Ultrasound-Guided Dextrose Hydrodissection of the Median Nerve

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy of the upper extremity and is caused by compression of the median nerve within the carpal tunnel. Conservative treatment options are commonly preferred in patients with mild to moderate CTS. Ultrasound-guided interventions have gained increasing attention due to their ability to provide real-time visualization of anatomical structures and improve procedural accuracy and safety.

Ultrasound-guided median nerve hydrodissection is a minimally invasive technique that aims to mechanically separate the median nerve from surrounding tissues within the carpal tunnel, potentially reducing nerve compression and improving nerve mobility. The use of 5% dextrose solution has been suggested to provide both mechanical and potential neuromodulatory effects, which may contribute to symptom relief.

In this prospective study, patients diagnosed with mild and moderate CTS undergo ultrasound-guided median nerve hydrodissection using 5% dextrose. All procedures are performed under aseptic conditions by experienced physicians trained in ultrasound-guided interventions. A high-frequency linear ultrasound transducer is used to visualize the median nerve and surrounding anatomical structures at the level of the carpal tunnel. Hydrodissection is performed using an in-plane technique, which allows for continuous visualization of the needle and injectate during the procedure.

Participants receive a single-session ultrasound-guided hydrodissection, during which the injectate is administered to separate the median nerve from adjacent connective tissues. The procedure is conducted according to a standardized protocol to ensure consistency across all participants.

Clinical and ultrasonographic assessments are performed at baseline, and at 1-month and 3-month follow-up visits after the ultrasound-guided injection. Patients are monitored for any procedure-related adverse events throughout the study period. The study aims to evaluate changes in clinical symptoms and ultrasound findings following the intervention, as well as to assess the safety profile of ultrasound-guided dextrose hydrodissection in patients with mild and moderate CTS.

Inclusion criteria

• Age between 18 and 65 years
• Electrophysiologically confirmed mild to moderate CTS on electroneuromyography (ENMG)
• Paresthesia or dysesthesia that worsens at night or with repetitive wrist movement
• Presence of at least one of the following clinical findings:

• Numbness in the median nerve distribution
• Decreased hand strength or thenar muscle weakness
• Positive Phalen's test and/or Tinel's sign
• Pain intensity of ≥3 on the Visual Analog Scale (VAS)

Exclusion criteria

• Previous carpal tunnel surgery
• Severe CTS on ENMG
• Polyneuropathy
• Pregnancy
• Injections in the same area within the last 3 months
• Peripheral nerve injury, thoracic outlet syndrome, cervical radiculopathy, brachial plexopathy
• Traumatic hand injury in the last 2 years
• Inflammatory rheumatological disease
• Thyroid and autoimmune disease