Background: Thumb pain frequently arises from multiple conditions—de Quervain’s tenosynovitis, carpometacarpal (CMC) osteoarthritis, carpal tunnel syndrome, intersection syndrome, and myofascial pain syndrome—that often coexist yet are traditionally managed as separate entities. Fascial abnormalities, including hyaluronic acid-related densification and impaired interlayer gliding, have been proposed to constitute a shared pathological substrate underlying these conditions. Ultrasound-guided fascia hydrorelease (US-FHR) targeting fascial pathology has been used clinically for thumb–wrist pain; however, the anatomical targets and treatment regions have not been systematically described. Aim: This article presents a fifteen-point US-FHR clinical protocol for five converging thumb pain conditions, based on shared fascial abnormalities—densification and impaired interlayer gliding—that these conditions may have in common. It further provides a shared practical framework for pain physicians, orthopedic specialists, hand therapists, and acupuncturists. Methods: The protocol was organized based on a focused literature review on fascial biology, thumb–wrist anatomy, and the five converging conditions, combined with long-term clinical experience at Kimura Pain Clinic. For each POINT, the anatomical rationale, associated pain pattern, procedural concept, and major safety considerations were summarized. A four-direction screening test (thumb flexion, extension, abduction, and adduction) assessed in three modes (active contraction, resistance loading, and passive stretch), combined with nine established clinical tests, was integrated to identify the affected fascial structures. A diagnostic ultrasound finding characterized by multi-layered hyperechoic bands with reduced interlayer gliding—the sonographic appearance termed “stacking fascia” (a hyperechoic, stripe-shaped lesion), a previously described morphological sign that may reflect fascial densification—is described. Results: The protocol comprises 15 POINTs distributed across two approaches: nine POINTs via a dorsal approach and six POINTs via a palmar approach. The dorsal approach (9 POINTs) covers the first and third extensor compartments, their intersections (1st–2nd and 2nd–3rd), the two radial-artery crossing points (Points 5 and 6, where the radial artery passes deep to the first-compartment and EPL/ECRB–ECRL tendons, respectively), Gokoku (Hegu), the adductor pollicis, and the deep palmar arch. The palmar approach (6 POINTs) covers the thenar muscles, transverse carpal ligament, paraneural sheath and interfascicular epineurium of the median nerve, the median-nerve/FPL/FCR interface, the median nerve within the carpal tunnel, and the deeper palmar ligamentous structures adjacent to the median nerve. Periarterial release around the radial artery is proposed as a hypothesis-generating approach to CMC osteoarthritis, in which fascial constriction of periarterial tissue may contribute to subchondral vascular compromise. For each POINT, the anatomical rationale, associated pain patterns, procedural concept, and safety considerations are integrated and described. Conclusions: The proposed fifteen-point protocol represents an expanded, structured, and clinical-experience-based framework for US-FHR in five converging thumb pain conditions sharing common fascial abnormalities. It may serve as a practical basis for the standardization, education, and broader dissemination of US-FHR in this population. Prospective observational studies, randomized controlled trials, and imaging validation studies are needed to evaluate its clinical effectiveness and to test the underlying mechanistic hypotheses, including potential periarterial vascular contributions to CMC osteoarthritis.

Background and Objectives: Non-odontogenic toothache often persists without an identifiable dental cause and may lead to unnecessary pulpectomy or tooth extraction. It may also result in long-term combined use of psychotropic medications, forming a recurrent clinical pattern. Ultrasound-guided fascia hydrorelease (US-FHR) targeting fascia-derived pathology has been applied to non-odontogenic toothache; however, treatment regions have not been systematically described. This article presents a proposed eleven-point US-FHR protocol for non-odontogenic toothache and related orofacial pain. Materials and Methods: This is an experience-based clinical protocol; it is not an efficacy study and does not include a new prospective study on human participants. The protocol was organized on the basis of long-term clinical experience at Kimura Pain Clinic and a focused literature search. Results: The protocol comprises 11 POINTs distributed across six anatomical regions: (1) three POINTs in the masticatory muscle region, (2) three POINTs in the medial pterygoid and capsular region, (3) one POINT in the parotid region, (4) two POINTs in the cervical region, (5) one POINT in the facial-artery region, and (6) one POINT in the upper posterior cervical region. For each POINT, the anatomical rationale, referred-pain pattern, procedural concept, and safety considerations are described. Conclusions: The proposed eleven-point protocol represents an expanded and structured development of the earlier four-region approach. Prospective, ideally controlled, studies are needed to evaluate its clinical effectiveness.

Background/Objectives: Non-specific low back pain (LBP) is multifactorial, and psychosocial factors are often important. Densified fascial tissues of the thoracolumbar and lumbogluteal fascial system, seen as “stacking fascia,” may represent one under-recognized and treatable peripheral source; routine imaging assesses the disc, vertebra and nerve root but not these tissues [1]. The release points presented are representative examples, not an exhaustive list. The objective is to present a standardized, multi-point ultrasound-guided fascia hydrorelease (US-FHR) protocol for the fascia-derived component of LBP, identified by the Fascial Pain Syndrome (FPS) criteria [2] and a stacking-fascia appearance on ultrasound, after exclusion of red-flag disease and clear radiculopathy. Methods: A Protocol Development Framework (narrative synthesis of anatomy, neurophysiology and the authors’ clinical experience; no new prospective dataset) was used to define diagnosis/evaluation, the US-FHR procedure and a region-based multi-point protocol. Results: Fifteen release points, ordered from the lower thoracic to the sacroiliac region, cover the thoracic paraspinal/latissimus–TLF continuity, serratus posterior inferior, diaphragm–quadratus lumborum interface at Th12, lumbar interfascial triangle, quadratus lumborum, psoas major at L2, lumbar plexus, posterior midline ligaments, thoracolumbar fascia, multifidus and peri-facet fascia, iliolumbar ligament, ligamentum flavum/flavum–facet point, superior cluneal nerve, gluteus medius and superior gluteal artery, and posterior sacroiliac ligament. Each point is described by anatomical rationale, referred-pain pattern, technique concept and safety, with a representative ultrasound still. Conclusions: The protocol describes a peripheral component of LBP that may be identifiable and treatable, and is offered as the methodological basis for a planned prospective study distinct from the single-site TLF pilot NCT06818175 [3].

