Comparison of Hydrodissection Methods Using 5% Dextrose in the Treatment of Carpal Tunnel Syndrome

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.

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.

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).

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.