A Novel Dual-Modality Approach Using Trapezius Hydrodissection and Botulinum Toxin for Chronic Neck Pain

Chronic neck pain is a common and disabling condition, with Myofascial Pain Syndrome (MPS) of the upper trapezius muscle frequently contributing to symptoms. Standard treatments often provide only transient relief, and many patients remain refractory. Ultrasound-guided hydrodissection and botulinum toxin A (BoNT-A) injection are emerging therapies targeting mechanical and neuromuscular contributors to myofascial pain, respectively. However, their combined use has not previously been reported. We present the case of a 30-year-old female with chronic right-sided neck pain lasting over one year, unresponsive to oral medications, physiotherapy, and corticosteroid injections. Examination revealed localized trapezius tenderness and reduced cervical range of motion, without radiographic pathology. The patient underwent an ultra-sound-guided hydrodissection of the upper trapezius, targeting the interfascial plane between the trapezius and underlying musculature. This was followed by BoNT-A injections into three ultrasound-guided trigger points within the muscle. The patient reported immediate pain reduction (NAS 7/10 to 1/10 post-procedure) and sustained improvement at 6 and 12 weeks (3/10 and 2/10, respectively), with restoration of functional capacity and cessation of analgesic use. This is the first case to support the use of combined ultrasound-guided trapezius hydrodissection and botulinum toxin A injection as a novel, safe, and effective option for patients with chronic myofascial neck pain unresponsive to conventional therapy. The dual-modality approach addresses both mechanical adhesions and neuromuscular hyperactivity and may represent a valuable addition to the interventional pain management toolkit. These results warrant further investigation of this technique in the management of chronic myofascial pain syndrome.