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Nerve Hydrodissection

Ultrasound image showing a hydrodissection procedure for posterior interosseous nerve entrapment, as the nerve passes between the heads of the supinator muscle in the forearm.

Nerve Hydrodissection

Ultrasound guided hydrodissection is a new method of treatment of entraped nerves. Entrapment neuropathy of peripheral nerves is common, but often is under-recognized as a source of pain.

Nerves are supposed to glide smoothly around surrounding tissue, but entrapped nerves can be stuck or adhered to the surrounding tissue. This scar tissue can cause pain.

Nerves can also be compressed by trauma, scar tissue from surgery, or surrounding anatomic structures. Symptoms can range from mild discomfort to numbness, paralysis or pain.

Nerve hydrodissection can be an alternative to an open surgery for some people. Using ultrasound guidance, Dr. Sussman identifies the nerves and guides the needle next to the nerve. Once the needle tip nears the nerve, fluid is injected around the nerve to free the nerve from surrounding tissues. This can have the same effect as a surgical release, with resolution of the numbness, tingling and pain.

What conditions are treated with hydrodissection? Carpal Tunnel Syndrome is the most well-known and common entrapment neuropathy, occurring in 1% of the general population.

Neural therapy

Neural therapy was first described in medical journals in 1989, and is used to treat pain coming from scars.

Small terminal branches of cutaneous nerves can sometimes be scarred down or tethered to the skin and underlying fascia.

If you have pain when touching your surgical scar this technique may offer relief to a group of patients who have not found relief elsewhere.

What Conditions can be treated with hydrodissection?

Ultrasound image showing a hydrodissection procedure for posterior
interosseous nerve entrapment, as the nerve passes between the
heads of the supinator muscle in the forearm.

Nerve entrapment can affect any peripheral nerves. Common conditions include:

  • Carpal Tunnel Syndrome (CTS)
  • Thoracic outlet syndrome / brachial plexus neuritis
  • Radial nerve or posterior interosseous nerve (PIN) entrapment
  • Pronator Teres Syndrome
  • Cubital Tunnel Syndrome
  • Meralgia Paresthetica (Lateral Femoral Cutaneous Neuropathy)
  • Piriformis syndrome
  • Fibular Nerve / Peroneal Nerve entrapment syndrome
  • Tarsal Tunnel syndrome
  • Morton’s neuroma / Interdigital neuroma
  • Scar neuropathy

How is the procedure done?

Nerve hydrodissection uses fluid to release the nerve from the surrounding muscle or scar tissue. The nerve is first identified with ultrasound, and a solution of normal saline is gently placed around the entrapped nerve using ultrasound guidance. The solution releases the nerve from the surrounding tissue that is compressing the nerve.

How Many Treatments are Required?

Sometimes only one treatment is needed, but often the procedure needs to be repeated. Up to 3-6 treatments are needed in some cases.

Do I need surgery?

In some cases surgery is needed to prevent nerve damage. However, these treatments can save some people from needing surgery for conditions such as carpal tunnel syndrome (CTS) and other nerve entrapment syndromes. The procedures takes only minutes, requires no downtime, and does not pose the same risks as surgery.

If the fear of surgery has prevented you from seeking help, please know that non-surgical treatment options may exist!

Why BSB and OCPN?

Dr. Sussman is only 1 of 10 physicians in Massachusetts to be certified in musculoskeletal (RMSK) ultrasound by the American Registry of Diagnostic Medical Sonographers (ARDMS), and he is published in peer-review journals on the use of ultrasound-guided injections in orthopedics.

The Orthopedic Care Physician Network (OCPN) is one of only 5 practices in all of New England that is accredited by the American Institute of Ultrasound Medicine (AIUM). AIUM accreditation sets nationally-recognized standards in the performance and interpretation of diagnostic ultrasound examinations.