Case Study: Deciphering Middle Back Pain

Our Patient

Our patient is a 57 year old male complaining of right posterior thoracic pain that had persisted for over a month. The patient also reported chronic flatulence.

Our Diagnostic Process

Clinical Exam

Our initial clinical exam led us to suspect myofascial pain, with possible nerve compression at the junction of vertebrae T 7-8, and possible respiratory issues.

Diagnostic Ultrasonography

We used high-resolution diagnostic ultrasonography to examine the structures and organs within the thoracic space.


Our diagnostic ultrasound exam revealed:

  • An untreated myofascial trigger point at the level of T 6-8, confirming our suspicions of myofascial pain.
  • A small lesion in the right thoracic wall.
  • Lymphadenopathy (swelling) of the axillary lymph nodes in the retroperitoneal space – the area that includes the adrenal glands, aorta, kidneys, esophagus, ureters, pancreas, rectum, and parts of the stomach and colon.
  • A cyst on the left kidney, with impoverished blood vessel architecture in both kidneys – signs of nephropathy (kidney disease).
  • Diffuse changes in the liver parenchyma (liver cells).
  • Absence of fluid in the pleural cavities and fully pneumatized alveoli, ruling out potential respiratory factors.


Musculoskeletal pain is often secondary to lifestyle-induced disorders that disrupt the synchronicity of the body’s systems. Treating myofascial pain without considering other factors is likely to produce unsatisfactory results while overlooking critical health issues.


High resolution diagnostic ultrasonography gives us real-time images of the body’s structures and organs, empowering us to detect potential health problems that contribute to pain and dysfunction. Our holistic approach to patient care goes beyond treating symptoms, to uncovering and addressing issues that pose greater health threats.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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