Expert Clinical Perspectives: Ultrasound-Guided Nerve Hydrodissection for Peripheral Entrapment Neuropathies-Article

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Ultrasound-guided nerve hydrodissection is a minimally invasive technique used to treat peripheral entrapment neuropathies by injecting fluid to separate nerves from surrounding tissues causing compression. This procedure is increasingly recognized as a safe and effective alternative or adjunct to conservative treatments (e.g., splinting, activity modification) and may be considered before surgical intervention. It is applicable for conditions such as carpal tunnel syndrome (CTS), ulnar neuropathy at the elbow, radial tunnel syndrome, saphenous neuropathy, sciatic neuropathy, and fibular neuropathy.<br /><br />Pre-procedure ultrasound (US) scanning is essential to identify the nerve and entrapment site, typically just distal to maximal nerve swelling, and to plan a safe needle trajectory while avoiding injury to adjacent structures. Hydrodissection is performed under continuous US guidance using fine-gauge needles, with fluid slowly injected to separate the nerve from compressive tissues, improving the function of nervi nervorum and vasa nervorum vessels, potentially alleviating symptoms.<br /><br />Various injectates have been used, including anesthetics, normal saline, dextrose 5% in water (D5W), hyaluronic acid, platelet-rich plasma (PRP), and corticosteroids. Emerging evidence suggests D5W may be preferred when not using corticosteroids, as it reduces pain and disability, possibly by modulating neurogenic inflammation via TRPV1 receptor inhibition. PRP and hyaluronic acid have also shown promise, though results vary. The choice of injectate should be individualized, considering patient comorbidities and prior responses. Injectate volume varies widely (2-10+ mL) depending on nerve and anatomy; the minimal effective volume to achieve nerve release is recommended to avoid additional compression.<br /><br />CTS, the most studied neuropathy, shows improved symptoms and nerve mobility after hydrodissection, including in refractory or post-surgical cases. Other neuropathies have less data but case reports and small studies indicate potential benefits. Overall, hydrodissection offers a safe, image-guided, and repeatable treatment option for nerve entrapments. Further research is needed to optimize injectate type and volume and to better define patient selection criteria for maximal therapeutic benefit.

Keywords

ultrasound-guided nerve hydrodissection

peripheral entrapment neuropathies

carpal tunnel syndrome

CTS

nerve compression treatment

injectates for hydrodissection

dextrose 5% in water (D5W)

platelet-rich plasma (PRP)

nerve entrapment ultrasound scanning

minimally invasive nerve therapy

nerve mobility improvement