Thumb pain is involved in multiple conditions—de Quervain’s tenosynovitis, carpometacarpal (CMC) osteoarthritis, carpal tunnel syndrome, intersection syndrome, and myofascial pain syndrome—that frequently coexist, yet they are traditionally managed as separate entities. These conditions may share a common pathological substrate: fascial densification characterized by hyaluronic acid aggregation and impaired fascial gliding. This narrative review synthesizes anatomical, biomolecular, and clinical evidence supporting a unified fascial basis for five converging thumb pain conditions. We describe a representative 15-point ultrasound-guided fascia hydrorelease (FHR) protocol targeting the shared fascial substrate of the thumb–wrist–forearm complex, with each treatment point mapped to specific anatomical stress concentration sites. Ultrasound examination consistently reveals “stacking fascia”—densified fascial layers visualized as hyperechoic band-like lesions with reduced gliding—across multiple anatomical sites in patients regardless of primary diagnosis. A four-direction screening test assessing thumb flexion, extension, abduction, and adduction in three modes (active contraction, resistance loading, and passive stretch), combined with nine validated clinical tests (Finkelstein, Eichhoff, WHAT, Phalen, Tinel-wrist, Grind, Lever, Durkan, and Tinel-dorsal/Wartenberg), enables systematic identification of the affected fascial structures. The 15-point FHR protocol addresses dorsal and volar fascial pathology, including periarterial release for potential vascular improvement in CMC osteoarthritis. We propose Thumb Pain Syndrome (TPS) as a unifying clinical framework recognizing the shared fascial substrate underlying five common thumb pain conditions. The 15-point FHR protocol offers a systematic, minimally invasive treatment approach that may serve as a non-surgical alternative for refractory cases where conventional pharmacological or surgical interventions have reached their limits. Further controlled studies are needed to validate this integrated fascial perspective.

Background: Non-odontogenic toothache often persists without an identifiable dental cause and may lead to unnecessary pulpectomy or tooth extraction. It may also result in long-term combined use of psychotropic medications, forming an entrenched clinical vicious cycle. Ultrasound-guided fascia hydrorelease (US-FHR) targeting fascia-derived pathology can be used to treat non-odontogenic toothache; however, treatment regions have not been systematically described. Aim: This article presents an eleven-point US-FHR protocol for non-odontogenic toothache and related orofacial pain, and provides a shared practical framework for pain physicians, dentists, physical therapists, and acupuncturists. Methods: The protocol was organized based on a focused literature search and long-term clinical experience at Kimura Pain Clinic. For each POINT, the anatomical rationale, referred-pain pattern, procedural concept, and major safety considerations were summarized. Results: The protocol comprises 11 POINTs distributed across six anatomical regions: (1) three POINTs in the masticatory muscle region, (2) three POINTs in the medial pterygoid and capsular region, (3) one POINT in the parotid region, (4) two POINTs in the cervical region, (5) one POINT in the facial-artery region, and (6) one POINT in the upper posterior cervical region. For each POINT, the anatomical rationale, referred-pain pattern, procedural concept, and safety considerations are integrated and described. Conclusions: The proposed eleven-point protocol represents an expanded and structured development of the earlier four-region approach. It may serve as a practical basis for the standardization, education, and broader dissemination of US-FHR in non-odontogenic toothache and orofacial pain, although prospective observational studies are needed to evaluate its clinical effectiveness.

Background and Objectives: Passive release — a release technique performed while the target tissue is held in a passively stretched position — applies to the joint capsule, ligaments, tendons, muscles, peripheral nerves, vessels and subcutaneous tissue; when the release is delivered by injection it is termed “passive release with hydrorelease”. In our experience, no local anesthetic is required, the stretched position makes tender stacking fascia easier to localize, and range of motion tends to improve more than with hydrorelease in a relaxed position. The aim of this article is to describe, in a reproducible form, the treatment points and ultrasound technique of passive release with hydrorelease across multiple body regions. Materials and Methods: This protocol is based on our clinical experience. Eight treatment points in six regions (forearm; shoulder; hip, anterior and posterior; gluteal region; posterior thigh; posterior knee) were selected from our practice. For each point, the patient position, the assistant-maintained passive stretch, the ultrasound visualization, the release procedure, and the safety considerations are described with demonstration videos. Results: The protocol is presented as eight point-by-point descriptions (P1–P8), each pairing a passively stretched position with hydrorelease of the target fascia, ligament or capsule, with the anatomical rationale and corresponding video (Videos S1–S8). Conclusions: This article describes passive release with hydrorelease as a reproducible multi-region protocol. It is a technique description based on our clinical experience; no claim of effectiveness is made, the technique is proposed as one element of multimodal care rather than as a stand-alone treatment, and its prospective evaluation remains a task for future studies.