Brian P. Jacob, David C. Chen, Bruce Ramshaw, Shirin Towfigh (eds.) - The SAGES Manual of Groin Pain-Springer International Publishing (2016)

43. Thoracolumbar Syndrome
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The posterior ramus supplies the subcutaneous tissue of the lower waste
and buttocks. The anterior ramus supplies the lower abdomen and groin
[ 5 ]. Patients with TLS may also have other etiologies causing groin pain,
in addition to the TLS, thus adding complexity to pinpointing TLS as
one of the sources of discomfort.
Physical Examination
Physical exam begins with examination of the spine with the patient
in a prone position. Lateral pressure on the spinous processes of T9–L3
should elicit unilateral pain. The compression should be performed in
both a right and left movement. Direct compression over the affected
facet will elicit the same tenderness (Fig. 43.2 ). The posterior iliac crest
should then be palpated to identify point tenderness. Rubbing the crest
in an up-and-down motion should elicit pain at a point usually 7 cm
from the midline. The pain should be sharp in nature. This point is called
the posterior iliac crest point; it is where the irritated cutaneous branches
of T11–L1 are compressed [ 3 ] (Fig. 43.3 ).
The pinch–roll test is then performed to test for hyperalgesia of the
skin and subcutaneous tissues of the gluteal and iliac crest region.
Referred pain accompanies hyperalgesia and thickening of the skin.
The test is performed by grasping a fold of skin between the thumb and
forefinger and rolling the tissue in a controlled manner. The involved side
should elicit tenderness compared to the opposite side [ 4 ] (Fig. 43.4 ).
Fig. 43.2. Point pressure over iliac crest.