Ultrasound‐guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel

Evers, Stefanie; Thoreson, Andrew R.; Smith, Jay; Zhao, Chunfeng; Geske, Jennifer R.; Amadio, Peter C.

doi:10.1002/mus.25723

Cited by 48 publications

(47 citation statements)

References 32 publications

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“…Additionally, ultrasound guidance was used in the two trials of D5W, but not in all studies using PRP. A cadaveric study has demonstrated that a bolus saline injection could effectively reduce the peak gliding resistance of the median nerve [46]. Another randomized controlled trial pointed out that precise hydro-dissection of the median nerve using saline under ultrasound guidance yielded better clinical outcomes than subcutaneous saline injection [47].…”

Section: Discussionmentioning

confidence: 99%

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

et al. 2020

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This network meta-analysis aimed to integrate the available direct and indirect evidence on regenerative injections-including 5% dextrose (D5W) and platelet-rich plasma (PRP)-for the treatment of carpal tunnel syndrome (CTS). Literature reports comparing D5W and PRP injections with non-surgical managements of CTS were systematically reviewed. The main outcome was the standardized mean difference (SMD) of the symptom severity and functional status scales of the Boston Carpal Tunnel Syndrome Questionnaire at three months after injections. Ranking probabilities of the SMD of each treatment were acquired by using simulation. Ten studies with 497 patients and comparing five treatments (D5W, PRP, splinting, corticosteroid, and normal saline) were included. The results of the simulation of rank probabilities showed that D5W injection was likely to be the best treatment, followed by PRP injection, in terms of clinical effectiveness in providing symptom relief. With respect to functional improvement, splinting ranked higher than PRP and D5W injections. Lastly, corticosteroid and saline injections were consistently ranked fourth and fifth in terms of therapeutic effects on symptom severity and functional status. D5W and PRP injections are more effective than splinting and corticosteroid or saline injection for relieving the symptoms of CTS. Compared with splinting, D5W and PRP injections do not provide better functional recovery. More studies investigating the long-term effectiveness of regenerative injections in CTS are needed in the future.Pharmaceuticals 2020, 13, 49 2 of 17 factors of CTS include, but are not limited to, female sex, obesity, diabetes, and hypothyroidism [4,5]. The diagnosis of CTS is traditionally based on electrophysiological tests; however, ultrasonographic nerve cross-sectional area measurements have also recently emerged as useful alternatives [6]. The therapeutic algorism for CTS can be based on symptom severity, findings of electrophysiological tests, and responsiveness to non-surgical therapy. Conservative treatments for mild to moderate CTS include corticosteroid injection [7], splinting [8], and physiotherapy (like therapeutic ultrasound, exercise, and neural mobilization) [9,10]. In patients with moderate to severe symptoms and poor responsiveness to non-operative management, carpal tunnel release (CTR) is indicated [11]. However, the symptoms might persist in 3% to 20% of patients after CTR [12]. In recalcitrant cases, the physicians should consider surgical management, such as revision neuroplasty, neurolysis, and nerve reconstruction [12].Corticosteroids function as potent anti-inflammatory medications and have been widely used as the main injectate for treating CTS. A recent randomized controlled trial that recruited 234 patients with CTS demonstrated that a single corticosteroid injection was better than night splinting in terms of clinical effectiveness at six weeks post-injection [13]. The aforementioned result is consistent with that of a previous systematic review that revealed the s...

