Ultrasonographic Evaluation of Superior Cluneal Nerve Entrapment: Methodological Considerations. Comment on Iudicelli et al. The Role of Musculoskeletal Ultrasound in Detecting Superior Cluneal Nerve Entrapment: Biomechanical Insights in Chronic Low Back Pain—A Pilot Study. Diagnostics 2026, 16, 469

Abstract

Superior cluneal nerve (SCN) entrapment is an underrecognized cause of chronic low back pain, and musculoskeletal ultrasound has recently gained attention as a potential diagnostic tool. In a recent pilot study, an indirect ultrasonographic triad consisting of thoracolumbar fascia thickening, iliac crest enthesophytes, and Copeman nodules was proposed as a potential diagnostic indicator of SCN entrapment. In this comment, we discuss several anatomical and methodological considerations regarding the ultrasonographic evaluation of SCN entrapment. Based on previous anatomical studies and our own ultrasonographic experience, we emphasize that the principal role of ultrasonography in SCN entrapment is to facilitate accurate ultrasound-guided diagnostic nerve blocks by identifying the target anatomy. Although direct visualization of the SCN may provide supportive anatomical information, the diagnosis should remain based on the clinical presentation and, when indicated, confirmation by an ultrasound-guided diagnostic nerve block. Further multicenter prospective studies are needed to establish standardized ultrasonographic diagnostic criteria for SCN entrapment.