Neurogenic thoracic outlet syndrome (nTOS) is a condition caused by compression of the brachial plexus in the thoracic outlet, often leading to pain and paresthesia. In this article, we report a 34-year-old female patient with chronic nTOS symptoms refractory to prior management. Ultrasound-guided diagnostic blocks of the anterior scalene and pectoralis minor muscles provided significant temporary relief. Subsequent ultrasoundguided onabotulinum toxin A (BTX-A) injections into the scalene muscles resulted in near-complete symptom resolution lasting approximately six months. Over an 18-month follow-up, repeated injections at six-month intervals produced consistent clinical improvement without adverse effects. In conclusion, repeated ultrasound-guided BTX-A injections may be a safe and effective option within a multimodal treatment approach for nTOS.

While post-thoracotomy pain syndrome is a known phenomenon in thoracic surgery, its occurrence after pleural shunt placement has not been described in the literature. A 41-year-old female with a history of Chiari I decompression surgery was admitted with a complaint of paresthesia, neuropathic pain affecting all extremities, and gait difficulty. Cervical magnetic resonance imaging revealed a C2-7 syringomyelia, and a syringopleural shunt was placed. The patient improved both clinically and radiologically, but after four months of follow-up, she complained of pain near the thoracic incision and in the dermatome relevant to the intercostal nerve root. The wound was surgically explored, and reactive changes to the shunt catheter were found near the intercostal nerve root. The shunt was subsequently removed, and a syringoarachnoidal shunt was placed instead. The patient improved postoperatively and was discharged without any complications. In conclusion, careful consideration of the location and course of the intercostal nerves is essential when placing pleural shunt systems.

Interventional spine procedures are widely used non-surgical approaches for the management of acute and chronic pain. Although usually considered safe, these procedures may still be associated with temporary and minor complications, including hiccups. In this article, we report a rare case of a 60-year-old male patient with low back pain who developed recurrent hiccups following a lumbar epidural steroid injection. In conclusion, the exact mechanism of hiccups remains unclear, and their relationship with the level of epidural injection or the specific drug mixture used is not well established. As hiccups following epidural injections have been insufficiently documented in the literature, this case aims to highlight hiccups as a potentially under-recognized adverse effect of epidural steroid injections in interventional pain management.