The procedure itself is done in the office with the use of local anesthesia in under 2-3 minutes. (Watch an example of median nerve hydrodissection performed successfully by Dr. (39-47) Furthermore, cadaveric studies had demonstrated increased glide when this is performed around the median nerve at the carpal tunnel. Research has shown that ultrasound guided hydrodissection has been beneficial in case reports of multiple different peripheral nerve entrapments. Then normal saline or dextrose (neuroprolotherapy) is used to hydrodissect around the nerve, to increase nerve glide. This involves using ultrasound to guide a needle to the area of nerve entrapment/enlargement. What is ultrasound guided nerve hydrodissection? See also section on ultrasound guided carpal tunnel release. Bracing and padding can also be used to help with peripheral nerve entrapments.įor patients that fail conservative measures, they may consider an injection under ultrasound guidance to try and alleviate the symptoms in conjunction with the conservative measures mentioned above.įor patients that fail both, ultrasound guided or traditional open releases (depending on the nerve) may provide benefit. Often this may be work/occupationally related, or can be related to workout frequency, equipment, and/or technique. Often the most effective treatment of peripheral nerve entrapments is figuring out what the offending agent is and reducing, modifying, or eliminating it. It can also help delineate anatomical variants, such as a bifid (split median nerve) or a nerve going through a ligament, like the lateral femoral cutaneous nerve (inguinal ligament). (32-34,37,38) Furthermore, The dynamic nature of ultrasound allows the provider to identify impingement that is related to motion, that may otherwise go missed on imaging or nerve testing, such as a muscle herniation (supinator syndrome) or a snapping nerve (Ulnar nerve). (33-37) Common findings on ultrasound in the setting of nerve entrapment are that of nerve enlargement, focal median nerve constriction, reduced median nerve gliding (dynamically), TCL bowing, flexor tenosynovitis, or space-occupying lesions (eg, ganglia, tumors, thrombosed or anomalous arteries, abnormal muscle slips, or supernumerary muscles or tendons). (33-37) Diagnostic ultrasound has been shown to be as accurate as EMG/NCS with the diagnosis of some nerve entrapment syndromes. Recent studies have increasingly shown the use of ultrasound as effective to evaluate and manage patients with peripheral nerve entrapment. This can be confirmed with electromyography and nerve conduction testing however, these tests may provide a false negative result, as some nerves are pinched with movement called “dynamic impingement”. Peripheral nerve entrapment is often diagnosed on examination with patients complaining of numbness, tingling or weakness of the areas and muscles that that nerve supplies. At the medial ankle (Tarsal tunnel syndrome).At the posterior calf (Soleal sling syndrome).At the ankle (Anterior tarsal tunnel syndrome).At the lower leg (can be from chronic exertional compartment syndrome).At the lateral knee (Fibular head syndrome).At the lower leg (often iatrogenic/from vein striping procedure or cardiac harvest).At the medial thigh/knee (often from trauma).At the level of the hip (Meralgia paresthetica).At the medial thigh (Adductor canal syndrome). At the posterior hip (ischio-femoral space syndrome).At the pelvic outlet (piriformis syndrome).At the wrist (dorsal ulnar cutaneous nerve syndrome).At the back of hand/ dorsal wrist (possibly from a wrist cyst (ganglion).At the pronator teres (pronator syndrome).At the carpal tunnel (carpal tunnel syndrome).What are some of the common sites for peripheral nerve entrapment?Ĭommon sites of peripheral nerve entrapment include but are not limited to:īrachial plexus (Thoracic outlet syndrome)
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