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Ultrasound-Guided 5% Dextrose Hydrodissection Procedures for Persistent and Recurrent Post-Surgical Carpal Tunnel
Marius Nicolae Popescu1,2, Claudiu Căpeț1,2, Simona Elena Săvulescu1,2
1Department of Physical and Rehabilitation Medicine, Elias Emergency University Hospital, Carol Davila University of Medicine and Pharmacy, 020021 Bucharest, Romania.
None:
Background/Objectives: Persistent and recurrent symptoms after carpal tunnel release remain challenging, and non-surgical options for post-surgical carpal tunnel syndrome (CTS) are poorly defined. This study evaluated 6-month treatment success after ultrasound-guided 5% dextrose in water (D5W) hydrodissection in persistent or recurrent post-surgical CTS and compared outcomes between subgroups. Methods: In this prospective single-center interventional cohort study, 100 patients with post-surgical CTS were enrolled: 50 with persistent disease and 50 with recurrent disease. All underwent 1-4 treatments with ultrasound-guided D5W hydrodissection using a standardized protocol. Treatment success at 6 months was defined as Patient Global Impression of Change (PGIC) scores of 6-7 together with clinically meaningful improvement in at least two of three domains: ≥30% reduction in 0-10 VAS pain, ≥0.8-point reduction in BCTQ-SSS, and ≥0.5-point reduction in BCTQ-FSS. Secondary outcomes included 12-month durability; longitudinal clinical, ultrasonographic, and electrodiagnostic changes; predictors of treatment success; treatment exposure; and safety. Results: Treatment success at 6 months occurred in 58 of 100 patients (58.0%) and was more frequent in recurrent than persistent CTS (70.0% vs. 46.0%, p = 0.015). At 12 months, treatment success persisted in 52.0% of the cohort (64.0% vs. 40.0%, p = 0.017). Clinical and ultrasonographic outcomes improved significantly over time, with greater improvement in recurrent CTS. Electrodiagnostic improvement was more modest. Recurrent CTS independently predicted success (adjusted OR 2.58, 95% CI 1.10-6.03), whereas severe electrodiagnostic involvement and greater baseline median nerve cross-sectional area were associated with lower odds of success. No serious treatment-related adverse events occurred. Conclusions: Ultrasound-guided D5W hydrodissection was associated with meaningful improvement in post-surgical CTS, particularly recurrent disease.
