AB101. SOH24AB_165. Trapezius muscle hydrodissection as a novel treatment for chronic neck and shoulder pain

Background: Neck pain is a common condition with multiple potential causes. Myofascial pain is a component and is characterised by painful trigger points in a taut band of skeletal muscle. Its’s underlying pathophysiology is poorly understood. Recent studies, however, have confirmed the presence of nerve structures within fascial layers. This has questioned the possible contribution of fascial nerve entrapment to myofascial pain and several musculoskeletal disorders such as chronic neck and back pain. Hydrodissection is a novel technique used to separate fascia from underlying structures using a combination of local anaesthetic and saline or 5% dextrose. It’s proposed mechanism of action involves the release of entrapped nerves from a rigid fascial matrix.

Methods: We present the case of a 39-year-old gentleman suffering from chronic neck and back pain after a road traffic accident five years previously. This was unresponsive to pharmacological therapy, physiotherapy and previous cervical facet injections. An ultrasound-guided hydrodissection of the trapezius muscle fascial layer was carried out in the prone position. Nine mL of 0.9% saline, 1 mL of 0.25% levobupivacaine and a total of 40 mg of triamcinolone was injected on each side of the muscle.

Results: No immediate complications were reported. On follow-up questioning two weeks later the patient reported a drastic improvement in his symptoms, with his numeric pain rating scale score decreasing from eight to two and a significant improvement in his quality of life.

Conclusions: Myofascial nerve entrapment is a potential cause of several chronic pain disorders. This case highlights the effectiveness of hydrodissection in the short-term relief of chronic neck pain. Further research is required to determine its long-term effectiveness and applications in other regional pain syndromes.

Keywords: Hydrodissection; myofascial pain; ultrasound; neck pain; trapezius muscle