Saline hydrodissection outperformed steroid injection at six months in carpal tunnel trial

In a randomized trial of 63 patients with persistent carpal tunnel syndrome, ultrasound-guided saline hydrodissection was compared with hydrodissection plus corticosteroid and corticosteroid injection alone. Both hydrodissection groups had sustained symptom and functional improvement through 24 weeks, while symptoms recurred after steroid-only injection; larger, longer studies are needed.

Trial randomized 63 patients across three treatment groups.
Hydrodissection groups improved through 24 weeks.
Adding corticosteroid did not improve long-term outcomes.
Small sample and six-month follow-up limit conclusions.

A prospective randomized controlled trial published in *Radiology* enrolled 63 patients with confirmed carpal tunnel syndrome whose symptoms persisted despite conventional treatment. Participants were assigned in equal groups to ultrasound-guided median nerve hydrodissection with saline, hydrodissection with saline plus corticosteroid, or ultrasound-guided corticosteroid injection without hydrodissection. Outcomes included pain, symptom severity, hand function and ultrasound measurement of median nerve size, assessed at four, 12 and 24 weeks.

All three groups improved at four weeks. At 12 and 24 weeks, both hydrodissection groups continued to improve in clinical symptoms and function, whereas symptoms recurred in the steroid-only group. Adding corticosteroid to hydrodissection did not provide a statistically significant additional long-term benefit. Median nerve cross-sectional area decreased by about 43% to 45% in the hydrodissection groups, compared with about 15% after steroid injection alone.

The procedure took about 15 minutes on average, and the study reported no significant complications during follow-up. The findings suggest saline hydrodissection may be a minimally invasive option for patients with persistent symptoms, but the trial did not establish that it prevents surgery. Its small sample and six-month follow-up limit conclusions about durability and wider applicability; larger, multicenter studies are needed.

In practice

For patients with persistent carpal tunnel syndrome, this small randomized trial suggests ultrasound-guided saline hydrodissection may provide sustained symptom and functional improvement over six months, compared with steroid injection alone. Adding corticosteroid to hydrodissection showed no statistically significant additional long-term benefit. These results are promising but do not establish that the procedure can prevent surgery or define its longer-term effectiveness: only 63 patients were studied, follow-up was limited to 24 weeks, and larger studies are needed before broad practice conclusions can be drawn.

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Source

Radiology (via ScienceDaily): A simple 15-minute treatment could help patients avoid carpal tunnel surgery ↗

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