AB278. SOH26AB_0178. Sonopalpation for targeted trapezius hydrodissection: a case report

Background: Trapezius involvement in chronic neck pain is a common phenomenon, occurring either as a separate, contributory pathology or as a secondary effect of persistent pain and associated alterations in movement patterns. Trigger point injections are a commonly employed technique for treatment of palpably tender foci, but this technique provides little guidance regarding the depth of needle insertion or the reproducibility of effect between practitioners.

Case Description: We present the case of a 27-year-old woman who experienced chronic neck pain with associated trigger point tenderness as part of a whiplash-associated disorder following a road traffic collision 2 years earlier. She was experiencing substantial limitation to her normal range of motion and had undergone trigger point injections twice in the past, with mixed benefits at identified sites each time. A theatre-based procedure involving sonopalpation with a linear 12 MHz ultrasound probe was undertaken, with markedly increased echolucency of the fascial plane at the point of maximal tenderness as reported by the patient. Following this identification, hydrodissection with 5% dextrose was performed to separate the fascial layers, release entrapped small nerves, and address perineural inflammation. Following this targeted hydrodissection, the patient experienced substantial improvement in both pain and range of movement, facilitating engagement with a recommended course of neck stretches demonstrated and explained to the patient at the time of injection. At 2 months of follow-up, there was continued improvement in the range of movement and a substantial reduction in her pain experienced. No complications were reported.

Conclusions: This case supports the use of sonopalpation as a technique to identify echolucent sites of maximal tenderness in the trapezius and guide targeted hydrodissection as a key element of multimodal efforts to improve neck range of motion. This can be considered as a potential alternative to, or component of, trigger point injections of the trapezius.

Keywords: Hydrodissection; pain medicine; sonopalpation; trapezius; case report