Stepwise acupuncture exploration followed by ultrasound-guided needle-knife release combined with local infiltration for chronic intercostal muscle-related myofascial pain: A case report

Rationale

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.