Chronic chest wall and upper limb pain is a common complication following breast cancer surgery and radiotherapy, affecting up to 60% of patients and significantly impacting their quality of life. We present the case of an 83-year-old woman with significant right-sided chest wall pain persisting several years after lumpectomy and radiotherapy. Her symptoms included burning and shooting pain, radiating from the breast to the axilla and fingers, not responding to conservative management. She underwent ultrasound-guided hydrodissection of the pectoral muscles using 10？mls of 5% dextrose. The procedure was well tolerated and resulted in a complete resolution of her symptoms at two-month follow-up, with self-reported improvements in function, mood, sleep, and mobility. To our knowledge, this is the first reported case of pectoral muscle hydrodissection for chronic breast pain post-breast cancer surgery. This technique can offer a minimally invasive, non-pharmacological alternative that may reduce the need for oral analgesics and improve patient outcomes. Further research is warranted to explore its broader clinical application.
References
[1]
Tang, D.D., Ye, Z.J., Liu, W.W., Wu, J., Tan, J.Y., Zhang, Y., et al. (2025) Survival Feature and Trend of Female Breast Cancer: A Comprehensive Review of Survival Analysis from Cancer Registration Data. TheBreast, 79, Article ID: 103862. https://doi.org/10.1016/j.breast.2024.103862
[2]
Smith, H.S. and Wu, S.-X. (2012) Persistent Pain after Breast Cancer Treatment. AnnalsofPalliativeMedicine, 1, 182-194.
[3]
Wang, K., Yee, C., Tam, S., Drost, L., Chan, S., Zaki, P., et al. (2018) Prevalence of Pain in Patients with Breast Cancer Post-Treatment: A Systematic Review. TheBreast, 42, 113-127. https://doi.org/10.1016/j.breast.2018.08.105
[4]
Tait, R.C., Zoberi, K., Ferguson, M., Levenhagen, K., Luebbert, R.A., Rowland, K., et al. (2018) Persistent Post-Mastectomy Pain: Risk Factors and Current Approaches to Treatment. TheJournalofPain, 19, 1367-1383. https://doi.org/10.1016/j.jpain.2018.06.002
[5]
Vilholm, O.J., Cold, S., Rasmussen, L. and Sindrup, S.H. (2008) The Postmastectomy Pain Syndrome: An Epidemiological Study on the Prevalence of Chronic Pain after Surgery for Breast Cancer. BritishJournalofCancer, 99, 604-610. https://doi.org/10.1038/sj.bjc.6604534
[6]
Lee, C.H., Chung, S.Y., Kim, W.Y. and Yang, S.N. (2019) Effect of Breast Cancer Surgery on Chest Tightness and Upper Limb Dysfunction. Medicine (Baltimore), 98, e15524. https://doi.org/10.1097/md.0000000000015524
[7]
Nakamura, S., Fujii, K., Sakai, M., Sakai, K., Hanazawa, H., Nishimura, K., et al. (2025) Arm-behind-the-Back Position for Breast Cancer Radiotherapy in Patients with Lupus Erythematosus and Shoulder Arthropathy: A Case Report. American Journal of Case Reports, 26, e946674.
[8]
Steegers, M.A., Wolters, B., Evers, A.W., Strobbe, L. and Wilder-Smith, O.H. (2008) Effect of Axillary Lymph Node Dissection on Prevalence and Intensity of Chronic and Phantom Pain after Breast Cancer Surgery. TheJournalofPain, 9, 813-822. https://doi.org/10.1016/j.jpain.2008.04.001
[9]
Rosenberger, D.C. and Pogatzki-Zahn, E.M. (2022) Chronic Post-Surgical Pain—Update on Incidence, Risk Factors and Preventive Treatment Options. BJAEducation, 22, 190-196. https://doi.org/10.1016/j.bjae.2021.11.008
[10]
Lam, K.H.S., Su, D.C., Wu, Y., Janze, A. and Reeves, K.D. (2024) Novel Ultrasound-Guided Hydrodissection with 5% Dextrose for the Treatment of Occipital Neuralgia Targeting the Greater Occipital Nerve. Diagnostics, 14, Article No. 1380. https://doi.org/10.3390/diagnostics14131380
[11]
Wong, E. and Harmon, D.C. (2025) Hydrodissection of Greater Occipital Nerve for Migraine Treatment: A Case Report. PainStudiesandTreatment, 13, 37-42. https://doi.org/10.4236/pst.2025.132005
