“Acupuncture for patients with Maigne’s syndrome: A case series” (Lee et al., 2023) — Six patients with Maigne’s syndrome underwent acupuncture targeting the T11–L2 region and associated nerve entrapment zones (superior cluneal, subcostal, iliohypogastric). All reported improvement in low back pain; four had better results in vertebral compression tests (i.e. provocation). The authors acknowledge the limitations of case series and concurrent therapies.
“Pelvic pain in Maigne’s syndrome — a multi‑segmental approach” (Singh & Kumar, 2022) — Reports a case where combined manual therapy targeted both TLJ and SIJ dysfunctions, with rehabilitation exercises, leading to significant improvements (Oswestry, VAS) in a patient with signs of Maigne’s syndrome and SI involvement.
Another useful anatomical / interventional note: “Successful Identification and Assessment of the Superior Cluneal Nerves with High‑Resolution Sonography” (Bodner et al., 2016) — This study showed that using ultrasound, the medial branch of the superior cluneal nerve (mSCN) can be visualized, and selective nerve blocks under ultrasound guidance produced symptomatic relief in patients with suspected cluneal nerve involvement (a related entity). This supports the concept that cutaneous branches of dorsal rami can be targeted diagnostically/therapeutically.
Clinical Pearls & Application in Sports/Chiropractic Context
Because the TLJ is a transitional biomechanical zone, rotational / shear stresses (especially from twisting sports, loading, asymmetrical movements) may predispose to micro‑dysfunction or irritation.
In an athlete presenting with groin, inguinal, or lower abdominal pain (especially when hip imaging / pathology is negative), consider Maigne’s syndrome (or thoracolumbar referral) in the differential.
The skin‑rolling (pinch / roll) test over the iliac crest / gluteal surface can help differentiate cutaneous hypersensitivity referral from deeper sources.
Palpation / segmental mobility testing at T11–L2 (or T12–L1 region) may reveal subtle hypomobility or tenderness; reproduction of the patient’s “extra-spinal” symptoms on PA pressure over TLJ is suggestive.
A diagnostic local anesthetic injection (into the suspected facet / posterior ramus region) may confirm the diagnosis in ambiguous cases.
In terms of treatment, a multimodal approach is likely best: manual therapy (mobilization / manipulation), targeted exercise (especially to improve control and load transfer at the thoracolumbar junction), neural mobilization / desensitization, and possibly injections or nerve blocks if conservative measures fail.
Be cautious about overreliance on imaging: many cases of Maigne’s syndrome will have no clear structural correlate, and incidental findings (e.g. facet arthropathy) may mislead the clinician.
Also consider regional interdependence: many patients with Maigne’s syndrome may have associated sacroiliac, lumbar, or hip mechanics that contribute to the stress at TLJ (as in the case report in Singh & Kumar).