Minimally Invasive Hydrodissection Technique Offers Lasting Relief for Carpal Tunnel Syndrome

A study published in Radiology highlights a minimally invasive ultrasound-guided technique that offers long-term relief for patients suffering from carpal tunnel syndrome (CTS) with fewer side effects compared to corticosteroids.

Carpal tunnel syndrome is commonly linked to repetitive motions of the wrist and hands, leading to symptoms like numbness, tingling, weakness, and pain. The condition is prevalent in approximately 5% to 10% of the population, with rising incidence rates. Traditional treatments often include corticosteroid injections aimed at reducing swelling and alleviating pressure on the affected nerve, but these injections typically provide only temporary relief.

According to co-author Anupama Tandon, MD, from the University College of Medical Sciences and Guru Teg Bahadur Hospital in Delhi, India, corticosteroids come with risks of localized skin changes, fat thinning, and tendon weakening.

Hydrodissection Technique

Nerve hydrodissection is a steroid-free alternative where fluid is carefully injected around the impacted nerve using ultrasound guidance to release adhesions and enhance mobility. While hydrodissection is usually applied alongside steroid treatments, its effectiveness as a standalone option had not been well-studied until now.

To investigate this, Dr. Tandon and lead author Anindita Bose, MD, from Mahatma Gandhi Medical College and Hospital in Jaipur, India, conducted a randomized controlled trial involving 63 patients diagnosed with CTS who had not responded to conventional treatments. Participants were divided into three groups: two receiving ultrasound-guided hydrodissection of the median nerve (one with normal saline alone and the other combining saline with corticosteroid), and a third receiving solely a corticosteroid injection.

Results

All three groups exhibited significant improvements at four weeks post-treatment. Notably, the hydrodissection group demonstrated sustained improvements at 12 weeks and six months, while the corticosteroid injection group showed a recurrence of symptoms, indicating that the initial relief was temporary. Additionally, the hydrodissection procedure resulted in a decrease of approximately 43% to 45% in the cross-sectional area of the median nerve, compared to about 15% with corticosteroid treatment alone, suggesting greater effectiveness in reducing nerve swelling.

Dr. Tandon remarked on the positive outcomes, emphasizing that many patients had suffered for extended periods despite various treatments. The hydrodissection procedure, averaging 15 minutes in duration, was well-tolerated with no significant complications, allowing patients to return to work shortly after treatment.

The study supports the role of hydrodissection as a valuable treatment option for growing numbers of patients with carpal tunnel syndrome, potentially deferring or eliminating the need for surgical intervention. The authors advocate for further multicenter studies with larger sample sizes to evaluate the long-term effectiveness of hydrodissection using different injectates. Dr. Tandon concluded that their forthcoming trial would seek to establish the durability of this treatment method.