The answer is at your fingertips: Idiopathic intercostal neuroma as a rare mimicker of chronic refractory dorsalgia

Background: Chronic thoracic dorsalgia is frequently attributed to degenerative spinal pathology identified on standard magnetic resonance imaging (MRI), a cognitive heuristic termed Spinal Centric Bias. Idiopathic intercostal neuroma (IN) is a rare, surgically curable peripheral nerve entity that is systematically overlooked within this diagnostic paradigm.  
Case Presentation: A 58-year-old female presented with 24 months of right-sided refractory neuropathic thoracic pain, initially attributed to incidental T5–T6 degenerative disc disease on axial spinal MRI. All conservative pharmacological measures failed. Targeted clinical examination elicited a positive Tinel-like sign along the 5th right intercostal space. High-resolution MR Neurography (T2-STIR) demonstrated a 6-mm subcutaneous fusiform lesion arising from the cutaneous branch of the right 5th intercostal nerve, exhibiting marked T2 hyperintensity and a characteristic tail sign. Ultrasound-guided diagnostic nerve block produced immediate, complete pain resolution. Surgical neurectomy with intramuscular stump transposition was performed; histopathology confirmed idiopathic neuroma. The patient was symptom-free at 12-month follow-up.  
Conclusion: A structured three-step protocol systematic topographic palpation, dedicated MR Neurography, and image-guided nerve block enables accurate diagnosis and curative surgical treatment of idiopathic intercostal neuroma, preventing years of diagnostic wandering.