Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details
<b>Background and Clinical Significance:</b> Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading...
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2025-07-01
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| author | Nunung Nugroho King Hei Stanley Lam Theodore Tandiono Teinny Suryadi Anwar Suhaimi Wahida Ratnawati Daniel Chiung-Jui Su Yonghyun Yoon Kenneth Dean Reeves |
| author_facet | Nunung Nugroho King Hei Stanley Lam Theodore Tandiono Teinny Suryadi Anwar Suhaimi Wahida Ratnawati Daniel Chiung-Jui Su Yonghyun Yoon Kenneth Dean Reeves |
| author_sort | Nunung Nugroho |
| collection | DOAJ |
| description | <b>Background and Clinical Significance:</b> Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. <b>Case Presentation:</b> A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. <b>Conclusions:</b> Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates. |
| format | Article |
| id | doaj-art-14f152ad851841cb918384efaf4cf00a |
| institution | Kabale University |
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| publishDate | 2025-07-01 |
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| spelling | doaj-art-14f152ad851841cb918384efaf4cf00a2025-08-20T03:36:26ZengMDPI AGDiagnostics2075-44182025-07-011515189110.3390/diagnostics15151891Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical DetailsNunung Nugroho0King Hei Stanley Lam1Theodore Tandiono2Teinny Suryadi3Anwar Suhaimi4Wahida Ratnawati5Daniel Chiung-Jui Su6Yonghyun Yoon7Kenneth Dean Reeves8Department of Physical Medicine and Rehabilitation, Primasatya Husada Citra Hospital, Surabaya 60165, IndonesiaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaGeneral Practitioner, Surabaya Orthopedic and Traumatology Hospital, Surabaya 60213, IndonesiaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaThe Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, ChinaIndependent Researcher, Roeland Park, KS 66205, USA<b>Background and Clinical Significance:</b> Serratus Anterior Muscle Pain Syndrome (SAMPS) is an underdiagnosed cause of anterior chest wall pain, often attributed to myofascial trigger points of the serratus anterior muscle (SAM) or dysfunction of the Long Thoracic Nerve (LTN), leading to significant disability and affecting ipsilateral upper limb movement and quality of life. Current diagnosis relies on exclusion and physical examination, with limited treatment options beyond conservative approaches. This case report presents a novel approach to chronic SAMPS, successfully diagnosed using Sonoguided Digital Palpation (SDP) and treated with ultrasound-guided hydrodissection of the LTN using 5% dextrose in water (D5W) without local anesthetic (LA), in a patient where conventional treatments had failed. <b>Case Presentation:</b> A 72-year-old male presented with a three-year history of persistent left chest pain radiating to the upper back, exacerbated by activity and mimicking cardiac pain. His medical history included two percutaneous coronary interventions. Physical examination revealed tenderness along the anterior axillary line and a positive hyperirritable spot at the mid axillary line at the 5th rib level. SDP was used to visualize the serratus anterior fascia (SAF) and LTN, and to reproduce the patient’s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20–30cc of D5W without LA to separate the nerve from the surrounding tissues, employing a “fascial unzipping” technique. The patient reported immediate pain relief post-procedure, with the pain reducing from 9/10 to 1/10 on the Numeric Rating Scale (NRS), and sustained relief and functional improvement at the 12-month follow-up. <b>Conclusions:</b> Sonoguided Digital Palpation (SDP) of the LTN can serve as a valuable diagnostic adjunct for visualizing and diagnosing SAMPS. Ultrasound-guided hydrodissection of the LTN with D5W without LA may provide a promising and safe treatment option for patients with chronic SAMPS refractory to conservative management, resulting in rapid and sustained pain relief. Further research, including controlled trials, is warranted to evaluate the long-term efficacy and generalizability of these findings and to compare D5W to other injectates.https://www.mdpi.com/2075-4418/15/15/1891serratus anterior muscle pain syndromelong thoracic nervemyofascial trigger pointschest painsonoguided digital palpationultrasound-guided hydrodissection |
| spellingShingle | Nunung Nugroho King Hei Stanley Lam Theodore Tandiono Teinny Suryadi Anwar Suhaimi Wahida Ratnawati Daniel Chiung-Jui Su Yonghyun Yoon Kenneth Dean Reeves Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details Diagnostics serratus anterior muscle pain syndrome long thoracic nerve myofascial trigger points chest pain sonoguided digital palpation ultrasound-guided hydrodissection |
| title | Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details |
| title_full | Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details |
| title_fullStr | Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details |
| title_full_unstemmed | Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details |
| title_short | Novel Sonoguided Digital Palpation and Ultrasound-Guided Hydrodissection of the Long Thoracic Nerve for Managing Serratus Anterior Muscle Pain Syndrome: A Case Report with Technical Details |
| title_sort | novel sonoguided digital palpation and ultrasound guided hydrodissection of the long thoracic nerve for managing serratus anterior muscle pain syndrome a case report with technical details |
| topic | serratus anterior muscle pain syndrome long thoracic nerve myofascial trigger points chest pain sonoguided digital palpation ultrasound-guided hydrodissection |
| url | https://www.mdpi.com/2075-4418/15/15/1891 |
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