[12]
DN4 Questionnaire: PDF & Online Calculator. https://www.physiotutors.com/questionnaires/dn4-questionnaire-neuropathic-pain/
[13]
Quality of Life Scale. https://www.acpanow.com/uploads/9/9/8/3/99838302/quality_of_life_scale.pdf
[14]
Maniquis-Smigel, L., Reeves, K.D., Rosen, H.J., Lyftogt, J., Graham-Coleman, C., Cheng, A., et al. (2018) Analgesic Effect and Potential Cumulative Benefit from Caudal Epidural D5W in Consecutive Participants with Chronic Low-Back and Buttock/Leg Pain. The Journal of Alternative and Complementary Medicine, 24, 1189-1196. https://doi.org/10.1089/acm.2018.0085
[15]
Yoshii, Y., Zhao, C., Schmelzer, J.D., Low, P.A., An, K. and Amadio, P.C. (2009) The Effects of Hypertonic Dextrose Injection on Connective Tissue and Nerve Conduction through the Rabbit Carpal Tunnel. ArchivesofPhysicalMedicineandRehabilitation, 90, 333-339. https://doi.org/10.1016/j.apmr.2008.07.028
[16]
Basbaum, A.I., Bautista, D.M., Scherrer, G. and Julius, D. (2009) Cellular and Molecular Mechanisms of Pain. Cell, 139, 267-284. https://doi.org/10.1016/j.cell.2009.09.028
[17]
Cui, M., Gosu, V., Basith, S., Hong, S. and Choi, S. (2016) Polymodal Transient Receptor Potential Vanilloid Type 1 Nocisensor. In: AdvancesinProteinChemistryandStructuralBiology, Elsevier, 81-125. https://doi.org/10.1016/bs.apcsb.2015.11.005
[18]
Jensen, V.F.H., Bøgh, I.B. and Lykkesfeldt, J. (2014) Effect of Insulin-Induced Hypoglycaemia on Thecentral Nervous System: Evidence from Experimental Studies. JournalofNeuroendocrinology, 26, 123-150. https://doi.org/10.1111/jne.12133
[19]
Jensen, V.F.H., Mølck, A.-M., Bøgh, I.B. and Lykkesfeldt, J. (2014) Effect of Insulin-induced Hypoglycaemia on the Peripheral Nervous System: Focus on Adaptive Mechanisms, Pathogenesis and Histopathological Changes. JournalofNeuroendocrinology, 26, 482-496. https://doi.org/10.1111/jne.12170
[20]
Maclver, M.B. and Tanelian, D.L. (1992) Activation of C Fibers by Metabolic Perturbations Associated with Tourniquet Ischemia. Anesthesiology, 76, 617-623. https://doi.org/10.1097/00000542-199204000-00020
[21]
Pirahanchi, Y. (2023) Physiology, Sodium Potassium Pump [Internet]. U.S. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK537088/
[22]
Chronic Pain after Mastectomy and Chest Surgery. https://www.uofmhealth.org/conditions-treatments/surgery/chronic-pain-after-mastectomy-and-chest-surgery
[23]
Khoury, A.L., Keane, H., Varghese, F., Hosseini, A., Mukhtar, R., Eder, S.E., et al. (2021) Trigger Point Injection for Post-Mastectomy Pain: A Simple Intervention with High Rate of Long-Term Relief. NPJBreastCancer, 7, Article No. 123. https://doi.org/10.1038/s41523-021-00321-w
[24]
Institute T. (2024) Relief from Post-Mastectomy Pain: Signs, Symptoms, and Solutions. ARSA—Advanced Reconstructive Surgery Alliance. https://www.advancedreconstruction.com/blog/relief-from-post-mastectomy-pain
[25]
Yang, A., Nadav, D., Legler, A., Chen, G.H., Hingula, L., Puttanniah, V., et al. (2020) An Interventional Pain Algorithm for the Treatment of Postmastectomy Pain Syndrome: A Single-Center Retrospective Review. PainMedicine, 22, 677-686. https://doi.org/10.1093/pm/pnaa343
[26]
Sercan, O., Karavelli, A., Ozmen, S. and Uslu, A. (2021) Comparison of the Effects of Pectoral Nerve Block and Local Infiltration Anesthesia on Postoperative Pain for Breast Reduction Surgery: A Prospective Observational Study. TheEurasianJournalofMedicine, 53, 102-107. https://doi.org/10.5152/eurasianjmed.2021.20111
[27]
Kim, H.T., Kim, K.Y., Kim, Y.D. and Moon, H.S. (2010) Pulsed Radiofrequency Lesioning for Treatment of Chronic Breast Neuropathic Pain after Breast Reduction—A Case Report. KoreanJournalofAnesthesiology, 59, S238. https://doi.org/10.4097/kjae.2010.59.s.s238
