Demystifying Pandora’s box: A landmark-based approach for gluteal region ultrasound with magnetic resonance imaging correlation

Abstract

The gluteal region is situated at anatomically complex crossroads between the axial and appendicular skeleton and provides pathfinding for many critical neurovascular and myotendinous structures that are essential for synchronous co-ordination between the trunk and lower limbs and dynamic stability during locomotion. While these structures can be evaluated individually using cross-sectional imaging modalities such as magnetic resonance imaging, the extrapolation of the same on grayscale ultrasonography (US) is relatively difficult. Furthermore, the inherently compact arrangement of gluteal anatomy demands protocol-based approach to improve diagnostic efficacy. In this article, a novel approach using five key bony anatomical landmarks is introduced to the readers with the aim of simplifying the approach toward US of gluteal region. Consequently, the use of this staggered approach in patients presenting with deep gluteal pain will not only aid in diagnosis and localization of pathology to respective compartments but shall also serve as a cartograph to plan and perform safe and effective guided interventions.