Zhenlan Liao,1,* Yajing Zhou,2,* Wen Cao3 

1Department of Ultrasound, The First People’s Hospital of Neijiang, Neijiang, People’s Republic of China; 2Department of Ultrasound Medicine, TongRen Hospital, Capital Medical University, Beijing, People’s Republic of China; 3Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, People’s Republic of China

*These authors contributed equally to this work

Correspondence: Wen Cao, The Department of Ultrasound Medicine, Beijing Chao-Yang Hospital, Capital Medical University, No. 8 Gongren Tiyuchang Nanlu, Chaoyang District, Beijing, 100020, People’s Republic of China, Tel +86 (010) 85231030, Email caowenemail@126.com

Objective: The aim of this retrospective study was to evaluate the effectiveness of ultrasound-guided hydrodissection of the C5 nerve root, in combination with prevertebral fascia incision, as a treatment for neurogenic thoracic outlet syndrome (NTOS).
Methods: Between January 2023 and January 2024, a total of 34 patients diagnosed with NTOS were enrolled in the treatment group, all of whom underwent ultrasound-guided hydrodissection of the C5 nerve root and prevertebral fascia incision. A control group consisting of 34 healthy participants was also included for comparative purposes. Preoperative and postoperative ultrasound measurements were taken at 1 and 6 weeks, including the thickness of the prevertebral fascia, the distance between the C5 nerve root and fascia, and the cross-sectional area (CSA) of the C5 nerve root. Pain intensity and functional status were assessed using the Visual Analog Scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores.
Results: Preoperative measurements in the NTOS group showed increased prevertebral fascia thickness (median: 0.1 mm [IQR 0.08– 0.12]), reduced distance between the C5 nerve root and the fascia (median: 0.13 mm [IQR 0.10– 0.16]), and a larger CSA of the C5 nerve root (median: 0.08 mm² [IQR 0.06– 0.10]). Post-treatment, VAS scores significantly improved from a median of 7 (IQR 6– 8) to 2 (IQR 2– 3) at 1 week and remained stable at 6 weeks, while DASH scores improved from 85 (IQR 82– 89) to 34 (IQR 31– 36) at 1 week and 33 at 6 weeks.
Conclusion: Ultrasound-guided hydrodissection of the C5 nerve root, along with prevertebral fascia incision, is an effective, minimally invasive treatment for NTOS.

Keywords: ultrasound guidance, hydrodissection, thoracic outlet syndrome, c5 nerve root, minimally invasive treatment