The Effectiveness of Hydrodissection with 5% Dextrose for Persistent and Recurrent Carpal Tunnel Syndrome: A Retrospective Study

Abstract

Patients with failure of primary surgery for carpal tunnel syndrome (CTS) present a frustrating clinical problem because there are no relevant treatment guidelines, and the effect of current conservative management or revision surgery is unsatisfactory. Hydrodissection with 5% dextrose is emerging as an effective treatment for primary CTS and may be an effective alternative treatment method for persistent or recurrent post-surgical CTS. We retrospectively investigated the long-term effectiveness of hydrodissection with 5% dextrose for persistent or recurrent CTS. Thirty-six of forty consecutively-treated patients with either persistent or recurrent symptoms of CTS after surgery, who were treated with ultrasound-guided hydrodissection of the median nerve using 10 mL of 5% dextrose, were available to provide outcome data by a structured phone interview at least six months after treatment completion. Symptom relief ≥ 50% represented an effective outcome, while symptom relief < 50% was rated as a poor outcome. Nearly 2/3 (61.1%) of patients reported an effective outcome after a mean of 3.1 injections, with a post-injection follow-up mean of 33 (6–67) months. A non-significant trend toward a more frequently-effective outcome was observed in those with recurrent versus persistent symptoms following CTS (76.9% vs. 52.2%, p = 0.165). However, a significantly higher percentage of those with recurrent symptoms reported an excellent outcome, defined as a greater than 70% improvement (8/13 [61.6%] vs. 3/23 [13%], p = 0.006). The percentage of patients achieving an effective outcome was not significantly different between <2, 2–4, and >4 years of post-treatment follow-up (36.4% vs. 77.8% vs. 57.1%; p = 0.077). Hydrodissection with 5% dextrose may result in a clinically important and durable benefit in those experiencing persistent or recurrent CTS after surgery.

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

“…Among the six studies of UPIT using D5W ( Table 5 ), four were double-blind RCTs [ 49 , 50 , 51 , 52 ], one investigated UPIT with D5W vs. normal saline [ 49 ], one evaluated UPIT with D5W vs. corticosteroids [ 50 ], and two compared different volumes of D5W in UPIT [ 51 , 52 ]. Of the two retrospective case series [ 73 , 74 ], one reported the long-term outcomes of UPIT with D5W [ 73 ] and another evaluated the effectiveness of UPIT with D5W in the post-surgical persistence and recurrence of CTS [ 74 ].…”

“…In addition, the 20th edition of Harrison’s Principles of Internal Medicine also officially lists this method as an alternative treatment for CTS [ 105 ]. Recently, a retrospective study by Chao et al [ 74 ] suggested that UPIT with D5W is clinically important with a durable effect in patients with failure of CTS surgery. They retrospectively followed 36 patients with persistent or recurrent symptoms after CTS surgery for a mean post-injection follow-up of 33 months and symptom relief of more than 50% was reported by 22 patients (61%) after a mean of 3.1 injections of UPIT with 10 mL D5W.…”

Safety and Efficacy of Ultrasound-Guided Perineural Hydrodissection as a Minimally Invasive Treatment in Carpal Tunnel Syndrome: A Systematic Review

“…After removing review articles, unpublished studies, meta-analyses, case studies, practical guidelines, and books (n = 776,065), the full text of the remaining 150 articles was assessed for eligibility. Ultimately, 15 research articles were included in the review (Figure 2) [21,[34][35][36][37][38][39][40][41][42][43][44][45][46][47].…”

“…Santoso et al administered a corticosteroid injection in one group of 15 patients and dextrose water (D5W) in another group of 15 patients, with a total of 30 patients injected [35]. D5W was also used as the principal type of injection in six studies to treat CTS [21,35,36,[40][41][42]. As previously mentioned by Santoso et al, Li et al evaluated 185 patients with CTS after D5W injection [41].…”

Glucopuncture: A novel injection therapy for non-specific low back pain

“…At this point, we can only rely on a few small studies [28,29]. The largest studies so far describe the benefits of ultrasound guided injections for carpal tunnel [30][31][32]. Currently, the twentieth edition of "Harrison's Principles of Internal Medicine" textbook recommends this novel injection therapy as an alternative local treatment for carpal tunnel syndrome [33].…”