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Lumbar transverse process (TP) fractures are often overlooked, leading to chronic pain that is frequently refractory to standard treatments. This case report describes the diagnostic use of musculoskeletal ultrasound (MSK-US) and a novel therapeutic application of ultrasound-guided hydrodissection for a case of neglected TP stress fracture. A 41-year-old male presented with an 18-month history of chronic right groin and thoracolumbar pain, unresponsive to extensive prior treatments, including physical therapy, medications, and multiple nerve blocks. MSK-US confirmed a cortical irregularity and step-off deformity at the left L2 TP, with sonoguided digital palpation precisely localizing the source of his symptoms. An ultrasound-guided hydrodissection procedure was performed using 5% dextrose in water (D5W) to address suspected neurovascular entrapment. The patient reported an immediate 80% reduction in resting pain following the procedure. After two additional weekly sessions, he achieved a sustained 95% pain reduction and complete resolution of physical examination deficits. Follow-up imaging demonstrated evidence of bony healing. This case highlights MSK-US as a pivotal diagnostic tool for elusive chronic TP fractures and introduces ultrasound-guided hydrodissection as a novel, minimally invasive therapeutic strategy. This "image-and-intervene" paradigm effectively provided rapid pain relief, functional restoration, and facilitated a healing environment, offering a promising approach for managing similar refractory chronic pain conditions.
Yoon et al. (Sun,) studied this question.