Concurrent Long Thoracic and Lateral Cutaneous Intercostal Nerve Entrapment After Chest Tube Thoracostomy Causing Scapular Winging and Chest Wall Pain: Diagnosis With Ultrasound and Treatment With Hydrodissection.
Yonghyun Yoon, King Hei Stanley Lam, Daniel Chiung-Jui Su et al.
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Case in brief
A 43-year-old man experienced severe left shoulder and chest wall pain six months after chest tube placement for traumatic hemopneumothorax. Examination revealed scapular winging and tenderness at the chest tube scar. Musculoskeletal ultrasound identified entrapment of both the long thoracic nerve and the lateral cutaneous branch of an intercostal nerve. Ultrasound-guided hydrodissection significantly reduced pain and improved function, with sustained results at one-year follow-up.
What made this case unusual
The concurrent entrapment of both the long thoracic nerve and the lateral cutaneous branch of an intercostal nerve after chest tube thoracostomy is rarely reported.
Diagnostic / clinical pearl
Clinicians should consider iatrogenic peripheral nerve entrapment in patients with persistent shoulder or chest wall pain following chest tube placement.
Why it matters
This case underscores the importance of using musculoskeletal ultrasound for diagnosing nerve entrapment and highlights a minimally invasive treatment option that can lead to significant symptom relief.