Nerve
Nerve Conditions
Peripheral nerve entrapments and neuromas treated with ultrasound-guided hydrodissection and corticosteroid injections — precise, non-surgical approaches to relieve nerve compression and restore function.
Understanding nerve entrapment
Peripheral nerve entrapment occurs when a nerve becomes compressed, irritated, or restricted by surrounding tissues such as fascia, ligaments, scar tissue, or swollen tendons. This compression disrupts normal nerve signaling and can cause pain, numbness, tingling, and weakness in the areas supplied by the affected nerve.
The most well-known example is carpal tunnel syndrome, where the median nerve is compressed at the wrist, but nerve entrapment can occur at many sites throughout the body. These conditions are common in both athletes and the general population, particularly in individuals who perform repetitive motions or sustained postures.
Our approach uses high-resolution musculoskeletal ultrasound to directly visualize the nerve, identify the site and cause of compression, and deliver targeted treatment with precision — all in the office, without surgery.
Diagnostic imaging
High-resolution musculoskeletal ultrasound is our primary tool for evaluating peripheral nerve conditions. Ultrasound allows us to visualize nerve swelling, changes in nerve echogenicity, and the surrounding structures causing compression in real time. It also guides our needle during hydrodissection procedures for maximal precision and safety. Electrodiagnostic studies (EMG/NCS) may be recommended to assess the severity of nerve dysfunction and guide treatment decisions.
Nerve conditions we treat
- Carpal tunnel syndrome
- Cubital tunnel syndrome (ulnar neuropathy)
- Radial tunnel syndrome
- Morton's neuroma
- Tarsal tunnel syndrome
- Lateral femoral cutaneous neuropathy (meralgia paresthetica)
- Suprascapular neuropathy
- Peroneal nerve entrapment
- Posterior interosseous nerve syndrome
- Scar-related nerve entrapment
Treatment options
Nerve hydrodissection
Nerve hydrodissection is a minimally invasive, ultrasound-guided procedure in which fluid — typically a mixture of saline, local anesthetic, and sometimes a small amount of corticosteroid — is injected around a compressed or entrapped nerve. The fluid creates a cushion of separation between the nerve and the surrounding tissues that are restricting it, effectively freeing the nerve from adhesions, scar tissue, or fascial bands.
The procedure is performed in real time under high-resolution ultrasound, allowing precise visualization of the needle, the nerve, and the surrounding structures throughout the entire process. This ensures the fluid is delivered exactly where it is needed and that the nerve is not contacted by the needle.
Multiple studies have demonstrated significant improvements in pain, paresthesias, and functional outcomes following nerve hydrodissection for carpal tunnel syndrome and other peripheral nerve entrapments. Many patients experience relief within days, and the procedure can be repeated if needed.
Corticosteroid injection
Ultrasound-guided corticosteroid injection delivers a potent anti-inflammatory medication directly to the site of nerve compression. For conditions where inflammation or swelling of surrounding tissues is contributing to nerve irritation — such as carpal tunnel syndrome or cubital tunnel syndrome — corticosteroid injection can reduce swelling and relieve pressure on the nerve.
Under ultrasound guidance, we can precisely target the injection to the tissue surrounding the nerve without contacting the nerve itself, maximizing efficacy while minimizing risk. Corticosteroid injections typically provide relief within several days and can last weeks to months.
For some patients, corticosteroid injection serves as a diagnostic tool as well: a positive response to injection confirms that the nerve compression at that location is the source of symptoms, which can be particularly helpful when the clinical picture is complex.
What to expect
Your visit begins with a detailed history, focused neurological exam, and diagnostic ultrasound evaluation of the affected nerve. We will assess the nerve for signs of swelling, compression, and surrounding structural abnormalities. Based on the findings, we will discuss which treatment approach is most appropriate.
Both hydrodissection and corticosteroid injection procedures are performed in-office and typically take 20 to 30 minutes. Most patients tolerate the procedures well with minimal discomfort due to the local anesthetic used. You can typically return to normal activities the same day, though we may recommend avoiding heavy gripping or strenuous use of the affected area for 24 to 48 hours.
Improvement timelines vary by condition and severity. Some patients experience significant relief within the first week, while others notice gradual improvement over several weeks. We schedule follow-up visits to assess your response and determine whether additional treatment is needed.
References
- Wu YT, Ke MJ, Chou YC, et al. Effect of ultrasound-guided nerve hydrodissection for carpal tunnel syndrome: a randomized clinical trial. JAMA Netw Open. 2019;2(8):e199053. doi:10.1001/jamanetworkopen.2019.9053
- Evers S, Bryan AJ, Sanders TL, et al. Corticosteroid injections for carpal tunnel syndrome: a systematic review. J Hand Surg Am. 2017;42(8):e479. doi:10.1016/j.jhsa.2017.05.029
- Cass SP. Ultrasound-guided nerve hydrodissection: what is it? A review of the literature. Curr Sports Med Rep. 2016;15(1):20-22. doi:10.1249/JSR.0000000000000226
- Choi CK, Lee HS, Kwon JY, Lee WJ. Clinical implications of real-time visualized ultrasound-guided injection for the treatment of ulnar neuropathy at the elbow. Ann Rehabil Med. 2015;39(2):176-182. doi:10.5535/arm.2015.39.2.176
- Markovic M, Crichton K, Read JW, Lam P, Slater HK. Effectiveness of ultrasound-guided corticosteroid injection in the treatment of Morton's neuroma. Foot Ankle Int. 2008;29(5):483-487. doi:10.3113/FAI.2008.0483
- Lam KHS, Hung CY, Chiang YP, et al. Ultrasound-guided nerve hydrodissection for pain management: rationale, methods, current literature, and theoretical mechanisms. J Pain Res. 2020;13:1957-1968. doi:10.2147/JPR.S247208