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What It Is

• A minimally invasive injection technique that separates fascial layers, releasing adhesions and restoring gliding surfaces.

• Uses fluid (typically normal saline, 5% dextrose, anesthetic, or biologics like PRP) to mechanically “dissect” tissue planes.

• Performed under ultrasound guidance to ensure accurate placement between fascia, muscle, and neurovascular structures.

Physiologic Rationale

• Fascial adhesions restrict muscle movement and create myofascial pain, altered biomechanics, and nerve entrapment.

• Hydrodissection restores shear plane mobility, decreases nociceptive signaling, and improves blood flow to the area.

• Similar concept to nerve hydrodissection, but targeting fascial interfaces rather than peripheral nerves.

Indications

• Chronic myofascial pain syndromes

• Post-injury or post-surgical scarring/adhesions

• IT band, hamstring, quadriceps, and calf fascial tightness

• Thoracolumbar fascia dysfunction

• Peri-shoulder fascial restrictions (e.g., supraspinatus, infraspinatus fascia)

• Plantar fascia pain (as an alternative to injection into the fascia itself)

• Tendon-gliding limitation due to fascial thickening

Common Solutions Used

• Normal saline (most common, safe, inexpensive)

• D5W (used in perineural therapy; analgesic mechanism via TRPV1 modulation)

• Local anesthetic (0.1–0.5% lidocaine or ropivacaine)

• PRP added after hydrodissection for regenerative effect (optional step)