Cluneal nerve entrapment syndromes: Clinical recognition, diagnosis, and contemporary management – A narrative review

Cluneal nerve entrapment is a significant, though frequently underdiagnosed, cause of chronic low back and buttock pain, accounting for an estimated 1.6–14% of cases. The cluneal nerves are purely sensory branches that innervate the skin of the lower back, buttocks, and upper thigh and are conventionally divided into superior, middle, and inferior groups according to their spinal origin and anatomical course. Entrapment typically occurs where these nerves cross rigid osteofibrous tunnels or pass beneath dense ligamentous structures, producing a deep, poorly localized pain that frequently radiates into the posterior thigh and mimics lumbar radiculopathy, a pattern often termed “pseudo-sciatica.” Because motor strength, reflexes, and dermatomal sensory findings are typically preserved, the condition is easily overlooked or misattributed to more familiar spinal or sacroiliac pathology, and patients often endure years of unexplained pain before an accurate diagnosis is reached. This narrative review synthesizes current evidence on the anatomy, pathophysiology, clinical presentation, diagnostic evaluation, and stepwise management of cluneal nerve entrapment, with particular attention to the diagnostic role of image-guided nerve blocks and the comparative outcomes of injection therapy, radiofrequency ablation, and surgical decompression.