Stepwise acupuncture exploration followed by ultrasound-guided needle-knife release combined with local infiltration for chronic intercostal muscle–related myofascial pain
Yuyang Ou, Dan Li, Guanghan Li, Hui LiRationale:
Intercostal muscle–related myofascial pain can be difficult to localize when superficial tenderness is absent because the muscles lie deep to the thoracic musculature and close to the pleura. We report a case in which stepwise muscle-specific acupuncture provided ancillary localization information before targeted treatment.
Patient concerns:
A 73-year-old man presented with a 3-year history of persistent right posterolateral chest wall heaviness and dull pain, predominantly involving the fourth to tenth intercostal spaces. The resting numerical rating scale (NRS) score was 8, and no definite superficial tender point was identified.
Diagnoses:
Clinical and imaging evaluations excluded more plausible cardiopulmonary, pleural, osseous, spinal, herpetic, or neuropathic causes. More than 1 month of sequential acupuncture targeting the trapezius, rhomboid, multifidus, erector spinae, and serratus muscles produced no meaningful improvement. When exploration reached the suspected deep intercostal layer, ultrasound-guided acupuncture reproduced the habitual pain and produced mild relief. This response was interpreted as hypothesis-generating localization information rather than confirmatory evidence and contributed to a provisional diagnosis of intercostal muscle–related myofascial pain.
Interventions:
The patient underwent 4 weekly sessions of ultrasound-guided needle-knife release combined with local infiltration of 0.25% lidocaine and compound betamethasone. The intercostal anatomy and needle tip were monitored in real time using an out-of-plane approach.
Outcomes:
The NRS score decreased from 8 to 5 immediately after the first treatment and further decreased to 1 one week after the fourth treatment. Pain completely resolved at the 1-, 3-, and 6-month follow-ups, with no treatment-related adverse events.
Lessons:
Stepwise muscle-specific acupuncture may provide ancillary localization information when conventional examination cannot identify a deep chest wall pain generator. Ultrasound-guided needle-knife release combined with local infiltration targeting the suspected intercostal muscle was associated with sustained improvement and may represent a potential treatment approach for selected patients with deep intercostal muscle–related myofascial pain.