Procedures · Carpal tunnel · Glastonbury, CT
Hand numbness and tingling do not always mean carpal tunnel surgery. Dr. Paul Tortland, DO, uses live ultrasound to see whether the median nerve is stuck or squeezed, and whether ultrasound-guided hydrodissection, cortisone or surgery fits. Patients travel from across New England for this evaluation.
For some people, yes. Hydrodissection uses ultrasound to place fluid around a compressed or stuck nerve to free it, and it can give lasting relief when the nerve is squeezed but still conducting. Long-standing cases with constant numbness or muscle wasting at the base of the thumb are more likely to need surgery.
Each option works in a different way. Your exam and ultrasound decide which one fits your hand.
| Consideration | Nerve hydrodissection | Cortisone injection | Carpal tunnel release surgery |
|---|---|---|---|
| What it does | Frees the nerve from tight surrounding tissue using ultrasound-guided fluid | Reduces inflammation around the nerve | Cuts the ligament that is pressing on the nerve |
| Best fit | Compressed or stuck nerve that is still conducting; people wanting to avoid surgery | Short-term relief of a flare | Severe or long-standing compression, constant numbness, muscle wasting |
| Main limit | Less suited to advanced nerve damage | Relief is often temporary | Recovery time and surgical risks; revision surgery is more complex |
| Anesthesia | Skin numbing only, no sedation | Local numbing | Per the surgical practice |
| Pricing | Pending a full diagnostic workup, if recommended by Dr. Tortland | Pending a full diagnostic workup, if recommended by Dr. Tortland | Set by the surgical practice and your plan |
The $500 evaluation includes a same-visit nerve and tendon ultrasound that Dr. Tortland performs himself. He can see whether the median nerve is swollen, flattened or stuck, and tests how it moves. Patients come from across New England, and about 30 percent travel from outside Connecticut.
If surgery is the better path, he says so directly and refers you to a trusted surgeon. Seeing a non-surgical specialist first does not close off surgery as an option.
Related reading: hydrodissection, elbow, wrist and hand pain treatment, alternatives to orthopedic surgery and how Dr. Tortland diagnoses nerve and joint pain.
It can produce lasting relief when the nerve is compressed but still conducting well. Long-standing cases with constant numbness and muscle wasting at the base of the thumb are less likely to respond and may need surgery.
The entry point is numbed first. During the release, patients typically feel pressure and sometimes a brief reproduction of their usual symptoms as the nerve is freed. No sedation is used.
They do different jobs. Cortisone calms inflammation. Hydrodissection aims to free the nerve itself. Dr. Tortland chooses after examining your hand and viewing the nerve on ultrasound.
In most cases, start with a non-surgical specialist. A thorough evaluation makes sure surgery is recommended only when it is truly necessary.
Bring any nerve testing (EMG) results, wrist or neck imaging from the last year, and a list of prior treatments.
Mulvaney SW, Tortland PD, Shiple B, Curtis K. Regenerative medicine options for chronic musculoskeletal conditions: a review of the literature. Endurance and Sports Medicine. 2018.
Candidacy is determined on ultrasound, not over the phone. Bring your imaging and get a straight answer about your joint in one visit.