Ultrasound-Guided Hydrodissection for Neurogenic Thoracic Outlet Syndrome Caused by a Cervical Rib: A Case Report

Thoracic outlet syndrome (TOS) is an underdiagnosed condition that is frequently misattributed to cervical spine pathology. Neurogenic TOS (nTOS), the most common subtype, often presents nonspecific upper extremity pain and paresthesia, making diagnosis challenging. We report a case of nTOS associated with a cervical rib that was successfully treated with ultrasound-guided hydrodissection (HD). Dynamic ultrasound examination demonstrated brachial plexus tethering with symptom reproduction. Serial HD resulted in immediate and sustained symptom relief, suggesting that this minimally invasive technique may represent a potential diagnostic adjunct and minimally invasive therapeutic option in carefully selected patients with cervical rib-associated nTOS.