Ultrasound-guided10%dextroseinterfascialhydrodissectionforpatientswithmyofascialpainsyndrome:Aretrospectiveobservationalstudy

Myofascial pain syndrome (MPS) is one of the most common causes of musculoskeletal pain, with episodes triggered by myofascial trigger points. While various physical therapies, medications, and even botulinum toxin can help many patients, a subset of individuals remains dissatisfied with conventional treatments. Interfascial hydrodissection (IH), sometimes called "Liquid Knife," has emerged as a novel approach that targets fascial adhesions between muscles by injecting solution into interfascial spaces. Dextrose solutions have shown promise in prolotherapy and nerve hydrodissection for chronic musculoskeletal conditions, but the efficacy of 10% dextrose specifically for IH in MPS had not been previously evaluated.

This study aimed to fill that gap by examining whether ultrasound-guided 10% dextrose interfascial hydrodissection could reduce pain and improve quality of life in patients with refractory MPS.

The researchers conducted a retrospective analysis of 95 patients with refractory MPS treated at their Physical Medicine and Rehabilitation outpatient clinic between June 2022 and June 2024. All patients had failed to respond to conventional treatments including medical therapy, physical therapy, and manual therapy, and had Numerical Rating Scale (NRS) scores of 5 or higher with symptom duration of at least 2 months. Patients received ultrasound-guided injections of a premixed solution containing 10% dextrose (prepared from 50% dextrose 1 mL, 2% lidocaine 2 mL, and 0.9% sodium chloride 2 mL). Under real-time ultrasound guidance using an in-plane approach, 5 mL of the solution was slowly injected into the fascial space beneath each trigger point, with successful injection confirmed by visible separation of fascial layers.

Patients could receive up to 3 weekly injections if pain remained above 3 on the NRS. All patients were also instructed to perform daily self-stretching exercises. Outcomes were assessed by a blinded evaluator at baseline, 4 weeks, and 12 weeks after the final injection, measuring NRS pain scores at rest, at night, and during exercise, as well as EQ-5D-5L quality of life dimensions.

The study found significant pain reduction following treatment. Among 95 patients, 79 (83.1%) reported significant relief after the initial treatment, and at 12-week follow-up, 67 patients (70.5%) continued to report satisfactory pain relief with NRS scores of 3 or lower. NRS scores showed statistically significant decreases at both 4-week and 12-week follow-ups compared to baseline across all three conditions: at rest (median 5.0 to 2.0), at night (median 6.0 to 2.0), and during exercise (median 6.0 to 2.0), with P < .05 for all comparisons. However, no significant differences were found between the 4-week and 12-week time points, suggesting sustained rather than deteriorating effects.

For quality of life, the EQ-5D-5L showed no significant changes in mobility, self-care, or usual activities (P > .05), but significant improvements in pain/discomfort (from mean 3.17 to 1.57 at 12 weeks) and anxiety/depression (from mean 2.48 to 1.54 at 12 weeks), both with P < .05. Adverse effects were minimal and self-limited, consisting only of occasional injection-related pain and minimal bleeding or bruising, with no serious adverse events observed.

This study provides promising evidence that ultrasound-guided 10% dextrose interfascial hydrodissection is a safe and effective option for patients with refractory MPS who have not responded to conventional treatments. The treatment offers both short-term and sustained pain relief, with over 70% of patients maintaining satisfactory outcomes at 3 months. The improvement in anxiety and depression dimensions is particularly noteworthy, as chronic MPS is often associated with psychological distress. The lack of improvement in mobility, self-care, and usual activities likely reflects that this patient cohort, while in significant pain, did not have severe functional limitations at baseline.

For clinicians, this suggests that IH with 10% dextrose may be particularly appropriate for patients whose primary complaint is pain rather than disability. The procedure's safety profile and the use of ultrasound guidance for precision are additional advantages. However, the retrospective design, lack of control group, and relatively small sample size mean that randomized controlled trials comparing dextrose IH to sham or active treatments are still needed to confirm these findings and establish optimal treatment parameters including concentration, volume, and number of injections.