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Spinal accessory nerve entrapment is difficult to diagnose due to its overlapping clinical features with other common diseases and nerve entrapments. It severely affects the life of an individual as normal neuronal physiology of the nerve is important for proper functioning and stability of the shoulder girdle. The patient develops symptoms like pain over the shoulder and neck, drooping of the shoulder, and weakness of overhead abduction of the arm. Ultrasound-guided block of this nerve has been described in the literature, but hydro-dissection using ultrasound as treatment has not been described yet. We have reported a case of spinal accessory nerve entrapment following sebaceous cyst excision in the posterior neck which was diagnosed clinically and confirmed using ultrasound-guided block and managed simultaneously by hydro-dissection. A case of 56 years female who underwent sebaceous cyst excision in the posterior triangle of the neck on the right side in May 2016. After 6 weeks of surgery, the patient developed pain in the right shoulder and gradually developed weakness in the overhead abduction of the arm. She went from one hospital to another for her pain relief but her pain remained undiagnosed and untreated. She came to Daradia Pain Hospital with complaint of pain in her right shoulder.