Hydrodissection as a therapeutic and diagnostic modality in treating peroneal nerve compression

Area of Science:

• Neurology
• Musculoskeletal Imaging
• Interventional Pain Management

Background:

• A 51-year-old male presented with persistent left patellar tendon and fibular head pain.
• Previous treatments including L5 epidural steroid injections and physical therapy provided no relief.
• Standard diagnostic imaging (MRI) and electrodiagnostic studies (EMG/NCS) were inconclusive, showing only fat pad impingement and normal nerve function.

Observation:

• Ultrasound revealed an enlarged peroneal nerve, indicating potential entrapment.
• Ultrasound-guided hydrodissection was performed three times, offering symptomatic improvement.
• A specific area posterior to the fibular head proved resistant to hydrodissection, suggesting dense scar tissue.

Findings:

• The hydrodissection procedure effectively identified scar tissue as the cause of peroneal nerve compression.
• This specific finding was not visualized by prior MRI or EMG/NCS.
• The targeted decompression of the entrapped peroneal nerve resulted in complete symptom resolution.

Implications:

• Ultrasound-guided hydrodissection is a valuable tool for diagnosing nerve entrapment, particularly when conventional methods fail.
• It can precisely identify the location and nature of nerve compression, such as scar tissue.
• This technique offers a minimally invasive approach to diagnosis and can guide subsequent surgical interventions for improved patient outcomes.