In contrast to these examples of medical disinformation, in my medical writing, I aim to provide easy to understand, accurate information about medical conditions and treatments. A few years ago, I wrote about a rare condition called thoracic outlet syndrome. I followed that up with a blog post about another rare condition called quadrilateral space syndrome. This time, instead of focusing on a condition, I’m focusing on a treatment: hydrodissection.
What is Hydrodissection?
As explained by the Sports Medicine Center at the University of Washington (UW) Medical Center, hydrodissection is a minimally invasive procedure that aims to decompress nerves entrapped by surrounding tissues. These entrapments can result from scarring or tight muscles caused by injuries. To eliminate the entrapments, a provider with specialized training injects liquid into the tissue surrounding the affected nerve in order to break up the entrapments and allow the nerve to glide smoothly. The procedure is performed in a medical office under ultrasound so the provider has a clear view of the affected tissue and nerve. As described in the Journal of Pain Research, the needle used ranges from 50 mm–100 mm (about two to four inches) long, and it can be repositioned while inserted during the procedure to direct the liquid effectively.
The UW Sports Medicine Center indicates that the liquid injected into the tissue is often a combination of numbing medicine, saline, and cortisone, with each provider determining the best liquids to use in each case. Other options, as reported in the Journal of Pain Research, replace the saline and cortisone with sugar water, a type of enzyme called hyaluronidase, or platelet rich plasma. This report also notes that not only scarring and tight muscles can be the culprit in causing nerve entrapments but that fascia can cause entrapments as well. As described by the Cleveland Clinic, “Fascia is a sheath of stringy connective tissue that surrounds every part of your body….When your fascia is healthy, it’s flexible and stretches with you. When your fascia tightens up, it can restrict movement and cause painful health conditions.”
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Hydrodissection
procedure. (A) Prone
position for the ultrasound-guided ulnar nerve in-plane injection with the
elbow flexed and hanging over the examination bed. (B) The same procedure as
described before in detail. (C)
Supine position for the ultrasound-guided ulnar nerve in-plane injection; the
patient is positioned on the examination bed with the elbow flexed and hand
over the head. (D) The same
procedure as described before in details. (Ulnar Neuropathy at the Elbow:
From Ultrasound Scanning to Treatment/Kamal Mezian et al.) |
Which Nerves Are Treated With Hydrodissection?
Several studies have investigated the use of hydrodissection to treat various nerves. For example, some studies have focused on the nerves that pass through the wrist. One study published in the journal Current Sports Medicine Reports examined the use of hydrodissection in radial tunnel syndrome, which affects the radial nerve as it passes through the wrist. Another study, this one published in the Journal of Clinical Medicine, focused on the use of hydrodissection for treating carpal tunnel syndrome, which affects the median nerve as it passes through the wrist.
Other studies have focused on other areas of the body. For example, a study published in Springer Nature’s Scientific Reports investigated the use of hydrodissection on the tissues surrounding nerves in the neck. An article in the Baylor University Medical Center Proceedings presented data related to the use of hydrodissection for the peroneal nerve in the knee. And, a study published in the Journal of Women’s Health and Gynecology examined the use of hydrodissection to treat the tissues surrounding nerves in the pelvic floor. Additionally, in speaking with a provider who uses hydrodissection in his medical practice, I learned that hydrodissection can also be used to treat the tissues surrounding the axillary nerve, a nerve that passes through the back of the shoulder and upper arm. These are just a few examples of the many nerves in the body with the potential to be treated with hydrodissection.
How Many Hydrodissection Treatments are Required?
The articles I’ve cited range in the number of hydrodissection treatments used. The lowest number of treatments mentioned that resulted in a positive effect was just one treatment in the article published by the Journal of Pain Research, and the highest number was six treatments over six weeks in the article published by the Journal of Women’s Health and Gynecology. The doctor I spoke with who uses hydrodissection in his practice mentioned that the literature supports using up to six or seven treatments, after which a significant break of six months to a year should be taken before resuming. Overall, it seems a wide range of treatment practices are observed, and patients should consult with their doctor about the best course of action for their case.
Who Provides Hydrodissection?
As evidenced by the articles I’ve cited, doctors researching hydrodissection work in several areas of medicine, including musculoskeletal medicine, physical medicine, rehabilitative medicine, orthopedic medicine, pain medicine, and sports medicine. Sometimes, the authors of the articles performed the hydrodissection treatments themselves, meaning practitioners of hydrodissection can be found among this same list of medical specialties. Other times, the authors of the articles reported on case studies carried out by other doctors. In these instances, the doctors who carried out the hydrodissection treatments represented a similar list of specialties, with the addition of neurology, radiology, and anesthesiology. Overall, then, patients have a wide variety of options for seeking out a practitioner who provides this treatment.
Who Can Benefit From Hydrodissection?
Anyone with a nerve injury caused by entrapment in a location that can be reached by a needle can benefit from hydrodissection. As reported in the Journal of Pain Research, one type of person who might experience this phenomenon is someone who has suffered a sprain or strain that has stretched a nerve in the injured area. The report additionally notes that nerve stretch injuries can occur during surgeries. Someone who has had a surgery with pain lingering beyond the expected time for healing could be a good candidate for hydrodissection..
As also reported in the Journal of Pain Research, someone with bone spurs, tendinosis (an injury to a tendon), or ligamentosis (an injury to a ligament) could also benefit from hydrodissection. The report also notes that fractures can cause injuries to nerves and that these injuries can be candidates for treatment with hydrodissection. Someone who has suffered a fracture and is experiencing lingering pain could therefore benefit from the treatment.
Some syndromes can also cause injuries to nerves, such as radial tunnel syndrome as reported on in Current Sports Medicine Reports, carpal tunnel syndrome as reported on in the Journal of Clinical Medicine, and quadrilateral space syndrome as mentioned by the doctor I spoke with in researching this article who has used hydrodissection to treat the axillary nerve that is a factor in this condition. Anyone with one of these conditions might want to consider hydrodissection as a treatment option. Neck pain, knee pain, and pelvic floor pain have all been treated with hydrodissection, as reported in Scientific Reports, Baylor University Medical Center Proceedings, and the Journal of Women’s Health and Gynecology. Someone with one of these types of pains could benefit from hydrodissection.
These are just a few examples of the types of conditions that could be treated with hydrodissection. If you have chronic pain that hasn’t responded to other treatments, you might consider hydrodissection as a treatment option. Of course, you should consult with a doctor before embarking on any treatment, ideally getting several opinions. When looking for doctors to interview about this procedure, it took me six tries before I found someone who provides hydrodissection in his practice. Although doctors with many medical specialties can offer hydrodissection, not all are trained in the procedure, so if you aren’t able to find a provider on your first attempt, keep trying. You might find someone with your next attempt.
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