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Section: Discussionmentioning

confidence: 99%

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

et al. 2020

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“…5,12 Advantages of the procedure are that injection may be applied using sterile saline solution or physiologically similar fluid and it may be performed in office conditions. 13 Rosales et al have applied a perisciatic USguided infiltration technique. 14 They used a mixture containing 20 mL saline, 4 mL local anaesthetic and 1 mL corticosteroid and infiltrated in the perisciatic region between the gluteus maximus and pelvitrochanteric muscles.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Atar¹,

Gürçay²,

Demir³

et al. 2020

J PMR Sci

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Knee plays an important role in the human movement. 1,2 Knee stiffness, in an another word a limitation in range of motion (ROM), is a potential complication after intra-articular or extra-articular injuries involving articular structures. It is primarily due to intra-and extra-articular fibrosis and scarring adhesions in the quadriceps-femoral apparatus. Patients with diabetes mellitus, poor compliance to exercise therapy, and joint immobilization are at an increased risk for forming knee stiffness. 1,3,4 OLGU SUNUMU CASE REPORT ABS TRACT Knee stiffness is an important complication of knee injury and commonly affects natural ambulation. We demonstrated a case of 29-year old male who presented with knee stiffness following femur fracture and knee surgery and underwent ultrasound-guided hydrodissection into the fibrotic tissues. The patient's history revealed an open reduction internal fixation surgery after femur fracture and graft surgery for the tissue defect in the popliteal region. Although the patient had a 2-month physical therapy program including range of motion (ROM), stretching and strengthening exercises, and underwent arthroscopic lysis of adhesions after while, the left knee ROM continued to be seriously limited. Ultrasound-guided hydrodissection procedure around fibrotic tissues and common peroneal nerve block were performed once a week, 4 times in total. The patient underwent a total of 20 training sessions including ROM, stretching and strengthening exercises. The improvement of the knee flexion from 60° to 70° and extension from-35° to-15° were detected. This case report demonstrates that ultrasound-guided hydrodissection combined with peripheral block is a minimally invasive and a safe method in the treatment of patients with joint stiffness after knee trauma/surgery.

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“…In this procedure, a large (15 ml or less) volume of anesthetic, saline, or dextrose‐containing fluid is injected in the perineural region in hopes of breaking adhesions that may be contributing to the mononeuropathy. Hydrodissection (or hydroneurolysis) has been shown to reduce gliding resistance in the carpal tunnel in cadaver models . This technique may be especially helpful in situations where scar tissue contributes to the pathology, such as in recurrent carpal tunnel syndrome (CTS) after a surgical release .…”

Section: Types Of Ultrasound‐guided Interventionsmentioning

confidence: 99%

“…Studies have demonstrated reduced nerve mobility in CTS, and histopathology has demonstrated increased activity of fibroblasts in the subsynovium, which results in adhesions . Mechanical hydrodissection may relieve these adhesions and is far easier to perform using an in‐plane transverse approach. In addition to the injection, operators can repeatedly fenestrate or “release” the transverse carpal ligament with a needle, or perform a minimally invasive release with a specialized surgical instrument …”

Section: Approach To Ultrasound‐guided Treatment Of Individual Entrapmentioning

confidence: 99%

Ultrasound‐guided treatment of peripheral entrapment mononeuropathies

Norbury

Nazarian

2019

Muscle and Nerve

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The advent of high‐resolution neuromuscular ultrasound (US) has provided a useful tool for conservative treatment of peripheral entrapment mononeuropathies. US‐guided interventions require careful coordination of transducer and needle movement along with a detailed understanding of sonoanatomy. Preprocedural planning and positioning can be helpful in performing these interventions. Corticosteroid injections, aspiration of ganglia, hydrodissection, and minimally invasive procedures can be useful nonsurgical treatments for mononeuropathies refractory to conservative care. Technical aspects as well as the current understanding of the indications and efficacy of these procedures for common entrapment mononeuropathies are reviewed in this study. Muscle Nerve, 2019

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Ultrasound‐guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel

Cited by 48 publications

References 32 publications

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Regenerative Injections Including 5% Dextrose and Platelet-Rich Plasma for the Treatment of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Ultrasound-Guided Hydrodissection Combined with Peripheral Nerve Block for the Treatment of Post-Traumatic Knee Stiffness

Ultrasound‐guided treatment of peripheral entrapment mononeuropathies

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