NERVE / NEURAL HYDRODISSECTION

Nerve entrapment and neuritis is seldom considered as a cause of musculoskeletal pain.

This can be difficult to diagnose clinically and can be normal on imaging.

If correctly diagnosed this can potentially be successfully treated.

There are certain sites where nerve entrapment is more likely and should be considered when a patient presents with pain in these areas.

Nerves normally glide between muscles and soft tissue with movement.

With injury the nerves can either get irritated (neuritis) or “stuck” due to surrounding scar tissue. Of course these can occur in combination.

A potential treatment for an entrapped nerve is ultrasound guided neural hydro dissection.

Ultrasound is used to visualize the nerve and a needle is placed next to the nerve and a dilute solution of anaesthetic with saline is injected to mechanically free it from the surrounding tissues.

This is a minimally invasive technique that is surprisingly well tolerated with minimal discomfort (the nerve itself is not touched by the needle)

Nerves that can be potentially entrapped and “freed” include the following:

1. Posterior interosseous nerve at the elbow – pain mimicking tennis elbow.
2. Lateral cutaneous nerve of the thigh – anterior thigh pain.
3. Inferior calcaneal nerve and medial calcaneal nerve – mimicking plantar fasciitis
4. Ulnar nerve at the elbow – pain and numbness in 4^th and 5^th fingers
5. Median nerve – Carpal tunnel syndrome
6. Infrapatellar branch saphenous nerve – medial knee pain and pain mimicking pes anserine bursitis.
7. There are nerves can get entrapped such as saphenous nerve, common peroneal nerve

Reference:

Malone, Daniel G., et al. “Ultrasound-guided percutaneous injection, hydrodissection, and fenestration for carpal tunnel syndrome: description of a new technique.” Journal of Applied Research, vol. 11, no. 1, 2011,