Disclosures: Zachary Bailowitz, MD, FAAPMR: No financial relationships or conflicts of interest

Case Diagnosis: Chronic calf pain

Case Description: A 51-year-old male, previous marathon runner, presented to clinic with 10 years of calf and Achilles pain. He had previously been diagnosed with Achilles tendinopathy, but despite conservative treatments had not been able to run for 10 years. He described pain and tightness in his calf and Achilles that was low level at baseline but became prohibitive with exertion. Physical exam revealed tenderness in his medial and lateral gastrocnemius that referred down to the Achilles. Diagnostic ultrasound did not reveal any abnormalities in the Achilles tendon, gastrocnemius, or soleus. At his initial visit, trigger point injections were performed in his gastrocnemius and soleus, which provided him partial relief for only a few days. At a return visit, due to his persistent tightness and pain, we performed an ultrasound-guided hydrodissection of the fascial plane between the soleus and gastrocnemius muscles in addition to the same trigger points. The procedure was tolerated well, provided him with about 8 weeks of relief, and enabled him to run for the first time in 10 years.

Setting: Outpatient sports medicine clinicAssessment/

Results: The hydrodissection procedure was repeated at a subsequent visit and gave him >12 weeks relief. To date he remains improved and continues to run.

Discussion: Calf injuries are common in athletes and typically resolve with conservative treatment. However, a subset of patients can have chronic calf pain that limits athletic participation. Despite normal imaging, fascial adhesions between muscles have been thought to contribute to chronic muscular pain. Fascial hydrodissections have been described in the literature for hamstring injuries, but to our knowledge, this is the first case of fascial hydrodissection used to treat chronic calf pain.

Conclusion: Ultrasound-guided fascial hydrodissection is an emerging technique for managing chronic muscle injuries and should be considered as a potential treatment option when other conservative measures have failed.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/ultrasound-guided-fascial-plane-hydrodissection-for-chronic-calf-pain/