Introduction
Hydrodissection and hydrorelease are new procedures that are gaining traction in treating fascia. Fascia is not only a protective covering of many organs, nerves, bone, skin, and muscle but also has many nerves fibers that course through it. When fascia is injured or develops scar tissue, the nerve endings can get irritated and cause pain. A hydrodissection procedure involves injecting a fluid under ultrasound guidance to release tight fascia that is pushing on a nerve, such as the carpal tunnel nerve. A hydrorelease is similar but specifically involves injecting a fluid under ultrasound guidance to break up scar tissue or fascial adhesions, most often found in muscle. Both procedures are showing immense success in the clinic.
Hydrodissection
Instead of immediately getting surgery for an entrapped nerve, you may consider a hydrodissection first. There are four common areas in which a nerve hydrodissection is performed. The first involves hydrodissecting the dorsal scapular nerve, which is the nerve that causes pain in the upper back and near the shoulder blades. This nerve can be entrapped between the fascia that separates the trapezius and rhomboid muscles. A hydrodissection in this area can significantly reduce pain, but it may take a few sessions because of the large area of this particular fascial plane.
The second most common area involves hydrodissecting the cluneal nerve, which is a common (often underdiagnosed) cause of low back pain. Similar to the hydrodissection of the dorsal scapular nerve, it may take many treatments to fully release the nerve. However, many patients do report significant improvement after the first treatment.
Hydrodissection of the median nerve (carpal tunnel nerve) and ulnar nerve at the elbow (cubital tunnel) can also lead to significant improvement. Numbness and tingling in the hands and fingers often come from fascial entrapment of the ulnar and median nerves. Performing a fascial hydrodissection can allow improved blood flow and function to the nerves now that they are no longer compressed.
Hydrorelease
A hydrorelease is virtually the same procedure as a hydrodissection, but involves fascia in and between muscles. When viewing areas of pain under ultrasound imaging, fascia thickening is a common theme. Instead of two sheets of fascia, a fascial adhesion may involve 5 or 6 layers that are tight and do not move well. When multiple areas of abnormal fascial planes exist in an area that causes pain, a hydrorelease procedure may be considered.
Under ultrasound guidance, the physician will inject a fluid between the fascial planes to spread them apart and release them. The hydrorelease procedure typically involves treating a wide area to reduce fascial tightness. The most common areas of a fascial hydrorelease include the neck, trapezius muscles, pec muscles, biceps, forearms, mid and low back, glutes, hamstrings, quadriceps, and calves. Quite often fascial release can also be performed for the foot. We may recommend equipment, such as a hamstring sleeve after the procedure.
Similar to hydrodissections, a hydrorelease can offer immediate relief but is best used for long-term treatment. More than one hydrorelease session may be needed.
Summary
While hydrodissection and hydrorelease procedures are emerging in the field of musculoskeletal and sports medicine, the concepts are simple, reasonable, and effective. The hydrodissection and hydrorelease procedures involve little downtime so our patients can go back to doing what they love as soon as possible.
