Nerve Hydrodissection
Persistent numbness, tingling or nerve pain? Ultrasound-guided nerve hydrodissection may be an option for selected peripheral nerve entrapments. Dr. Borys starts with an evaluation to determine whether it fits your diagnosis.
Book an initial visitWhat is nerve hydrodissection?
Nerve hydrodissection is an ultrasound-guided procedure that uses a carefully injected fluid to mechanically separate a compressed or entrapped nerve from the surrounding tissue. Nerves are meant to glide freely — but scar tissue, fascial thickening, trauma, or anatomical structures can tether a nerve in place, causing pain, numbness, tingling, or weakness.
Using real-time diagnostic ultrasound, Dr. Borys identifies the likely site of entrapment and guides the needle along the nerve. A gentle stream of fluid is then injected around the nerve to separate it from surrounding tissue planes and reduce mechanical irritation — a nonsurgical option that does not require cutting or general anesthesia.
The solution is typically a buffered dextrose or saline-based preparation selected to gently separate tissue planes and support a less irritated nerve environment once the mechanical compression is relieved.
How the procedure works
Each step is performed under real-time ultrasound guidance, to visualize the nerve and surrounding structures and guide needle placement.
Ultrasound identification
The affected nerve is located using real-time diagnostic ultrasound, allowing Dr. Borys to visualize the likely entrapment site and guide needle placement.
Hydrodissection
A gentle stream of fluid — typically a buffered dextrose or saline solution — is injected around the nerve to separate it from surrounding tissue planes and reduce mechanical irritation.
Nerve recovery
The goal is to reduce mechanical irritation around the nerve and restore its ability to glide more normally as the area settles.
Could nerve hydrodissection be right for you?
Hydrodissection may be considered when symptoms and exam findings point to a specific peripheral nerve entrapment, particularly when splinting, activity changes or rehab haven't been enough. Not all nerve pain comes from a local entrapment. Symptoms can be felt away from the site of nerve compression. Dr. Borys uses the examination and diagnostic ultrasound, when appropriate, to help identify the source.
If findings suggest significant nerve injury or another cause, he may recommend further testing, a different treatment or a surgical consult.
Not sure whether a nerve is causing your symptoms?
Your initial visit is an evaluation, not a commitment to an injection.
Hydrodissection vs. perineural injection therapy
Both are nerve-targeted treatments, but they work in different ways and address different types of nerve pain.
Conditions treated
Nerve entrapment can affect any peripheral nerve. Common presentations treated with hydrodissection include:
Evidence-informed research
Research is most developed for carpal tunnel syndrome, with smaller studies on other peripheral nerve entrapments. Trials report improvement in symptoms and function in selected patients, though long-term effectiveness is still uncertain.
Perineural dextrose for carpal tunnel
Prospective, randomized, double-blind RCT (Wu et al., Mayo Clin Proc, 2017) reporting greater improvement with 5% dextrose than saline through six months for carpal tunnel syndrome.
Read on PubMedDextrose vs corticosteroid for carpal tunnel
Randomized double-blind clinical trial (Wu et al., Ann Neurol, 2018) comparing 5% dextrose and triamcinolone perineural injections, with dextrose showing greater reductions in pain and disability from four to six months.
Read on PubMedPerineural dextrose for upper limb compression neuropathies
Systematic review and meta-analysis (Azizi et al., Heliyon, 2025) reporting benefit from perineural dextrose injection across peripheral compression neuropathies of the upper limbs.
Read on PubMedPerineural dextrose for ulnar neuropathy at the elbow
A small randomized, double-blind trial (40 patients) reporting improvement with perineural dextrose compared with saline for ulnar neuropathy at the elbow.
Read on PubMedRelated conditions
Nerve Hydrodissection: Common Questions
What are the risks of nerve hydrodissection?
Temporary soreness, bruising or a short-term increase in symptoms can occur. Less common risks include bleeding, infection or injury to nearby nerves or blood vessels. Ultrasound guidance helps identify nearby nerves and blood vessels and guide needle placement, but it does not eliminate these risks.
What conditions does nerve hydrodissection treat?
Nerve hydrodissection is used for carpal tunnel syndrome, cubital tunnel syndrome, and other selected peripheral nerve entrapments or neuropathic pain syndromes where a nerve is being pinched or restricted.
How is nerve hydrodissection different from surgery?
Unlike open surgical release, nerve hydrodissection is performed through a needle using real-time ultrasound guidance, with no incision. This means it is non-surgical, typically has minimal downtime, and can be an option for patients who want to avoid or delay surgery.
Does nerve hydrodissection hurt?
Most patients tolerate the procedure well. Ultrasound guidance and a local anesthetic help keep it comfortable, and some patients feel relief of nerve symptoms relatively quickly. Mild soreness at the injection site afterward is normal.
How many hydrodissection treatments are needed?
The number of treatments depends on the nerve involved, how long it has been compressed, and how you respond. Dr. Borys evaluates your symptoms with diagnostic ultrasound and recommends a personalized plan — call (360) 738-3230 to discuss your situation.
Nerve hydrodissection in Bellingham, WA
Dr. Borys performs ultrasound-guided nerve hydrodissection at his clinic in Bellingham, serving patients from Whatcom County, Skagit County, and the San Juan Islands. Real-time ultrasound imaging allows him to visualize the nerve, help identify the site of compression, and guide needle placement — making image guidance essential rather than optional for this procedure.
Many patients arrive having already been offered surgery or having had limited relief from standard conservative care. An initial evaluation includes a full history, physical examination, and ultrasound assessment before any treatment is recommended.