Author: Watanabe I, et al.
Cureus 17(9): e91853, September 08, 2025. doi:10.7759/cureus.91853
This case report describes a 48-year-old man who developed delayed-onset myofascial pain syndrome (MPS) one year after axillary artery cannulation for total arch replacement surgery. While chronic postsurgical pain (CPSP) is usually attributed to neuropathic or psychosocial factors, this case highlights musculoskeletal causes that are often overlooked. The patient presented with persistent right anterior chest pain, postural asymmetry, muscle atrophy, and myofascial trigger points near the cannulation site and scapula. Ultrasonography confirmed structural disruption of the pectoralis major and surrounding connective tissue.
Management included pregabalin, ultrasound-guided trigger point injections with levobupivacaine and triamcinolone, and type II pectoral nerve blocks. After five biweekly sessions, the patient experienced significant pain relief, resolution of allodynia, and improved posture. These findings suggest the likely contribution of localized muscle trauma and possible pectoral nerve injury from axillary artery cannulation.
What You Should Know:
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Delayed-onset MPS can be a musculoskeletal cause of CPSP following axillary artery cannulation.
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Careful clinical examination and ultrasonography can identify myofascial trigger points.
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A multimodal treatment strategy combining pharmacotherapy and ultrasound-guided interventions can yield substantial recovery.
Thank you to Cureus for allowing us to use this article.