{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,11]],"date-time":"2026-09-11T23:34:12Z","timestamp":1789169652973,"version":"build-2803163510"},"reference-count":35,"publisher":"MDPI AG","issue":"15","license":[{"start":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T00:00:00Z","timestamp":1753660800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>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\u2019s concordant pain by palpating the LTN. Ultrasound-guided hydrodissection of the LTN was then performed using 20\u201330cc of D5W without LA to separate the nerve from the surrounding tissues, employing a \u201cfascial unzipping\u201d 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.<\/jats:p>","DOI":"10.3390\/diagnostics15151891","type":"journal-article","created":{"date-parts":[[2025,7,28]],"date-time":"2025-07-28T14:50:03Z","timestamp":1753714203000},"page":"1891","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":7,"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"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0009-8950-8161","authenticated-orcid":false,"given":"Nunung","family":"Nugroho","sequence":"first","affiliation":[{"name":"Department of Physical Medicine and Rehabilitation, Primasatya Husada Citra Hospital, Surabaya 60165, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Widya Mandala Catholic University, Surabaya 60112, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Faculty of Medicine, The University of Hong Kong, Hong Kong, China"},{"name":"The Department of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Center for Regional Anesthesia and Pain Medicine, Wan Fang Hospital, Taipei Medical University, Taipei 110, Taiwan"},{"name":"Center for Regional Anesthesia and Pain Medicine, Chung Shan Medical University Hospital, Taichung 402, Taiwan"},{"name":"International Association of Regenerative Medicine, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-0808-3801","authenticated-orcid":false,"given":"Theodore","family":"Tandiono","sequence":"additional","affiliation":[{"name":"General Practitioner, Surabaya Orthopedic and Traumatology Hospital, Surabaya 60213, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 12950, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11510, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wahida","family":"Ratnawati","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Neurology, Makassar Ministry of Health Central General Hospital, Makassar, Bone, South Sulawesi 90155, Indonesia"},{"name":"Department of Neurology, Tenriawaru General Hospital, Bone, South Sulawesi 90713, Indonesia"},{"name":"Department of Neurology, La Mappapenning General Hospital, Bone, South Sulawesi 90713, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0918","authenticated-orcid":false,"given":"Daniel Chiung-Jui","family":"Su","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan"},{"name":"A Tempo Regeneration Center for Musicians, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"The Department of Clinical Research, The International Association of Musculoskeletal Medicine, Hong Kong, China"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China"},{"name":"International Association of Regenerative Medicine, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"IncheonTerminal Orthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"MSKUS, 1035 E. Vista Way #128, Vista, CA 92084, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-2326","authenticated-orcid":false,"given":"Kenneth Dean","family":"Reeves","sequence":"additional","affiliation":[{"name":"Independent Researcher, Roeland Park, KS 66205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,28]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1600","DOI":"10.1093\/pm\/pnw350","article-title":"Serratus Anterior Muscle Pain Syndrome: A Diagnostic Conundrum","volume":"18","author":"Bautista","year":"2017","journal-title":"Pain Med."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"Waldman, S.D. (2014). 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