AB284. SOH26AB_0300. Ultrasound-guided hydrodissection in the management of myofascial-type pain: a narrative review

Background and Objective: Myofascial-type pain is a prevalent yet often under-recognised cause of chronic musculoskeletal pain. It is characterised by hyperirritable trigger points within muscles and fascia that can generate both local and referred pain, leading to significant functional impairment and reduced quality of life. Its mechanisms are multifactorial, involving muscle overuse, altered fascial mobility, and peripheral and central sensitisation. Hydrodissection has recently emerged as a promising ultrasound-guided intervention for managing myofascial and related pain syndromes. By mechanically separating nerves and fascia from surrounding tissues through targeted fluid injection, hydrodissection aims to restore mobility, reduce entrapment, and alleviate pain. Ultrasound offers superior soft tissue resolution, real-time guidance, portability, and cost-effectiveness, making it the imaging modality of choice. The objective was to conduct a review of the associated literature.

Methods: A narrative review of the literature was conducted, examining the background, technique, clinical applications, advantages, limitations, and training aspects of ultrasound-guided hydrodissection, with particular focus on its role in myofascial-type pain.

Key Content and Findings: Evidence from case reports, cohort studies, and small randomized trials suggests hydrodissection provides pain relief and functional improvement in peripheral nerve entrapment (e.g., carpal tunnel syndrome, cervical radiculopathy) and musculoskeletal conditions. Emerging data also support its role in myofascial-type pain by addressing fascial adhesions and trigger points. Reported complications are rare, typically minor, and self-limiting. Best practices are evolving, with increasing use of in-plane ultrasound guidance and dextrose-based injectates.

Conclusions: Ultrasound-guided hydrodissection is a promising, minimally invasive intervention for neuropathic, musculoskeletal, and myofascial-type pain. Its advantages include safety, versatility, and enhanced diagnostic feedback. However, current evidence is limited by small sample sizes, heterogeneous protocols, and short follow-up. High-quality randomized controlled trials are required to confirm efficacy, refine technique, and standardise training.

Keywords: Hydrodissection; myofascial; pain; ultrasound