Did You Know?

When performing Hydrodissection with D5W, precision is essential to ensure the best results and avoid complications. One of the most important aspects of this procedure is the use of ultrasound guidance. Ultrasound allows for real-time visualization of the nerve, ensuring that the needle is placed correctly and the injectate is delivered precisely where it’s needed.

The technique of Hydrodissection varies slightly depending on the site of the treatment. For procedures involving the Median Nerve at the Carpal Tunnel, the injection can be performed using either an in-plane or out-of-plane approach. Here’s a breakdown of both:

In-Plane Approach

This approach is particularly effective for the Median Nerve at the Carpal Tunnel, as it provides clear visualization of the needle’s trajectory. The two primary approaches for needle placement are:

• Medial (Ulnar) Approach: The needle is inserted from the medial side of the wrist.
• Lateral (Radial) Approach: The needle is inserted from the lateral side of the wrist.

Both approaches involve placing the needle either from above the nerve, where it’s positioned between the Transverse Carpal Ligament and the Median Nerve, or from below the nerve, where it’s inserted between the Flexor Tendon Sheath and the Median Nerve.

Out-of-Plane Approach

This technique is an alternative when the in-plane approach isn’t possible or practical, but the goal remains the same: to deliver the injectate to the correct location around the nerve.

Nerve Visualization and Needle Movement

Once the key landmarks are identified, the needle can be adjusted. It’s crucial not to move the ultrasound probe after this point, but rather to adjust the needle to ensure accurate placement. The injectate is delivered in two stages:

• Half of the solution is deposited between the nerve and the ligament above.
• The other half is deposited between the nerve and the flexor tendons below.

To ensure the best outcomes, the injectate should be delivered slowly. The recommended speed is no more than 1 cc per 20 seconds. For a typical 5 cc injection, the entire process should take around 1 minute and 40 seconds to allow for gradual and controlled distribution of the solution.

By following these detailed techniques, healthcare providers can ensure that the Hydrodissection procedure is both safe and effective in relieving nerve compression and reducing symptoms.