Nerve Hydrodissection

Nerve hydrodissection is a specialized technique that uses image-guided injection to free compressed or entrapped nerves from surrounding scar tissue, adhesions, or inflammation.

By precisely delivering fluid solution around the affected nerve under real-time ultrasound guidance, Dr. Ghattas can mechanically separate the nerve from structures causing compression while simultaneously delivering healing factors to support nerve health and function.

Hydrodissection literally means “separating with fluid” – the technique provides both immediate mechanical relief and long-term healing support.

Understanding Bone Marrow Lesions:

MRI imaging may reveal areas of bone marrow swelling and inflammation (bone marrow lesions or BMLs) in joints affected by:

• Osteoarthritis
• Stress reactions
• Avascular necrosis (early stages)
• Post-traumatic changes
• Overload and repetitive stress

The Procedure:

1. Ultrasound Evaluation
   Real-time ultrasound identifies the exact location where the nerve is compressed or entrapped.
2. Precise Needle Placement
   Under continuous ultrasound visualization, Dr. Ghattas guides a small needle to the precise location of nerve compression, avoiding surrounding blood vessels and structures.
3. Controlled Fluid Injection
   Sterile solution (often containing Platelet Lysate or other healing preparations) is injected in controlled manner to:
   • Mechanically separate nerve from adhesions or scar tissue
   • Reduce inflammation around irritated nerve tissue
   • Deliver healing factors to support nerve recovery
   • Restore nerve’s normal gliding motion

Upper Extremity Nerve Compression:

• Carpal tunnel syndrome (median nerve compression)
• Cubital tunnel syndrome (ulnar nerve at elbow)
• Radial tunnel syndrome
• Thoracic outlet syndrome
• Suprascapular nerve entrapment

Lower Extremity Nerve Compression:

• Tarsal tunnel syndrome (tibial nerve)
• Morton’s neuroma
• Peroneal nerve entrapment
• Sural nerve entrapment
• Saphenous nerve entrapment

Other Applications:

• Scar tissue around nerves after surgery or injury
• Chronic nerve compression not responding to conservative care
• Nerve pain from repetitive motion
• Failed previous nerve treatments

Non-Surgical Nerve Release:
Provides mechanical freeing of nerve without surgery, avoiding surgical risks, recovery time, scarring, and general anesthesia.

Precision Targeting:
Real-time ultrasound ensures treatment is delivered exactly where needed, unlike blind injections or systemic medications.

Enhanced with Biologics:
Combining hydrodissection with Platelet Lysate or other preparations may offer both immediate mechanical relief and long-term healing support.

Diagnostic and Therapeutic:
The procedure provides information about the nerve’s response, helping confirm diagnosis and guide further treatment.

Pre-Procedure:

• Detailed nerve examination
• Ultrasound evaluation of nerve compression site
• Discussion of expected outcomes

Treatment (30-45 minutes):

• Patient positioned for optimal access
• Real-time ultrasound locates compressed nerve
• Skin cleaned and prepared
• Fine needle advanced under ultrasound guidance
• Precise placement confirmed adjacent to nerve
• Controlled injection of hydrodissection solution
• Observation of nerve separation on ultrasound
• May include Platelet Lysate or other healing solutions

Total Time: Approximately 1 hour

Immediate (Day 0-3):

• May notice immediate improvement in symptoms (from mechanical release)
• Some patients experience temporary increased sensitivity
• Mild soreness at injection site
• Ice and gentle movement as directed

Early Response (Week 1-2):

• Nerve symptoms often begin improving
• Reduced numbness, tingling, or pain
• Improved function in affected area
• May combine with therapy or splinting

Continued Improvement (Week 2-8):

• Progressive reduction in nerve symptoms
• Enhanced nerve function and sensation
• May require repeat treatment for optimal results
• Some conditions need series of treatments (2-3 sessions)

Long-Term (2-6 months):

• Sustained improvement in most responsive cases
• Nerve healing continues over months
• Lifestyle modifications may be needed to prevent recurrence

Many patients with nerve compression report:

• Significant reduction in nerve pain
• Decreased numbness and tingling
• Improved grip strength or function
• Avoided or delayed surgical intervention
• Reduced need for medications

Response varies based on:

• Severity and duration of compression
• Degree of nerve damage
• Presence of underlying conditions (diabetes, etc.)
• Adherence to post-procedure recommendations

May be appropriate when:

• You have confirmed nerve compression on imaging or testing
• Conservative treatments (splinting, therapy) haven’t provided relief
• You want to avoid or delay nerve release surgery
• You have nerve symptoms affecting quality of life or function

May NOT be best choice when:

• You have complete nerve transection (requires surgical repair)
• You have severe, chronic nerve damage with muscle wasting
• Underlying structural problems require surgical correction

Compared to Surgery:

• Less invasive with faster recovery
• Can be repeated if needed
• Avoids surgical risks and scarring
• Surgery remains option if hydrodissection insufficient

• Real-time ultrasound guidance for precision
• Fellowship-trained in interventional techniques
• Enhanced with Platelet Lysate preparations
• Nerve-specific expertise
• Systematic outcome tracking
• Non-surgical alternative

Insurance coverage varies by plan and diagnosis. We provide:

• Pre-authorization assistance
• Transparent cost estimates
• Superbills for submission
• HSA/FSA eligible
• CareCredit financing available