Orthopedics · Medical Literature
The analgesic effect of ultrasound-guided fascia hydrorelease around the artery for myofascial neck pain: a prospective single-arm interventional study.
Abstract
Myofascial pain syndrome (MPS) is a major cause of chronic neck pain, with tissue ischemia implicated as a contributing factor. This prospective, single-arm interventional study evaluated the analgesic effect of ultrasound-guided fascia hydrorelease (US-FHR) performed around arteries supplying the neck in patients with chronic neck MPS. Thirteen adults (median age 53.0 years; 38.5% female) underwent US-FHR targeting the perivascular fascia of either the transverse cervical or dorsal scapular artery using 2 mL of normal saline. Pain intensity was assessed by visual analog scale (VAS) at rest and during movement; disability by the 5-item Pain Disability Index, Japanese version (PDI-5-J); and arterial blood flow volume before and after the procedure. The primary outcome, pain VAS during movement, decreased from 49.0 mm (interquartile range [IQR], 44.5-64.0) at baseline to 22.0 mm (IQR, 14.5-31.5) at 15 min and 22.0 mm (IQR, 14.0-34.0) at 1 week (Hodges-Lehmann median difference, 30.5 mm [95% CI, 24.5 to 36.5] and 28.5 mm [95% CI, 18.5 to 37.0]; both P < 0.001). Pain VAS at rest improved from 21.0 mm (IQR, 13.0-43.5) to 8.0 mm at 15 min and 1 week (median difference, 14.5 mm [95% CI, 9.0 to 24.0; P = 0.001] and 13.5 mm [95% CI, 6.0 to 21.0; P = 0.007]). PDI-5-J decreased from 17.0 (IQR, 10.5-23.0) to 13.0 (IQR, 4.0-17.5) at 1 week (median difference, 5 [95% CI, 2-8; P = 0.004]). Blood flow volume increased from 11.2 mL/min (IQR, 4.5-14.4) to 17.2 mL/min (IQR, 6.1-23.7) immediately after US-FHR (median difference, + 4.1 mL/min [95% CI, + 2.5 to +8.9; P = 0.001]), although transient. One patient experienced transient bleeding that was promptly controlled. In this single-arm feasibility study, US-FHR around the target artery was simple and safe to perform and was associated with reduced neck pain. Because the study lacked a control group, these preliminary findings should be regarded as hypothesis-generating and require confirmation in controlled trials; they may also inform the future evaluation of MPS in other anatomical regions. Trial registration: UMIN Clinical Trials Registry, UMIN000053612.
Clinical relevance
Myofascial pain syndrome (MPS) is a leading cause of chronic neck pain, yet its pathophysiology—particularly the role of perivascular fascial restriction and tissue ischemia—remains undertreated by conventional interventions. This study addresses a therapeutic gap by evaluating ultrasound-guided fascia hydrorelease (US-FHR) targeting the perivascular fascia of neck-supplying arteries, a novel anatomical approach not previously described in this population. Clinicians managing refractory cervical MPS should be aware of this emerging technique as a potentially simple, office-based procedural option pending controlled trial validation.
Key findings
1. Primary outcome (pain VAS during movement) decreased significantly from a median of 49.0 mm at baseline to 22.0 mm at 15 minutes post-procedure (Hodges-Lehmann median difference: 30.5 mm [95% CI, 24.5–36.5]; P < 0.001) and remained at 22.0 mm at 1-week follow-up (median difference: 28.5 mm [95% CI, 18.5–37.0]; P < 0.001). 2. Pain VAS at rest improved from a median of 21.0 mm at baseline to 8.0 mm at both 15 minutes (median difference: 14.5 mm [95% CI, 9.0–24.0]; P = 0.001) and 1 week (median difference: 13.5 mm [95% CI, 6.0–21.0]; P = 0.007). 3. Functional disability assessed by the PDI-5-J improved from a median of 17.0 at baseline to 13.0 at 1 week (median difference: 5 [95% CI, 2–8]; P = 0.004), indicating a clinically meaningful reduction in pain-related disability. 4. Arterial blood flow volume in the target vessel increased from a median of 11.2 mL/min at baseline to 17.2 mL/min immediately post-procedure (median difference: +4.1 mL/min [95% CI, +2.5 to +8.9]; P = 0.001), supporting the mechanistic hypothesis of ischemia relief via perivascular fascial decompression, though this effect was transient. 5. The intervention utilized only 2 mL of normal saline per session, targeting the perivascular fascia of either the transverse cervical or dorsal scapular artery under ultrasound guidance, suggesting a minimally invasive and low-cost procedural profile. 6. Safety profile was favorable in this small cohort (n = 13); one adverse event of transient bleeding was reported and was promptly controlled, with no other significant complications documented.
Practice implications
US-FHR using 2 mL of normal saline injected into the perivascular fascia of the transverse cervical or dorsal scapular artery under ultrasound guidance may be considered as a feasibility-stage procedural option for adults with chronic cervical MPS who have not responded to conservative measures, with clinically significant pain reduction observed as early as 15 minutes post-intervention and sustained at 1 week. Given the absence of a control group and the small sample size (n = 13), these findings are strictly hypothesis-generating and should not yet alter standard-of-care protocols; clinicians should await confirmation from randomized controlled trials before adopting this technique broadly. Periprocedural ultrasound visualization is essential to minimize vascular complications, and practitioners should be prepared to manage transient bleeding at the injection site.