Hydrodissection of the Median Nerve: A Minimally Invasive Approach

hydrodissection of median nerve

What is Hydrodissection of the Median Nerve?

Hydrodissection of the median nerve is an advanced, minimally invasive technique used to relieve nerve entrapment syndromes, most commonly carpal tunnel syndrome (CTS). This procedure involves injecting fluid, typically saline, 5% dextrose, or platelet-rich plasma (PRP), around the median nerve to create a separation between the nerve and surrounding tissues. This reduces compression, improves nerve mobility, and alleviates pain and discomfort.

Why is the Median Nerve Important?

The median nerve runs from the forearm through the carpal tunnel into the hand, controlling sensation and movement in parts of the thumb, index, middle, and part of the ring finger. When compressed, it leads to numbness, tingling, pain, and weakness, commonly seen in carpal tunnel syndrome.

How Hydrodissection Works for Median Nerve Compression

Hydrodissection utilizes a controlled fluid injection under ultrasound guidance to separate the median nerve from restrictive surrounding tissues. The key benefits include:

  • Decompressing the nerve by reducing mechanical pressure
  • Breaking adhesions that may restrict nerve mobility
  • Improving nerve function by restoring normal movement
  • Enhancing blood flow to the affected nerve

Studies have shown that ultrasound-guided hydrodissection effectively improves median nerve gliding, reducing resistance within the carpal tunnel (Wu et al., 2017).

Daradia’s Innovative Approach: Fenestration of the Flexor Retinaculum with Hydrodissection

At Daradia: The Pain Clinic, an innovative method has been developed that combines hydrodissection with fenestration of the flexor retinaculum. This advanced technique enhances the decompression of the median nerve and offers superior clinical outcomes.

What is Flexor Retinaculum Fenestration?

The flexor retinaculum, also called the transverse carpal ligament, forms the roof of the carpal tunnel. Fenestration involves making micro-perforations in the flexor retinaculum to release pressure and allow better nerve movement.

Benefits of Combining Hydrodissection and Fenestration

By combining these techniques, the following advantages are achieved:

  • Immediate reduction in pressure on the median nerve
  • Lower risk of recurrence due to enhanced nerve mobility
  • Prevention of scar tissue formation
  • Enhanced long-term symptom relief compared to hydrodissection alone

Step-by-Step Procedure of Hydrodissection & Fenestration

This ultrasound-guided procedure is performed under local anesthesia and follows these steps:

  1. Ultrasound Guidance: The median nerve and surrounding tissues are visualized using high-resolution ultrasound.
  2. Needle Insertion: A fine needle is precisely placed near the nerve under real-time ultrasound guidance.
  3. Hydrodissection: A controlled amount of fluid (saline, dextrose, or PRP) is injected to separate the nerve from the flexor retinaculum and surrounding structures.
  4. Fenestration of the Flexor Retinaculum: Multiple micro-perforations are made in the flexor retinaculum to enhance nerve decompression.
  5. Post-Procedure Assessment: The median nerve’s mobility and pressure relief are assessed through ultrasound.

Recovery and Expected Outcomes

Most patients experience significant symptom relief within a few days to weeks. The benefits of this technique include:

  • Faster recovery compared to open surgery
  • Minimally invasive with no need for large incisions
  • Reduced postoperative complications
  • High success rate in relieving CTS symptoms

Why Choose Daradia’s Approach?

At Daradia: The Pain Clinic team have pioneered this innovative approach that significantly improves treatment outcomes. Their research and expertise in pain management provide patients with an effective, minimally invasive alternative to traditional surgery.

Conclusion

Hydrodissection of the median nerve, when combined with fenestration of the flexor retinaculum, represents a major advancement in treating carpal tunnel syndrome. This minimally invasive technique offers effective nerve decompression, reduces recurrence, and improves patient recovery time.

For a visual demonstration, watch the procedure here: Hydrodissection & Fenestration of Flexor Retinaculum – Video.

References:

  1. Wu, Y.-T., et al. (2017). “Ultrasound-Guided Hydrodissection for Carpal Tunnel Syndrome: A Meta-Analysis and Review.” PM&R Journal. Available at: PMC5722677.
  2. Smith, J., et al. (2020). “Innovations in Median Nerve Hydrodissection: A Review of Techniques and Outcomes.” Journal of Pain Research.