Ultrasound-Guided Nerve Hydrodissection for Pain Management: An Updated Review of Anatomy and Techniques

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. The aim of this review is to 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.

[1]  Ke-Vin Chang,et al.  Utility of Ultrasound Elastography in Evaluation of Carpal Tunnel Syndrome: A Systematic Review and Meta-analysis. , 2019, Ultrasound in medicine & biology.

[2]  Liang-Cheng Chen,et al.  Nerve hydrodissection for carpal tunnel syndrome: A prospective, randomized, double‐blind, controlled trial , 2018, Muscle & nerve.

[3]  Liang-Cheng Chen,et al.  Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients , 2018, Annals of neurology.

[4]  T. Tran,et al.  Prospective Pilot Study Comparing Pre- and Postsurgical CTSAQ and Neuro-QoL Questionnaire with Median Nerve High-Resolution Ultrasound Cross-Sectional Areas. , 2017, The Journal of hand surgery.

[5]  K. D. Reeves,et al.  Transition from Deep Regional Blocks toward Deep Nerve Hydrodissection in the Upper Body and Torso: Method Description and Results from a Retrospective Chart Review of the Analgesic Effect of 5% Dextrose Water as the Primary Hydrodissection Injectate to Enhance Safety , 2017, BioMed research international.

[6]  Liang-Cheng Chen,et al.  Six‐month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double‐Blind, Controlled Trial , 2017, Mayo Clinic proceedings.

[7]  Liang-Cheng Chen,et al.  Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: A prospective randomized, single-blind controlled trial , 2017, Scientific Reports.

[8]  Blair H. Smith,et al.  Neuropathic pain: an updated grading system for research and clinical practice , 2016, Pain.

[9]  Shane P. Cass,et al.  Ultrasound-Guided Nerve Hydrodissection: What is it? A Review of the Literature , 2016, Current sports medicine reports.

[10]  K. D. Reeves,et al.  Topical Mannitol Reduces Capsaicin‐Induced Pain: Results of a Pilot‐Level, Double‐Blind, Randomized Controlled Trial , 2015, PM & R : the journal of injury, function, and rehabilitation.

[11]  K. D. Reeves,et al.  Analgesic Effect of Caudal 5% Dextrose in Water in Chronic Low Back Pain , 2015 .

[12]  Baptiste Lacoste,et al.  Neuronal and vascular interactions. , 2015, Annual review of neuroscience.

[13]  A. Pająk,et al.  The importance of TRPV1-sensitisation factors for the development of neuropathic pain , 2015, Molecular and Cellular Neuroscience.

[14]  J. Szolcsányi,et al.  Multisteric TRPV1 nocisensor: a target for analgesics. , 2012, Trends in pharmacological sciences.

[15]  J. Gold,et al.  Sonographically Guided Percutaneous Needle Release of the Carpal Tunnel for Treatment of Carpal Tunnel Syndrome , 2012, Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine.

[16]  A. Mizisin,et al.  Homeostatic regulation of the endoneurial microenvironment during development, aging and in response to trauma, disease and toxic insult , 2010, Acta Neuropathologica.

[17]  Ruikang K. Wang,et al.  Label-free 3D optical microangiography imaging of functional vasa nervorum and peripheral microvascular tree in the hind limb of diabetic mice. , 2010, Journal of innovative optical health sciences.

[18]  Thomas B. Clark,et al.  Ultrasound-Guided Percutaneous Injection, Hydrodissection, and Fenestration for Carpal Tunnel Syndrome: Description of a New Technique , 2010 .

[19]  J. Ochoa,et al.  NEUROPATHIC PAIN: REDEFINITION AND A GRADING SYSTEM FOR CLINICAL AND RESEARCH PURPOSES , 2009, Neurology.

[20]  M. Bohland,et al.  Hypoglycemic detection at the portal vein is mediated by capsaicin-sensitive primary sensory neurons. , 2007, American journal of physiology. Endocrinology and metabolism.

[21]  Oleg Gerasimenko,et al.  Tandem-Pore K+ Channels Mediate Inhibition of Orexin Neurons by Glucose , 2006, Neuron.

[22]  S. Gilman,et al.  Sir Victor Horsley, Mr John Marshall, the nervi nervorum, and pain: more than a century ahead of their time. , 2005, Archives of neurology.

[23]  G. Bennett,et al.  Models of neuropathic pain in the rat. , 2003, Current protocols in pharmacology.

[24]  G. Carrero.  Fascicular anatomy, nervi nervorum, and paresthesia. , 2003, Regional anesthesia and pain medicine.

[25]  D. Tanelian,et al.  Activation of C fibers by metabolic perturbations associated with tourniquet ischemia. , 1992, Anesthesiology.

[26]  O. Sugar.  Victor Horsley, John Marshall, nerve stretching, and the nervi nervorum. , 1990, Surgical neurology.

[27]  Gary J. Bennett,et al.  A peripheral mononeuropathy in rat that produces disorders of pain sensation like those seen in man , 1988, Pain.

[28]  J. Marshall.  Bradshaw Lecture on Nerve-Stretching for the Relief or Cure of Pain , 1883, British medical journal.