Abstract
RATIONALE: Neurogenic pectoralis minor syndrome (NPMiS) is an underdiagnosed cause of persistent neck, shoulder, and upper extremity pain. It can mimic cervical radiculopathy or other musculoskeletal disorders, often resulting in misdiagnosis and ineffective treatment. This case series presents 5 patients with NPMiS who achieved symptomatic relief through diagnostic ultrasound-guided pectoralis minor muscle (PMiM) block followed by targeted rehabilitation. PATIENT CONCERNS: All patients presented with persistent neck pain often radiating to the scapula or anterior chest wall, along with paresthesia and impaired sleep quality. Prior treatments, including non-steroidal anti-inflammatory drugs, muscle relaxants, and physical therapy, were ineffective. One patient was referred for spine surgery before alternative evaluation. DIAGNOSES: The diagnosis of NPMiS was based on detailed clinical history, positive physical exam findings (e.g., Roos test, focal PMiM tenderness), and exclusion of cervical radiculopathy and peripheral neuropathies via imaging and electrophysiological studies. Confirmatory diagnosis was established with significant symptom relief following ultrasound-guided PMiM block. INTERVENTIONS: Patients received diagnostic ultrasound-guided injection of 1% lidocaine into the PMiM. This was followed by an individualized rehabilitation program including posture correction, ergonomic adjustments, and physical therapy focused on pectoral muscle stretching and shoulder stabilization. OUTCOMES: Patients experienced rapid pain reduction, improved function, reduced medication use, and better sleep. Sustained symptom relief was achieved through adherence to rehabilitation. LESSONS: NPMiS should be considered in the differential diagnosis of chronic, non-dermatomal neck and upper extremity pain, particularly when standard treatments fail. Ultrasound-guided PMiM block is a valuable tool both for confirming diagnosis and initiating effective, personalized therapy strategies.