Ultrasound-Assisted Hydrodissection in Neurogenic Thoracic Outlet Syndrome

Overview

This case study highlights the successful use of ultrasound-guided hydrodissection in a patient with neurogenic thoracic outlet syndrome (nTOS) associated with subclavius muscle atrophy. The intervention resulted in rapid symptom resolution and motor strength recovery after multiple treatment sessions.

Background

Expand on the anatomical significance of the subclavius muscle in relation to nTOS.

Data Highlights

Case Study: A 53-year-old male with nTOS underwent ultrasound-guided hydrodissection, resulting in:

• 70% improvement in paresthesia immediately post-procedure.
• Complete symptom resolution and full motor strength recovery after six sessions.

Key Findings

• Ultrasonography identified marked atrophy of the right subclavius muscle in the patient.
• Hydrodissection with 30 mL of 5% dextrose in water was performed in the infraclavicular region.
• Immediate post-procedural assessment showed significant improvement in symptoms.
• This is the first reported case of targeting the subclavius muscle for nTOS using ultrasound-guided hydrodissection.
• Further studies are needed to confirm the efficacy of this approach and refine patient selection criteria.

Clinical Implications

The findings suggest that ultrasound-guided hydrodissection may be a viable treatment option for patients with refractory nTOS, particularly when muscular atrophy is identified. Clinicians should consider this minimally invasive technique as part of a comprehensive management strategy for nTOS.

Conclusion

Ultrasound-guided hydrodissection targeting the subclavius muscle can lead to significant clinical improvements in patients with neurogenic thoracic outlet syndrome. Further research is warranted to validate these findings and optimize treatment protocols.

Related Resources & Content

1. Mayo Clinic, A collaborative and conservative approach to neurogenic thoracic outlet syndrome, 2026 -- Mayo Clinic Guidance
2. Khanjan H. Nagarsheth, Christina Schweitzer, Diagnostic Accuracy of Scalene and Pectoralis Minor Muscle Blocks for Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis, 2026 -- Systematic Review
3. Critical Care (Springer) — Revisiting subclavian access in the ultrasound era: are we comparing sites or techniques?
4. Frontiers in Ophthalmology — Ultrasound-guided preseptal hydrodissection with 5% dextrose in water for persistent botulinum toxin-associated ptosis: a technical protocol
5. Frontiers in Surgery — A surgical technique for lesions involving the ultra-high-riding carotid sheath based on the anatomical principles of the prevertebral fascia: cadaveric dissection and case illustrations
6. Essential Surgical Anatomy Considerations for Endoscopic Thyroidectomy Using a Gasless Unilateral Axillary Technique
7. Revisiting subclavian access in the ultrasound era
8. Ultrasound-guided preseptal hydrodissection for persistent botulinum toxin-associated ptosis
9. A collaborative and conservative approach to neurogenic thoracic outlet syndrome - Mayo Clinic
10. Diagnostic Accuracy of Scalene and Pectoralis Minor Muscle Blocks for Thoracic Outlet Syndrome: A Systematic Review and Meta-Analysis - Khanjan H. Nagarsheth, Christina Schweitzer, 2026
11. To resect or avulse first rib in management of neurogenic thoracic outlet syndrome: a randomized controlled trial - PubMed