University of Lynchburg DMSc Doctoral Project Assignment Repository

University of Lynchburg DMSc Doctoral Project Assignment Repository


Pain Management


Larry Herman, DMSc, MPA, PA-C, DFAAPA


ABSTRACT Purpose: Common peripheral nerve injuries present in a mix of confusing, complex, overlapping, and interwoven histories, signs, and symptoms. Peripheral nerves are at risk of injury having poor protection from acute trauma and chronic compressive forces. If left untreated, relative to time and compressive pressures, there is risk of lifelong disability. Extensive research on different treatment modalities chronicles complete recovery with return to normal function being largely dependent upon the timeline from compression to decompression. Hydrodissection, with large volume injection under ultrasound guidance, can provide a timelier reduction of peripheral nerve compression compared to awaiting the necessary indications for surgical decompression, such as significant positive electric neurodynamic study results. This review highlights the pathophysiology of compressive peripheral neural injuries and the interventional treatment method of hydrodissection under ultrasound guidance for decompression of peripheral neurocompressive pathologies as a means to promote the regenerative process.

Method: A literature search was conducted using PubMed, NCBI, Access Medicine, Cochran, JSTOR, MEDLINE, Oxford Reference Online, ProQuest Central, and Google Scholar with search terms “nerve compression”, “hydrodissection”, “nerve impingement”, “nerve compressive syndromes”, “nerve entrapment”, “pain management”, and “nerve pain”. The dates of study are within seven years of submission with seven exceptions for articles used for historical data, reviewing injection anatomy, and anatomy and physiology studies. Sixty-six articles, including one self-publicized manual, were used as the basis for this review article.

Results: The evidence supports hydrodissection under ultrasound guidance in select cases as an effective alternative treatment for neural compressive syndromes with reduced risk and proven efficacy.

Conclusions: Hydrodissection under ultrasound guidance (HD-USG) is a technique used to decompress neural compressions when treating painful medical conditions such as nerve entrapments, mixed neuropathic pain, post-traumatic injury, and post-surgical neuropathies. Multiple studies have demonstrated a relationship between minimal nerve compression to resultant neuropathic pain.1 Treatment studies referencing HD-USG in different combinations of ingredients with normal saline, local anesthetics, corticosteroids, and other ingredients have produced a clinically significant reduction of neuropathic pain. HD-USG technique has been used for axial and non-axial pain, and mild to moderate compressive neuropathies. Typically, deep and superficial nerve compressions have been treated with traditional corticosteroid nerve blocks, decompressive surgeries, and medical management. The most common peripheral nerve impingement is carpal tunnel syndrome; however, over 101 HD-USG procedures have shown efficacy in reducing or resolving the symptoms of peripheral nerve entrapments.2


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