This topic contains 6 replies, has 4 voices, and was last updated by 
Brandon Cohen DC, CSCS May 7, 2020 at 4:50 pm.
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Christopher Aysom
Wondering if anyone has any experience with lipoma’s around the posterior iliac crest and SIJ regions in low back patients. I am working with a low back case, male 38, high BMI with bilateral lipoma’s over the posterior iliac crests and also medially closer to the SIJ. The patient has a significantly limited QLF which is responding well, but I’m curious if there is any significance to the lipoma’s.
I’ve seen some literature that these can be involved with pain in chronic LBP cases and wondering if this could be due to the lipoma itself, or could the fat deposit possibly be involved in cluneal nerve entrapment which becomes pain producing?
Just wondering if the lipoma’s are something that needs to be factored into management. Thank you!
Seth Schultz, DC
Great question Chris! What is his sx location? Is it along the crest?
Can lipomas cause pain? Yes if the nerve becomes entangled, but they can also be asymptomatic.
Action steps for you moving forward are still to fix any dysfunction this patient has and see where the dust settles. Stay focused on treating relevant adhesion and nerve entrapment. If at the end of the case he is still having symptoms along the crest it may be necessary to remove the lipoma. This will take pressure off the nerve. But, again that is done once you’ve cleared all reducible pathology.
Logan Scharf
Thanks for the post Chris!
I agree with Seth, the action steps should be to clear as much dysfunction first and see how things shake out. I previously had a patient with a lipoma in the posterior aspect of his shoulder. After fixing his function, his symptoms improved drastically but the remaining symptoms were found to be directly due the lipoma having small vasculature and superficial nerves running through it, which he was then referred to have removed. After having the lipoma removed the remainder of his symptoms were resolved. Most lipomas are going to be asymptomatic, but in this case after removing all adhesion and clearing out his dysfunction, the lipoma was the remaining piece to the puzzle.
Brandon Cohen DC, CSCS
Similar story. Patient with a lipoma in the left interscapular area. Function improved to 90%, tension in the area. Had it removed symptoms completely gone. Range of motion improved to 100%. Lipoma was the size of 2 golf balls side by side. Bigger than I thought, and bigger than the surgeon thought it would be.
This is one case. No other cases I can think of. This patient also had a 40 on Fastmap for psychological. It may just have been she didn’t like the bump on the back, and she just felt better about herself. Going into surgery, there was not a lot of confidence that it would make a large difference in the pain.
Christopher Aysom
Seth, Logan, Brandon – thank you for your input, it’s much appreciated.
This patient has a long history of low back pain over 10 years. Imaging from 2017 showed a para-central disc protrusion at L5/S1 and S1 nerve root compression, with disc-space height loss and modic change at the same level. His initial presentation in recent weeks consisted of lower lumbar pain bilaterally across the iliac crest region with mild posterior-leg referral, all of which seemed consistent with an L5 sclerotome pattern. His worst test has been QLF where there is very little, if any, flexion across all levels. As the lumbar erectors have progressed through treatment and felt a lot better to palpate, the lipoma’s have become more obvious, although not particularly painful themselves directly.
We’ve seen a gradual centralisation of the symptoms to where it’s now just more of a mild ache deep to the midline. Although there has also been an intermittent ache over the iliac crest region on one side, which had me thinking of the lipoma. As you’ve suggested, we will keep going with addressing the adhesion blocking the QLF and see where we land. Thanks again.
Seth Schultz, DC
Thanks for the post Chris. Keep us updated with the case!
Brandon Cohen DC, CSCS
Yes. Nice work. Much of his symptoms are probably caused by the disc problems and degeneration. It sounds like he has quite certainly earned it. At this point, I wouldn’t get distracted with the lipomas, stay focused on reducing the relevant adhesion and unloading the disc until its as good as you can get it. You are on the right path!
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