Hydrodissection

Hydrodissection is a technique which involves the use of fluid (usually normal saline, or 5% Dextrose, or even cortisone in certain cases) to separate different levels or types of tissue. This technique depends largely on the skillful use of the Ultrasound Diagnostic Instrument to find and locate the target tissue, and the skill of the physician to put a needle into the correct position for treatment. When the needle is positioned properly, fluid is expressed under pressure to separate two layers of tissue.

Why is this technique used and when can it be used?

Many pain problems and functional deficits are due to pressure on nerves either in the spine or in the periphery after exiting the spine. Larger nerves, like the median and ulnar nerves in the arm, can become injured when there is a trauma to the arm and become enveloped in scar tissue or between tendons or bones or other structures. Post-surgical scarring can also affect the course or direction of a nerve. Additionally, it is possible for smaller nerves, which run on and between layers of fascia which cover muscles, to become “stuck” in the fascia and become painful or inhibited in sending signals to muscles or signals from pain sensors to the brain.

If any of these situations occur, the nerve can be freed from confinement by putting the tip of the needle just next to the nerve and injecting fluid next to the nerve, between it, and the surrounding tissue. How well this works and for how long is subject to many variables. I have treated many carpal tunnel problems successfully where the symptoms have been relieved for many years if not permanently. Others, however, have needed treatment repeatedly once or twice a year, or have opted for surgery. Compression of the ulnar nerve at the elbow, or of the posterior tibial nerve in the ankle associated with tarsal tunnel syndrome, are also treated successfully. Other nerves that can be released from pressure on them, include the radial nerve in the upper arm or forearm, the suprascapular nerve associated with shoulder pain, and the peroneal nerve in the lateral lower leg. There are many other places around the body that nerves can become compressed.

Physical therapists and massage therapists work hard on separation of muscle bundles to restore more normal range of motion. One of the mechanisms by which the tension in these muscles is maintained, is by the pressure and irritation of the very small nerves between these bundles. Hydrodissection between these muscle bundles can free the nerves, which then allows the nerves to work better and the muscles to relax.