AB142. SOH26AB_0096. Trapezius muscle and spinal accessory nerve hydrodissection: a case report

Background: Neck pain is common. Joint and muscle sources of neck pain are common. Hydrodissection is a minimally invasive technique involving the injection of fluid to separate fascial layers and release entrapped nerves and tendons. Its use in trapezius hydrodissection has been reported. The spinal accessory nerve innervates the trapezius muscle. Simultaneous hydrodissection of the trapezius muscle and spinal accessory nerve has not been reported. The simultaneous technique may offer a benefit in this patient cohort.

Case Description: A 42-year-old female presented with longstanding unilateral neck and shoulder pain, which was minimally responsive to first-line treatment. She had undergone physiotherapy and was on an assortment of oral analgesics. In a theatre setting, under monitoring and sterile conditions, the patient underwent an ultrasound-guided procedure. Fifteen mL of 5% dextrose was injected to release pressure on the nerves and surrounding tissue by spreading apart layers of fascia of the trapezius muscle and spinal accessory nerve. The patient reported immediate relief from symptoms. She was followed up at eight weeks and disclosed no complications; in fact, she obtained a significant improvement in quality of life and was able to complete activities of daily living with increased ease.

Conclusions: We put forward this case as an example of how a simultaneous hydrodissection of the trapezius and spinal accessory nerve may be used as a minimally invasive therapeutic intervention for long-term relief of refractory, debilitating myofascial neck pain.

Keywords: Hydrodissection; neck pain; trapezius; spinal accessory nerve; case report