Ultrasound-Guided Nerve Hydrodissection for Pain Management: From Anatomy to Techniques

King Hei Stanley Lam, Yung-Tsan Wu & Kenneth Dean Reeves

Musculoskeletal Ultrasound-Guided Regenerative Medicine, 2022, 343–354

ABSTRACT

Nerve hydrodissection (HD), a technique used when treating nerve entrapments, involves using an anesthetic or solution such as saline or 5% dextrose solution to separate the nerve from the surrounding tissue, fascia, or adjacent structures. This technique aims to treat neuropathic pain, or pain caused by the nerve. Ultrasound-guided HD of peripheral nerves has gained significant attention in the medical profession and pain management fields in recent years. This is due to a number of high impact publications of randomized control trials demonstrating the efficacy and safety of this technique for the treatment of carpal tunnel syndrome. Even the 20th edition of Harrison’s Principles of Internal Medicine textbook lists injection of 5% dextrose as an alternative local treatment that does not have the side effects of corticosteroids.

This chapter will provide a summary of the current literature on ultrasound-guided HD. The following major topics will be discussed: (1) the different procedural approaches, (2) its usage in different clinical situations, (3) its clinical pearls, (4) the solution used, and (5) the postulated mechanisms of action.

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