Ultrasound-guided hydrodissection of the subclavius muscle region in neurogenic thoracic outlet syndrome: a case report
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By
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Yonghyun Yoon
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King Hei Stanley Lam
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Jason Lee
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Jaewoo Lim
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Jihyo Hwang
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Rina Shin
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Teinny Suryadi
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Anwar Suhaimi
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Jaeik Choi
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Gyungseog Ko
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May 29, 2026
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Clinical Scorecard: Ultrasound-Assisted Hydrodissection in the Subclavius Muscle Area for Neurogenic Thoracic Outlet Syndrome: A Case Study
At a Glance
| Category | Detail |
|---|
| Condition | Neurogenic Thoracic Outlet Syndrome (nTOS) |
| Key Mechanisms | Compression of the brachial plexus within the costoclavicular space, potentially exacerbated by subclavius muscle atrophy. |
| Target Population | Patients with refractory neurogenic thoracic outlet syndrome, particularly those with subclavius muscle atrophy. |
| Care Setting | Outpatient interventional procedure setting. |
Key Highlights
- Ultrasonography identified focal subclavius muscle atrophy as a contributor to nTOS.
- Ultrasound-guided hydrodissection resulted in over 70% improvement in paresthesia.
- Complete resolution of symptoms and full motor strength recovery achieved after six treatment sessions.
- This case represents the first report of ultrasound-guided hydrodissection targeting the subclavius muscle for nTOS.
Guideline-Based Recommendations
Diagnosis
- Utilize high-resolution ultrasonography to assess the costoclavicular space and subclavius muscle.
Management
- Consider ultrasound-guided hydrodissection as a treatment option for refractory nTOS.
Monitoring & Follow-up
- Assess neurological improvement and symptom resolution post-procedure.
Risks
- Potential for mechanical irritation or complications related to injection.
Patient & Prescribing Data
Adult patients with neurogenic thoracic outlet syndrome and associated muscle atrophy.
Hydrodissection with 30 mL of 5% dextrose in water (D5W) may enhance outcomes by addressing adjacent structures.
Clinical Best Practices
- Perform thorough diagnostic evaluation including electrodiagnostic studies.
- Consider the anatomical relationship of the subclavius muscle in cases of unexplained proximal neuropathy.
- Utilize ultrasound for dynamic assessment of the thoracic outlet.
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