BACKGROUND: Ultrasound (US) has been widely used for the diagnosis and guided interventions of peripheral nerve disorders. Although superior cluneal nerve (SCN) entrapment is an important cause of lower back pain, a relevant review as to how US can be used for imaging and guided intervention for cases of SCN entrapment is still lacking. OBJECTIVES: This review aims to revisit the anatomy and pertinent clinical issues of SCN entrapment, as well as the role of US regarding the diagnosis and subsequent management of relevant clinical scenarios. STUDY DESIGN: A narrative review. METHODS: Although the present article is a narrative review, we used a systematic approach to search the relevant literature. The combinations of key words, including SCN, ultrasound, and sonography, were used to search PubMed and Medline without restriction of languages or article types. The search period was from the earliest record through November 2021. RESULTS: Our included studies showed that high-resolution US and knowledge of sonoanatomy facilitated the visualization of individual branches of the SCN after emerging from the erector spinae muscles. However, the diagnostic block was needed for confirmation of SCN entrapment. Perineural US-guided injection was helpful in relieving the complaints of SCN entrapment; whereas, hydrodissection underneath the thoracolumbar fascia over the iliac crest seems to be a feasible approach for postsurgical analgesia. LIMITATIONS: There was no clinical trial comparing the efficacy of different injection techniques and regimens. CONCLUSIONS: US imaging is helpful for guiding injections of SCN entrapment and related clinical conditions. The evidence of US imaging in diagnosing SCN disorders remains insufficient, which requires more prospective studies to validate.

Department of Physical and Rehabilitation Medicine Hacettepe University Medical School Ankara Turkey

Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Bei Hu Branch Taipei Taiwan

Department of Physical Medicine and Rehabilitation National Taiwan University Hospital Bei Hu Branch Taipei Taiwan; Department of Physical Medicine and Rehabilitation National Taiwan University College of Medicine Taipei Taiwan; Center for Regional Anesthesia and Pain Medicine Wang Fang Hospital Taipei Medical University Taipei Taiwan

Department of Rehabilitation Medicine Charles University and General University Hospital Prague Prague Czech Republic

Institute of Anatomy Charles University Czech Republic

Enhancing diagnosis and treatment of superior cluneal nerve entrapment: cadaveric, clinical, and ultrasonographic insights