Comparison of Hydrodissection Methods Using 5% Dextrose in the Treatment of Carpal Tunnel Syndrome
Berna Orhan, Ayse Merve Ata, Sinem Bozkurt, Filiz Acar SivasABSTRACT
Introduction/Aims
Evidence comparing hydrodissection techniques using 5% dextrose in water (D5W) for carpal tunnel syndrome (CTS) remains limited. This study evaluated the clinical, ultrasonographic, and electrodiagnostic outcomes of three hydrodissection techniques in patients with mild‐to‐moderate CTS.
Methods
In this randomized clinical trial, 74 patients with clinically and electrodiagnostically confirmed mild‐to‐moderate CTS were allocated to ultrasound‐guided in‐plane (IP), ultrasound‐guided out‐of‐plane (OP), or blind anatomical injection. All participants received one 5 mL D5W injection. Pain intensity, symptom severity, functional status, and neuropathic pain were assessed using the Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ‐SSS/FSS), and Douleur Neuropathique 4 (DN4), respectively, and median nerve cross‐sectional area (CSA) was measured at baseline, 2 weeks, and 3 months. Electrodiagnostic (EDX) studies were performed at baseline and 3 months.
Results
VAS, BCTQ‐SSS, BCTQ‐FSS, and DN4 showed no significant group‐by‐time differences (all p > 0.05). Within each group, VAS, BCTQ‐SSS, BCTQ‐FSS, and DN4 improved from baseline at 2 weeks and 3 months (all p < 0.001). Three‐month minimal clinically important difference (MCID) outcomes did not differ significantly among groups (BCTQ‐SSS, BCTQ‐FSS, and DN4) (all p > 0.05). The CSA group‐by‐time interaction was nonsignificant ( p > 0.05), but CSA decreased from baseline at both follow‐ups in all groups (all p < 0.001). No significant group‐by‐time interactions or within‐group changes were observed in EDX outcomes (all p > 0.05).
Discussion
Perineural hydrodissection with D5W was associated with short‐term clinical and sonographic improvement in mild‐to‐moderate CTS. Comparable outcomes with ultrasound‐guided IP and OP techniques and the blind technique suggest flexibility in technique selection based on clinician experience and patient comfort.