Ultrasound-guided Nerve Hydrodissection
What is nerve hydrodissection?
Nerve hydrodissection is a safe method of relieving nerve entrapment by injecting regenerative substances (e.g. PRP/platelet–rich plasma, diluted dextrose, cell-derived growth factors) around a nerve. This procedure can only be done safely under ultrasound visualization in order to pin-point choke point areas and also to avoid damage to surrounding structures, i.e. blood/lymphatic vessels or going into nerve fibers themselves. The injected fluid is meant to create a “halo” around the nerve to cushion it. This creation of space via injected fluid relieves the pressure off the nerve from the surrounding muscles and separates the nerve from restrictive adhesions or “webs” made by tissue, fascia (connective tissue lining of muscles), post-surgical scar tissue or adjacent structures like bony spurs, etc. Such adhesions restrict the nerve’s mobility and function thereby causing irritation, enlargement and chronic pain over time.
Patients will usually seek out this treatment after having exhausted standards of care with respect to pain management, including acupuncture, physiotherapy and/or surgical interventions.
- Chronic / non-responsive lower back, shoulder, joint or musculoskeletal pain
- Chronic post-surgical chronic pain
- Nerve impingements due to anatomical defects, trauma or surgery
- Thoracic outlet syndrome
- Non-responsive carpal/tarsal tunnel syndromes
- Cancer pain management
The resolution obtained from ultrasound has significant advantages over magnetic resonance (MRI) or X-ray imaging in the evaluation of peripheral nerves, including but not limited to:
- Superior or equal specificity and enhanced soft-tissue resolution and specificity vs. MRI
- Ability to see myofascial adhesions, soft tissue abnormalities and joint architecture
- Cost-effective over more expensive imaging approaches of CT or MRI
- Real-time and dynamic imaging (MRI and CT are static and cannot accentuate many pathologies)
- Defects and impingements can be seen during physical exam/motion palpation
- Clinically abnormal findings may be immediately compared with the contralateral side
- Targeted injections often have no long-lasting side effects or residual scarring of tissue
Avoid invasive procedures/surgery
The potential for nerve hydrodissections to get patients out of pain cannot be understated. Quality of life is often dramatically and immediately improved as well as the patient avoiding the high costs to more invasive interventions or surgeries which generally have higher risks and complications.
Nerve Hydrodissections for Cancer Pain Management
Targeted ultrasound-guided nerve hydrodissections may provide safe and effective pain management strategies for mitigating the side effects of standard cancer treatments using chemo/radiation therapy. The concept of bathing and protecting vital structures from heat injuries due to radiation/ablation is also well-acknowledged in the scientific literature. Long courses of chemotherapy, surgical resections and/or radiation often create serious injury to peripheral nerves or scarring causing numbness, tingling or impaired motor function/range of motion. By injecting regenerative solutions around damaged or inflamed nerves and opening myofascial planes we can improve swelling and reduce the long-term pain created by scar-tissue adhesions.
Many other common side effects post-surgery and chemo/radiation therapy may also be addressed by targeted hydrodissection including lymph edema, pain, numbness or weakness related to tumor surgery or radiation, abdominal wall/chest pain syndromes due to excess scar tissue adhesions, and others.