Carpal tunnel syndrome is a common nerve compression caused by 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 the thumb, index, and middle fingers. Mild cases may respond to physiotherapy, while more severe cases may require an injection. We usually give a cortisone injection into the carpal tunnel, which works reasonably well. But a newer procedure — ultrasound-guided median nerve hydrodissection — may be more effective. So what is carpal tunnel hydrodissection, and when should we do it?
What is median nerve hydrodissection?
Nerve hydrodissection is an advanced ultrasound-guided procedure that releases a compressed nerve by mechanically separating it from the surrounding tissues. For carpal tunnel syndrome, we inject fluid around the median nerve under ultrasound guidance, creating space between the nerve and the retinaculum, which forms the roof of the tunnel.
The injected solution usually contains:
- A small dose of local anaesthetic
- Sterile water or normal saline
- Occasionally cortisone, though some doctors prefer to leave it out to minimise side effects
Some doctors also use PRP or 5% dextrose. The goal is to restore normal nerve gliding and reduce pressure on it — which can ease symptoms and potentially avoid surgery.
How do we perform a carpal tunnel hydrodissection?
We perform the procedure in a treatment room under ultrasound guidance, which ensures correct needle placement and allows us to confirm that the fluid is tracking around the nerve.
- You lie down with your palm facing up.
- We identify the median nerve in the carpal tunnel.
- We insert a fine needle close to the nerve, taking care to avoid direct trauma.
- We inject fluid slowly around the nerve, creating a visible separation between the nerve, the retinaculum above, and the tendons below.
The procedure takes about 15 minutes and needs no stitches. You can return to normal activities shortly afterwards, though some soreness or bruising is possible, and everyday activities usually resume after 48 hours. You shouldn’t drive home immediately after the procedure.
Is carpal tunnel hydrodissection effective?
Several studies show promising results for mild to moderate carpal tunnel syndrome, especially in people who prefer to avoid surgery.
A 2017 study found that ultrasound-guided hydrodissection with 5% dextrose resulted in significant improvements in symptom severity and nerve conduction, with effects lasting up to 6 months. A 2021 review concluded that hydrodissection appears safe and can offer positive long-term effects in 88% of cases, with patients needing, on average, between two and three injections for a lasting result.
Studies suggest median nerve hydrodissection may give superior recovery compared with a simple cortisone injection. It won’t replace surgery in severe or advanced carpal tunnel syndrome, but it’s a valuable intermediate step — and it may be better than cortisone alone.
Who benefits from a median nerve hydrodissection?
Good candidates include:
- People with persistent carpal tunnel syndrome who haven’t improved with splinting and physiotherapy
- Recurrent symptoms after a steroid injection or after surgery
- Those who prefer a non-surgical approach
It’s not suited to severe carpal tunnel syndrome with wasting of the hand muscles — we prefer surgery for those cases.
How much does a median nerve hydrodissection cost?
Dr Masci performs the hydrodissection as a one-stop appointment — consultation, diagnostic ultrasound, and the procedure in a single visit. At the Chelsea clinic (the most cost-effective location), a hydrodissection is £450; other clinic locations cost more. See the full one-stop injection fees here, along with our clinic locations.
Frequently asked questions about median nerve hydrodissection
How does carpal tunnel hydrodissection compare to surgery?
One study compared hydrodissection with surgery in severe carpal tunnel syndrome, and found hydrodissection to be as effective as surgery — suggesting it’s worth considering even in more severe cases. That said, we still prefer surgery where there’s significant muscle wasting.
What’s the best way to perform it?
A recent study found that the procedure works best with a fluid volume of around 5 mL, delivered under ultrasound guidance to place the needle accurately and confirm that the fluid is tracking around the nerve.
How many injections will I need?
On average, people need between two and three injections for a lasting result, though some improve after one. We assess your response and plan any repeat accordingly.
Is it better than a cortisone injection?
For many people, yes. The evidence suggests hydrodissection yields better, longer-lasting recovery than a simple cortisone injection into the carpal tunnel — and it can be done with or without cortisone, which suits those who’d rather avoid steroids.
Is it painful, and what’s the recovery?
We use local anaesthetic, so the procedure is usually well tolerated. It takes about 15 minutes, needs no stitches, and most people resume everyday activities after around 48 hours — though you shouldn’t drive yourself home on the day.
Final word from Sport Doctor London about median nerve hydrodissection
Median nerve hydrodissection is a promising treatment for carpal tunnel syndrome that may work better than a simple cortisone injection. For athletes, active people, and anyone wanting to avoid surgery, it offers a safe and effective alternative. If you have carpal tunnel symptoms and are looking for a non-surgical option, speak to a sports medicine specialist experienced in ultrasound-guided median nerve hydrodissection.
To discuss median nerve hydrodissection with Dr Masci in London, contact the team here or call +44 (0) 203 488 0350.
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