Nerve hydrodissection
Burning, numbness and shooting pain often come from a nerve stuck where it should glide. Hydrodissection frees it with simple fluid instead of a scalpel.
Quick answer
Nerve hydrodissection is an injection treatment that uses live ultrasound to place fluid around a nerve that has become stuck to scar or nearby tissue, so it can glide again. Dr. Tortland performs it himself, usually over one to three sessions. The injection takes 15 to 30 minutes of a 30 to 45 minute visit, with no incision.
Time in office
30 to 45 minutes
Anesthesia
Local only
Typical course
1 to 3 sessions
Downtime
Usually none
First results
Days to 3 weeks
Guidance
Live ultrasound, always
Incision
None: needle only
Nerve function
Assessed before and after
Definition
It is the use of injected fluid, guided by precise MSK Musculoskeletal ultrasound, to free a nerve that has become tethered to the tissue around it.
Healthy nerves glide as you move. After injury, surgery, repetitive strain or chronic swelling, a nerve can adhere to the fascia, muscle or scar surrounding it. Every movement then drags on the nerve, producing burning, numbness, tingling or pain that follows no obvious joint pattern.
Under ultrasound, that adhesion is visible: the nerve stops sliding. Fluid, commonly dextrose in water, sometimes combined with PRP, is delivered precisely around the nerve to separate it from the restricting tissue while the release is watched live on screen.
Indications
Any peripheral nerve that ultrasound shows is compressed or tethered rather than structurally severed.
Step by step
01
The suspected nerve is traced along its course while you move the limb, identifying exactly where gliding stops and where the nerve is enlarged or flattened.
02
Sensation, strength and provocative testing are documented so the response to treatment can be measured objectively rather than by recall.
03
The entry point is numbed. No sedation is used, because your feedback during the release is clinically useful.
04
Fluid is delivered around the nerve in small increments, separating it from surrounding tissue. The nerve is seen lifting free of its adhesion on the screen.
05
Sensation and gliding are re-tested in the room. Many patients feel a change in symptoms before they stand up.
06
While many patients only require one treatment, patients generally wait about three to four weeks to decide whether a second session adds benefit.
Candidacy
Comparison
Frequently asked
The entry point is numbed first. During the release, patients typically feel pressure and sometimes a brief reproduction of their own symptoms as the nerve frees: useful confirmation that the correct nerve was targeted. Soreness afterward is usually mild and short-lived.
Faster than most orthobiologic treatments. Many patients notice change within days, and the full effect is usually clear by three weeks. This is one of the few procedures where same-day improvement is common.
Most often dextrose in sterile water, sometimes with local anesthetic, and frequently combined with PRP when the nerve sheath itself is inflamed or the entrapment is long-standing. Corticosteroid is generally avoided.
It can produce lasting relief when the nerve is compressed but still conducting well. Long-standing cases with constant numbness and thenar muscle wasting need surgical release, and ultrasound plus examination tell the difference before anything is injected.
No. A steroid injection reduces inflammation chemically. Hydrodissection mechanically separates the nerve from what is binding it, addressing the cause rather than the inflammatory response.
One to three. Simple positional entrapments often resolve with a single session; longer-standing or multi-level entrapments may need a series spaced three to four weeks apart.
Yes, and post-surgical scar tethering is one of its most useful applications, freeing a nerve trapped in scar without adding another incision.
No, but while the hydrodissection procedure is self-pay our staff verifies any specific treatment cost in advance.
Sources
01
Cass SP. Ultrasound-guided nerve hydrodissection: what is it? A review of the literature. Curr Sports Med Rep. 2016;15(1):20-22. PubMed
02
Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, Reeves KD. Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms. J Pain Res. 2020;13:1957-1968. PubMed
03
Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, Chen LC. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial. Mayo Clin Proc. 2017;92(8):1179-1189. PubMed
04
Wu YT, Ke MJ, Ho TY, Li TY, Shen YP, Chen LC. Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol. 2018;84(4):601-610. PubMed
05
Evers S, Thoreson AR, Smith J, Zhao C, Geske JR, Amadio PC. Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve. 2018;57(1):25-32. PubMed
06
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.
If your burning or numbness has never quite matched the diagnosis, a dynamic ultrasound examination will show whether a nerve is trapped and whether hydrodissection can free it.