Hydrodissection may yield clinical, morphological improvements in carpal tunnel syndrome
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Results showed ultrasound-guided hydrodissection of the median nerve may provide significant and persistent clinical and morphological improvements in patients with carpal tunnel syndrome not responding to conservative treatment.
“As hydrodissection proved to be beneficial for patients with carpal tunnel syndrome not responding to conservative treatment, it can serve as a nonsurgical option in these patients. It can definitely defer and can even alleviate the need for surgery in these patients,” Anupama Tandon, MD, MBBS, professor in the department of radio-diagnosis at the University College of Medical Sciences (University of Delhi) in Delhi, India, told Healio about results presented at the Radiological Society of North America Annual Meeting.
Tandon and colleagues randomly assigned 63 patients with carpal tunnel syndrome refractory to conventional treatment to receive ultrasound-guided hydrodissection with normal saline alone, ultrasound-guided hydrodissection with a normal saline and corticosteroid injection, or ultrasound-guided corticosteroid injection alone. Researchers performed clinical assessment with the VAS score and Boston Carpal Tunnel Syndrome Questionnaire-symptom severity score and functional status scale, as well as morphological assessment by measuring the cross-sectional area of the median nerve using ultrasound. Researchers performed clinical and ultrasound follow-up at 4 and 12 weeks, and at 6 months.
Results showed patients in all three groups had significant improvements in mean Boston Carpal Tunnel Syndrome Questionnaire scores and VAS scores at 4 weeks. However, Tandon noted improvements were slightly lower in patients who received hydrodissection alone.
“At 12 and 24 weeks, it was seen that both hydrodissection groups had further improvement in clinical scores. But in the steroid-only group, scores went up again, indicating that the effect of steroid was waning,” Tandon said.
She added patients who underwent hydrodissection with normal saline only and patients who underwent hydrodissection with normal saline and corticosteroid injection had a reduction in median nerve cross-sectional area by approximately 43% and 45%, respectively, vs. 15% in the steroid-only group.
“The [hydrodissection] procedure was quick, taking only about 15 minutes, and the patients could go back in an hour’s time [and resume routine work],” Tandon said. “It was well tolerated, and no significant immediate or delayed adverse effects were noted.”
Perspective
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Unfortunately, there are not many effective conservative treatment options for carpal tunnel syndrome. When patients fail bracing, anti-inflammatory medications and work/life modifications, many are left with only surgery offered as an option.
This study is looking at a “minimally invasive” treatment option for carpal tunnel syndrome. While the results are promising, it would be interesting to see how patients' nerve test results change a few months following hydrodissection. In addition to treating symptoms, the purpose of carpal tunnel surgery is often to prevent worsening nerve damage. It is unclear from the follow-up results if nerve conduction is improved.
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Tandon A, et al. Ultrasound-guided hydrodissection for treatment of carpal tunnel syndrome: A randomized controlled trial. Presented at: Radiological Society of North America Annual Meeting; Nov. 27-Dec. 1, 2022; Chicago.
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