A didactic ultrasound manual to identify peripheral nerves of the lower limb: gluteal region

Percutaneous electrical nerve stimulation (PENS) has gained increasing relevance as a minimally invasive neuromodulation technique for managing musculoskeletal pain and peripheral neuropathies. Its efficacy and safety largely depend on accurate needle placement near target nerves under ultrasound (US) guidance. However, comprehensive didactic resources detailing peripheral nerve visualization remain limited. This paper aimed to develop an educational US-based manual to identify major peripheral nerves of the gluteal region, integrating anatomical, clinical, and sonographic perspectives. A narrative, anatomy-driven approach was used to describe the sonoanatomy and clinical relevance of five key nerves in the gluteal area: superior and inferior gluteal nerves, pudendal nerve, sciatic nerve, and posterior femoral cutaneous nerve. For each structure, probe placement, optimal scanning planes, and characteristic US appearances were systematically illustrated using standardized positioning and technical parameters based on high-end diagnostic ultrasound equipment.