Yonsei Med J.  2025 Feb;66(2):111-120. 10.3349/ymj.2024.0089.

Ultrasound-Guided Nerve Hydrodissection for the Management of Carpal Tunnel Syndrome: A Systematic Review and Network Meta-Analysis

Affiliations
  • 1Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine, Seoul, Korea
  • 2Department of Physical Medicine and Rehabilitation, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
  • 3Cardiovascular Disease Initiative, Broad Institute of Harvard and MIT, Cambridge, MA, USA
  • 4Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA
  • 5Department of Pediatrics, Yonsei University College of Medicine, Seoul, Korea
  • 6The Center for Medical Education Training and Professional Development in Yonsei-Donggok Medical Education Institute, Seoul, Korea
  • 7Severance Underwood Meta-Research Center, Institute of Convergence Science, Yonsei University, Seoul, Korea.

Abstract

Purpose
Ultrasound-guided nerve hydrodissection has emerged as a potential non-surgical treatment for carpal tunnel syndrome (CTS). The objective of this research was to offer suggestions for optimizing injectables utilized in hydrodissection for the treatment of CTS through a systematic review and network meta-analysis.
Materials and Methods
PubMed, MEDLINE, EMBASE, Cochrane, Scopus, and Web of Science were searched through April 25, 2024. Effect sizes were quantified using standard mean differences within a random-effects model. Effectiveness ranking for each treatment was expressed as the surface under the cumulative ranking curve (SUCRA).
Results
Nine studies with 458 patients with CTS were included. According to SUCRA, 5% dextrose (DW) was the most effective option for the Boston Carpal Tunnel Questionnaire (BCTQ) function at 99.9, 89.8, and 88.8 at 4, 12, and 24 weeks, respectively; for BCTQ symptoms, 5% DW was the most effective option at 99.9 at 4 weeks and platelet-rich plasma at 95.7 and 93.9 at 12 and 24 weeks, respectively. In terms of both BCTQ symptoms and BCTQ function, the 5 cc injection was the most effective, with SUCRA values of 99.5 for both categories. However, the effectiveness of the electrodiagnostic assessment and ultrasound variables was dependent on the type and dose of medication.
Conclusion
Administration of 5% DW showed better results in terms of initial symptom relief and long-term functional recovery compared to other agents, while platelet-rich plasma showed greater long-term symptom improvement; an injection dose of 5 cc showed the greatest benefit. However, additional research is required to establish precise protocols based on disease severity.

Keyword

Carpal tunnel syndrome; ultrasonography interventional; median nerve; treatment outcome
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