A 20-year-old collegiate track athlete presented with persistent right posterior thigh, hip, and gluteal pain after a hamstring strain. Despite physical therapy and MRI excluding musculoskeletal or sciatic pathology, she reported sharp pain and numbness radiating to the posterior thigh and gluteal fold, impairing daily function and competition. Exam revealed sensory changes in the PFCN distribution without motor weakness. An ultrasound-guided PFCN block with 0.25% bupivacaine, epinephrine, and betamethasone was performed.

The PFCN lies in the gluteal deep investing fascia, medial to the inferior gluteal artery and superficial to the sciatic nerve. Hydrodissection separates gluteus maximus from fascia to expose the PFCN. Advancing too deep risks sciatic spread and motor blockade. This precise approach enabled a purely sensory block, facilitating return to competition. It is an effective intervention that highlights the importance of considering PFCN mononeuropathy in refractory thigh pain and demonstrates the role of targeted sensory nerve blocks in restoring function while preserving motor integrity.