Hydrodissection of nerves is a safe and effective non-operative treatment for painful nerve pain conditions caused by sensitised nerves due to compression from surrounding tissues.
Hydrodissection is the technique of relieving the entrapment around an impinged nerve using the same principles as with perineural injection treatment. Usually, an ultrasound is used to identify the affected nerve and the primary point(s) of impingement. Then a volume of 5-10mL of 5% glucose solution is injected (or hydrodissected) around the affected nerve.
Firstly, the glucose effect mentioned below will help calm the irritated and inflamed nerve.
All cells, including nerve cells, require glucose as an energy source. If a nerve is injured, compressed or stretched anywhere along its path, the blood supply and nerve supply to that nerve becomes compromised. This reduces the delivery of nutrients, including glucose, to the nerve and the nerve becomes distressed at that location. A distressed nerve becomes swollen, irritable and hypersensitive and starts to fire more rapidly, causing pain. The nerve also generates inflammation in an attempt to heal itself. These inflammatory substances further irritate the nerve if the compression and swelling persist. Injecting 5% glucose around these sensitised, irritable nerves, provides the fuel needed to reduce swelling and abnormal firing and restore normal nerve function and healing. The result is an immediate decrease in pain and improvement in range of motion and function.
Secondly, reducing the amount of compression by physically stretching the tissues around the nerve using the volume of glucose solution. Over the next 24 hours or so the glucose solution is reabsorbed by the body but once reabsorbed the residual stretching effect on the tissues means that the remaining constriction around the nerve afterwards is reduced.
Often perineural injection treatment and hydrodissection are used in conjunction, depending on the anatomical path of the nerve and points of maximal tenderness. Usually more than one treatment is required as detailed later. Average treatment regimens are around 4-6 treatments but can be less or more depending on response.
Following a detailed discussion and examination to determine if the treatment is suitable for you, tender points in the field of the irritated nerve are identified. Then a volume of 5-10mL of 5% glucose solution is injected (or hydrodissected) around the affected nerve. In most cases this will provide a nearly immediate improvement in symptoms. This improvement can last as long as a few hours to a few days. Sometimes it will return but not at the severity as prior to treatment. With each treatment we expect the improvements to increase in duration and/or pain levels. Treatments are repeated every 1-2 weeks until all the pain has resolved. Typically, patients require between 4-8 treatments in total.
Examples of conditions causing nerve entrapment include carpal tunnel syndrome (median nerve), meralgia paraesthetica (lateral cutaneous femoral nerve), tarsal tunnel syndrome (tibial nerve), cubital tunnel syndrome (ulnar nerve), just to name a few. This technique can also be used along the path of any irritated nerve to settle it.