Finding Relief from Thoracic Outlet Syndrome: How Ultrasound-Guided Dry Needling Helped One Patient Avoid Surgery

Keywords: thoracic outlet syndrome treatment, ultrasound guided dry needling, neurogenic TOS, POTS, dysautonomia, CRPS, non-surgical TOS treatment, scalene muscle dry needling, alternative to first rib surgery

Living with Thoracic Outlet Syndrome: More Than Just Pain

If you’ve been told you might have thoracic outlet syndrome (TOS), you probably know how confusing and frustrating this diagnosis can feel. The symptoms often come and go, they can look like other conditions, and many patients spend months or even years searching for answers.

TOS happens when nerves and blood vessels get compressed in the narrow space between the collarbone and the first rib. The result can be:

• Pain in the neck, shoulder, or arm

• Numbness, tingling, or weakness in the hand

• Headaches and muscle tightness

• In some cases, dizziness, palpitations, or symptoms that look like dysautonomia or POTS (postural orthostatic tachycardia syndrome)

The good news is that many people with TOS can improve without surgery. At our clinic, one of the most promising approaches we use is ultrasound-guided dry needling — a technique that targets the tight muscles causing compression, while keeping the procedure safe in such a delicate area.

In this post, I’ll explain how this works, why ultrasound guidance is essential, and I’ll share the story of a patient who came to us after struggling with pain, dizziness, and a recommendation for surgery. Her case shows how a non-surgical, muscle-focused approach can make all the difference.

Why Surgery Isn’t Always the Answer

When patients first hear “thoracic outlet syndrome,” many are told surgery is the next step. In some cases, surgeons recommend removing the first rib to create more space.

While surgery may help certain patients — especially in cases of severe vascular TOS — the outcomes are not always predictable. Some people feel better, but others develop chronic pain or even CRPS (complex regional pain syndrome) after surgery.

We have seen patients who underwent surgery and were left worse off. That’s why our philosophy is to exhaust conservative options first, especially when the compression is muscular in nature (as it often is in neurogenic TOS, the most common subtype).

This is where dry needling comes in.

What Is Dry Needling, and How Does Ultrasound Make It Safer?

Dry needling uses a very fine needle to release tight muscles and “trigger points.” By inserting the needle directly into the muscle fibers that are overactive or shortened, we can:

• Relax the muscle

• Improve blood flow

• Reduce nerve irritation

• Relieve pain and restore normal movement

In thoracic outlet syndrome, the most common culprits are:

• The scalenes (the small muscles in the side of the neck that sit right next to the brachial plexus and subclavian vessels)

• The pectoralis minor (in the chest, pulling the shoulder forward and down)

• The trapezius and suboccipital muscles (which often tighten in response to stress or posture)

But here’s the problem: this region is crowded with nerves and blood vessels. Blindly inserting needles in the neck can be risky.

That’s why we use ultrasound guidance. With ultrasound, we can actually see the muscles, nerves, and vessels in real time. This allows us to:

• Place the needle precisely where it belongs

• Avoid important structures like the carotid artery or brachial plexus

• Increase safety and comfort for the patient

• Improve results by targeting the true source of compression

It’s the difference between driving in the dark with your headlights off, and driving with bright lights and GPS.

Meet “Marissa”: A Patient Story

To show how powerful this approach can be, let me share the story of one of our patients. We’ll call her “Marissa” (not her real name).

Her Background

Marissa was in her early 30s, originally from Beijing, living with her family in Los Angeles. She had trained as a nurse, so she understood the medical system well, but she had been bounced around without real relief.

Her symptoms started suddenly while driving one day: her arms felt weak, she couldn’t breathe properly, and she rushed to the ER. The doctors checked her heart — the EKG was normal — but her symptoms didn’t go away.

Over the next months, she developed:

• Neck pain and stiffness

• Headaches

• Tingling and numbness in her hands

• Episodes of palpitations, blood pressure spikes, dizziness, sweating, and fatigue

She was eventually diagnosed with neurogenic thoracic outlet syndrome, confirmed with ultrasound imaging. The scan showed compression involving her scalene muscles.

