Pudendal and Cluneal Nerve Entrapment and a Diagnostic Roadmap

The pudendal nerve, arising from S2 to S4 and passing through Alcock's canal, can be compressed in cyclists or by prolonged sitting. Symptoms include perineal and genital pain that worsens with sitting and eases on standing, possible saddle numbness and sexual dysfunction, with no motor deficit. Internal palpation is most accurate, so referral to a pelvic floor physiotherapist is advised. Unlike deep gluteal nerve syndrome, it rarely radiates into the posterior thigh. Cluneal nerve entrapment, mostly of the superior cluneal nerves from L1 to L3 as they cross the iliac crest, is purely sensory and often mistaken for sacroiliac or lumbar pain. Pain may arc around the hip and worsen with lumbar extension or standing. Palpation along the iliac crest and a Tinel sign help confirm it. The roadmap: rule out red flags, then ask whether nerves are involved, whether pain is load-based on contraction, stretch or compression, and whether lumbar movement changes symptoms. Buttock pain is rarely purely local, so classify first, confirm, then rehabilitate progressively.