Ultrasound Guided Fascial Hydrodissection for Treatment of Acute Hamstring Strains: A Retrospective Chart Review

Background and/or Objectives: Acute hamstring muscle strains encompass a large portion of acute, sports-related musculoskeletal injuries at all levels, especially in those that have high sprinting demands such as track, football, rugby, and dancing. Hydrodissection, employed for peripheral nerve entrapments such as carpal tunnel syndrome, entails delicately separating the median nerve from the surrounding retinaculum and connective tissue to prevent injury during injection while also mitigating soft tissue adhesions causing entrapment. Although the literature on hydrodissection for myofascial injuries is limited, there are sparse instances of its application for conditions such as nerve entrapment and tendinopathy. However, there is a lack of reporting outcomes of a fascial hydrodissection for acute hamstring strains. The objective of this study is to evaluate the efficacy of ultrasound-guided fascial hydrodissection in treating acute fascial hamstring strains, focusing on pain relief and return to athletic activity.

Design: Retrospective chart review.

Setting : An outpatient pain management clinic with a focus on a multidisciplinary approach to diagnosing and treating fascial disorders, hypermobility spectrum disorders, and Ehlers-Danlos Syndromes.

Participants : A total of 155 patients treated for acute hamstring strains between May 2018 and May 2023.

Interventions: Ultrasound-guided fascial hydrodissection with injectates consisting of four ccs of one percent lidocaine, four ccs of bupivacaine, and one cc of depodrol.

Main Outcome Measures: Pain relief and return to prior levels of athletic activity.

Results: Of 155 patients, 96.8 percent returned to their earlier levels of activity, and 92.9 percent reported complete pain relief. The average patient age was 30.5 years, and the semitendinosus muscle was the most commonly injured site (52.9 percent). Concurrent strains at multiple sites were observed in 21.3 percent of patients, emphasizing the need for comprehensive evaluation protocols.

Conclusions: Ultrasound-guided fascial hydrodissection is an effective intervention for managing acute hamstring strains, achieving significant pain relief and an expedited return to activity across a diverse patient population.