Carpal tunnel syndrome is a common nerve compression condition caused by the entrapment of the median nerve as it passes through the carpal tunnel at the wrist. Symptoms include numbness, tingling, or weakness in the hand, particularly affecting the thumb, index finger, and middle finger. While mild cases may respond to physiotherapy, more severe cases may need an injection. Typically, we administer a cortisone injection into the carpal tunnel, which yields reasonably good results. However, a new procedure called ultrasound-guided hydrodissection median nerve may be more effective. This blog examines the role of carpal tunnel hydrodissection, including its definition, mechanism of action, and the evidence regarding its effectiveness.
What Is Hydrodissection Median Nerve?
Nerve Hydrodissection is an advanced ultrasound-guided procedure used to release a compressed nerve by mechanically separating it from surrounding tissues. In the case of carpal tunnel hydrodissection, we inject fluid around the median nerve under ultrasound guidance to create space between the nerve and the retinaculum lining the top of the carpal tunnel.
Generally, the injected solution consists of a combination of:
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A small dose of local anaesthetic
- Sterile water or normal saline
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Occasionally, cortisone is used, although some doctors prefer not to use it to minimise side effects.
Sometimes, doctors use other injectables such as PRP or 5% dextrose.
The goal is to restore normal nerve gliding and reduce nerve pressure. This can reduce symptoms and potentially avoid the need for surgery.
How Do We Perform a Carpal Tunnel Hydrodissection?
We do the procedure in a treatment room with ultrasound guidance, which ensures correct needle placement and confirmation of fluid tracking around the nerve.
Steps include:
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The patient lies down with their palm facing up.
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We identify the median nerve in the carpal tunnel.
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A fine needle is inserted close to the nerve, taking care to avoid direct trauma.
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We inject fluid slowly around the nerve, creating a visible separation between the nerve and the retinaculum above and the tendons below.
Usually, the procedure takes 15 minutes and does not require stitches. Patients can return to normal activities shortly afterwards, though some may experience temporary soreness or bruising. Generally, everyday activities are resumed after 48 hours. Patients should not drive home after the procedure.
Is a Carpal Tunnel Hydrodissection Effective?
Several studies have shown promising results for mild to moderate carpal tunnel syndrome, especially for those who prefer to avoid surgery.
A 2017 study found that ultrasound-guided hydrodissection using 5% dextrose led to significant improvements in symptom severity and nerve conduction parameters, with effects lasting up to six months.
A 2021 review concluded that hydrodissection appears to be safe and can offer positive long-term effects in 88% of cases. On average, patients needed between 2 and 3 injections for a lasting impact.
Studies show that hydrodissection median nerve may provide superior results in terms of recovery when compared to a simple cortisone injection.
While hydrodissection may not replace surgery in severe or advanced carpal tunnel syndrome, it can be an intermediate step in managing carpal tunnel syndrome. It may also be better than a simple cortisone injection.
Who Would Benefit from a Hydrodissection Median Nerve?
Patients who may benefit from a carpal tunnel hydrodissection include:
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Patients with persistent carpal tunnel syndrome who have not improved with splinting and physiotherapy.
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Recurrent symptoms after a steroid injection or surgery.
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Patients who prefer a non-surgical approach.
It is not suited to severe carpal tunnel syndrome with hand muscle wasting. We prefer surgery for these cases.
Other Frequently Asked Questions about hydrodissection Median Nerve:
How does carpal tunnel hydrodissection compare to surgery?
One study looked at hydrodissection compared to surgery in severe carpal tunnel syndrome. Results indicate that hydrodissection is as effective as surgery and should be considered even in severe carpal tunnel syndrome.
What is the best way to perform carpal tunnel hydrodissection?
A new study found that this procedure worked best if the following was performed:
- Volume injection of about 5mls
- Use of ultrasound to guide the needle
Final Word from Sportdoctorlondon about Hydrodissection Median Nerve
Hydrodissection median nerve offers a treatment option for carpal tunnel syndrome, which may be better than a simple cortisone injection. For athletes, active individuals, or patients who want to avoid surgery, carpal tunnel hydrodissection may provide a safe and effective alternative. If you’re experiencing symptoms of carpal tunnel syndrome and are looking for non-surgical solutions, speak to a sports medicine specialist experienced in ultrasound-guided median nerve hydrodissection to see if this intervention is proper for you.
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