Comment on the safety of the ultrasound-guided hydrodissection technique for carpal tunnel syndrome

Lam, Sum; Lai, Wai Wah; Ngai, Ho Yin; Wu, Wing Keung Ricky; Wu, Yung-Tsan

doi:10.1007/s40477-022-00664-5

Cited by 13 publications

(12 citation statements)

References 9 publications

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“…No significant safety issue and complications were reported in UPIT. Lam et al has stressed how to prevent damaging the MN during ultrasound-guided nerve hydrodissection [ 95 , 99 , 136 , 137 ]. A total of 33 complications were reported among the 2547 wrists that received UPCTR: 13 out of 213 with the loop thread approach, 10 out of 1400 with the hook knife (retrograde blade) method, and 10 out of 148 with anterograde blade use.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Lam

Reeves

et al. 2023

Diagnostics

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Carpal tunnel syndrome (CTS) is the most common peripheral entrapment, and recently, ultrasound-guided perineural injection (UPIT) and percutaneous flexor retinaculum release (UPCTR) have been utilized to treat CTS. However, no systematic review or meta-analysis has included both intervention types of ultrasound-guided interventions for CTS. Therefore, we performed this review using four databases (i.e., PubMed, EMBASE, Scopus, and Cochrane) to evaluate the quality of evidence, effectiveness, and safety of the published studies on ultrasound-guided interventions in CTS. Among sixty studies selected for systemic review, 20 randomized treatment comparison or controlled studies were included in six meta-analyses. Steroid UPIT with ultrasound guidance outperformed that with landmark guidance. UPIT with higher-dose steroids outperformed that with lower-dose steroids. UPIT with 5% dextrose in water (D5W) outperformed control injection and hydrodissection with high-volume D5W was superior to that with low-volume D5W. UPIT with platelet-rich plasma outperformed various control treatments. UPCTR outperformed open surgery in terms of symptom improvement but not functional improvement. No serious adverse events were reported in the studies reviewed. The findings suggest that both UPIT and UPCTR may provide clinically important benefits and appear safe. Further treatment comparison studies are required to determine comparative therapeutic efficacy.

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Section: Discussionmentioning

confidence: 99%

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Lam

Reeves

et al. 2023

Diagnostics

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“…However, this is not a concern with hydrodissection, as it does not require local anesthetics [ 3 ]. Common precautions for peripheral nerve block and hydrodissection include nerve damage and vascular damage [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

A Case Report on Abdominal Pain Treated With a New Technique of Ultrasound-Guided Transversus Abdominis Plane Hydrodissection Using a Low Concentration of Local Anesthetics

Kaga¹

2022

Cureus

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Hydrodissection, a technique for performing morphological dissection between the target tissues via injection, has attracted attention in recent years. However, high-quality evidence is available only for a few entrapment neuropathies, such as carpal tunnel syndrome, and further case studies are needed for other diseases. This case report presents the first case of hydrodissection of the ventral ramus of the spinal nerve, which innervates the abdominal wall, to improve abdominal pain. A 59-year-old Japanese man with a history of cerebral infarction and dyslipidemia presented to the emergency department with the chief complaint of left upper abdominal pain that began two days earlier. The pain radiated to the left side of the back and left axilla. The abdomen was flat and soft with no tenderness on examination, and the pinch test was negative. However, Carnett's sign was observed in the left upper abdomen, and the location of the left upper abdominal pain and that of the radiating pain were consistent with the ninth thoracic vertebra (Th9) dermatome; thus, the cause of the left upper abdominal pain was determined to be the ventral ramus of the spinal nerve of Th9. Two weeks of physical therapy and lifestyle guidance were ineffective; therefore, hydrodissection of the transversus abdominis plane (TAP) between the myofascia of the internal oblique muscle and that of the transversus abdominis at the Th9 level using a 23G 60 mm needle under ultrasound guidance was planned. The abdominal pain immediately improved after hydrodissection, and the patient was able to work without pain. Thus, ultrasound-guided TAP hydrodissection with a low-concentration local anesthetic is effective in the treatment of abdominal pain caused by the entrapment of the ventral ramus of the spinal nerve due to adhesions between the myofascia of the internal oblique muscle and that of the transversus abdominis. This condition should be termed ventral ramus of spinal nerve entrapment syndrome (VERNES), and this concept and TAP hydrodissection must be made known to the public.

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“…Where available, a dual image (with Doppler) can be useful. As the needle tip approached the synovial membrane by hydrodissection, its bevel was turned facing down, and hydrodissection continued to the cartilage surface 9 , 11 – 13 or until the bony cortex of the femoral condyle was reached (in patients with bone exposure due to an osteochondral lesion). Power Doppler can be used to visualize the injectate and assure the absence of spread back to the HFP (Video 3).…”

Section: Therapeutic Interventionmentioning

confidence: 99%

A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series

Lam

Reeves

et al. 2023

Therapeutic Advances in Musculoskeletal

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Knee osteoarthritis (OA) is common. Ultrasound-guided intra-articular injection (UGIAI) using the superolateral approach is currently the gold standard for treating knee OA, but it is not 100% accurate, especially in patients with no knee effusion. Herein, we present a case series of chronic knee OA treated with a novel infrapatellar approach to UGIAI. Five patients with chronic grade 2–3 knee OA, who had failed on conservative treatments and had no effusion but presented with osteochondral lesions over the femoral condyle, were treated with UGIAI with different injectates using the novel infrapatellar approach. The first patient was initially treated using the traditional superolateral approach, but the injectate was not delivered intra-articularly and became trapped in the pre-femoral fat pad. The trapped injectate was aspirated in the same session due to interference with knee extension, and the injection was repeated using the novel infrapatellar approach. All patients who received the UGIAI using the infrapatellar approach had the injectates successfully delivered intra-articularly, as confirmed with dynamic ultrasound scanning. Their Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, stiffness, and function scores significantly improved 1 and 4 weeks post-injection. UGIAI of the knee using a novel infrapatellar approach is readily learned and may improve accuracy of UGIAI, even for patients with no effusion.

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Comment on the safety of the ultrasound-guided hydrodissection technique for carpal tunnel syndrome

Cited by 13 publications

References 9 publications

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

Ultrasound-Guided Interventions for Carpal Tunnel Syndrome: A Systematic Review and Meta-Analyses

A Case Report on Abdominal Pain Treated With a New Technique of Ultrasound-Guided Transversus Abdominis Plane Hydrodissection Using a Low Concentration of Local Anesthetics

A novel infrapatellar approach of ultrasound-guided intra-articular injection of the knee from both lateral and medial side: a case series

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