What She Had Tried

Before coming to us, Marissa had:

• Done multiple rounds of physical therapy

• Tried exercise programs

• Taken NSAIDs and supplements

None of these brought lasting relief. In fact, one round of aggressive PT made her symptoms worse, especially her autonomic issues (POTS-like symptoms).

Our Plan

We agreed to try ultrasound-guided dry needling once a week for 9 sessions. The target muscles were:

• Scalenes

• Pectoralis minor

• Trapezius

• Suboccipitals

Our goals were clear:

• Relieve pain and muscle tension

• Improve function so she could return to daily life

• Avoid surgery

• Reduce the risk of CRPS or further complications

Her Results

The progress was steady and encouraging:

• After two treatments, her pain dropped from 5–6/10 to 3–4/10.

• Her neck felt looser, and stiffness improved.

• Autonomic symptoms (palpitations, dizziness, sweating) began to ease.

• She did not require surgery.

There were minor side effects — one day, her blood pressure spiked for a few hours after treatment — but overall, she tolerated the sessions well and improved more than she had with years of other therapies.

How Muscle Tension Connects to Dysautonomia

One of the most fascinating aspects of Marissa’s case was how her autonomic symptoms improved alongside her pain.

Here’s why: the sympathetic chain — part of the autonomic nervous system — runs very close to the muscles and nerves compressed in TOS. When those muscles are tight, they don’t just pinch nerves going into the arm. They can also irritate or influence the sympathetic chain, leading to symptoms like:

• Increased heart rate

• Fluctuating blood pressure

• Sweating

• Digestive issues

By releasing the compression with precise, ultrasound-guided needling, we were able to improve not just her musculoskeletal pain, but her whole-body balance.

Why Patients Choose Ultrasound-Guided Dry Needling

Patients often tell us they feel nervous about having needles in their neck — and that’s completely understandable. This is a delicate area.

But when we show them the live ultrasound screen — where they can see the needle moving directly into the tight muscle, away from nerves and vessels — they feel reassured.

The advantages are clear:

• It’s non-surgical

• It’s targeted and precise

• It addresses both pain and autonomic symptoms

• It avoids the risks of major surgery like first rib removal

For patients who are tired of being told their only option is surgery, this approach can feel like a lifeline.

Common Questions Patients Ask

“How many treatments will I need?”
Every case is different. In Marissa’s case, she had 9 weekly sessions. Some patients need fewer; others may benefit from ongoing care depending on severity.

“Is it painful?”
The needles are very thin, and most patients tolerate the procedure well. Some soreness afterward is normal, but many people feel immediate relief or loosening.

“What are the risks?”
The main risks are temporary soreness, mild bleeding, or temporary flare of symptoms. With ultrasound guidance, we minimize the chance of nerve or vascular injury.

“Will it fix my TOS completely?”
For some, yes. For others, it may be part of a long-term management plan alongside exercise, posture training, and stress reduction. The important thing is that it often helps avoid surgery.

Conservative First, Surgery Last

The big takeaway is this: if you have thoracic outlet syndrome — especially neurogenic TOS — consider conservative care first.

Dry needling, guided by ultrasound, is a powerful option that many patients have never been told about. For some, it can mean the difference between years of pain or a major surgery — and a safe, non-invasive pathway back to normal life.

Final Thoughts

Marissa’s story is not unique. We are seeing more patients with thoracic outlet syndrome complicated by dysautonomia, and many of them improve with precise, targeted dry needling.

If you’re living with neck pain, tingling, dizziness, or POTS-like symptoms and you’ve been told surgery is your only option — know that there are other ways forward.

Ultrasound-guided dry needling combines the best of modern imaging with the precision of targeted muscle release. It’s safe, effective, and patient-centered. And most importantly: it gives people their lives back.