Nunung Nugroho, King Hei Stanley Lam, Theodore Tandiono, Teinny Suryadi, Anwar Suhaimi, Wahida Ratnawati, Daniel Chiung-Jui Su, Yonghyun Yoon, Kenneth Dean Reeves
Background and Clinical Significance: 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. Case Presentation: 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. Conclusions: 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. © 2025 by the authors.
Department of Physical Medicine and Rehabilitation, Primasatya Husada Citra Hospital, Surabaya, 60165, Indonesia; Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Widya Mandala Catholic University, Surabaya, 60112, Indonesia; The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong; Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong; Faculty of Medicine, The University of Hong Kong, Hong Kong; The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong; Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, 110, Taiwan; Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung, 402, Taiwan; International Association of Regenerative Medicine, Namdong-gu, Incheon, 21574, South Korea; General Practitioner, Surabaya Orthopedic and Traumatology Hospital, Surabaya, 60213, Indonesia; Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta, 14350, Indonesia; Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta, 12950, Indonesia; Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta, 11510, Indonesia; Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur, 50603, Malaysia; Department of Neurology, Makassar Ministry of Health Central General Hospital, Bone, South Sulawesi, Makassar, 90155, Indonesia; Department of Neurology, Tenriawaru General Hospital, South Sulawesi, Bone, 90713, Indonesia; Department of Neurology, La Mappapenning General Hospital, South Sulawesi, Bone, 90713, Indonesia; Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan, 710, Taiwan; A Tempo Regeneration Center for Musicians, Tainan, 700, Taiwan; Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul, 07441, South Korea; IncheonTerminal Orthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon, 21574, South Korea; MSKUS, 1035 E. Vista Way #128, Vista, 92084, CA, United States; Independent Researcher, Roeland Park, 66205, KS, United States