171: 5% Dextrose Hydrodissection with FlexorRetinaculum Fenestration for Carpal Tunnel Syndrome

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic neuropathic pain, Non-pharmacological treatments, Treatment/management

Background and Aims: Carpal tunnel syndrome (CTS) is the most prevalent entrapment neuropathy, resulting from median nerve compression within the carpal tunnel. Ultrasound-guided 5% dextrose (D5W) hydrodissection has demonstrated clinical improvement by separating the median nerve from surrounding subsynovial connective tissue and reducing neurogenic inflammation. However, persistent mechanical constraint from a thickened flexor retinaculum may limit sustained decompression. Mechanical fenestration of the flexor retinaculum, performed under ultrasound guidance, may enhance decompression by disrupting fibrotic bands and increasing tunnel compliance. Combining fenestration with D5W hydrodissection theoretically provides both structural release and biological modulation, potentially improving symptom relief and functional recovery compared with hydrodissection alone.

Methods: This retrospective study analyzed 30 procedures performed in patients with clinically diagnosed CTS who underwent ultrasound-guided D5W hydrodissection in the short axis combined with flexor retinaculum fenestration (25 strokes) in the long axis. Pain intensity was assessed using the Numeric Rating Scale (NRS) at baseline, 1 month, and 6 months post-procedure. Treatment success was defined as ≥50% reduction in NRS score. Outcomes were compared with published literature reporting results of D5W hydrodissection alone.

Results: Mean NRS scores improved from 7.20 ± 0.92 at baseline to 3.10 ± 2.20 at 1 month and 2.53 ± 2.32 at 6 months, corresponding to 57.8% and 65.4% improvement, respectively. These reductions were statistically significant. Success rates were 70.0% at 1 month and 73.3% at 6 months. Published studies of D5W hydrodissection alone report approximately 60–62% improvement at 6 months. Additionally, direct comparative evidence from Zidan et al. demonstrated 67.1% improvement with D5W combined with fenestration compared to 42.5% with D5W alone, supporting the superiority of the combined technique.

Conclusions: Ultrasound-guided D5W hydrodissection combined with flexor retinaculum fenestration appears to be a safe, effective, and minimally invasive treatment for CTS, demonstrating sustained and statistically significant improvement at 6 months. Comparative analysis suggests potential superiority over hydrodissection alone. Prospective controlled studies are warranted.

References: 1. Wu YT, Ho TY, Chou YC, et al. Six-month efficacy of perineural dextrose for carpal tunnel syndrome: A prospective, randomized, double-blind, controlled trial. Mayo Clin Proc. 2017;92(8):1179-1189. doi:10.1016/j.mayocp.2017.05.025. PMID: 28778254
2. Zidan AM, Nafady HM, Alkenawy MA, et al. Impact of ultrasound-guided percutaneous flexor retinaculum fenestration on outcome of hydrostatic dissection of median nerve in patient with carpal tunnel syndrome. Egypt J Radiol Nucl Med. 2025;56:10. doi:10.1186/s43055-024-01378-w
3. Gnanasekar R, Das G. Ultrasonography-guided combined hydrodissection and fenestration for carpal tunnel syndrome. J Med Ultrasound Prev Med. 2023. doi:10.4103/jmupm.jmupm_5_23

Presenting Author: Sandeep margan
Submitting Author: Sandeep Margan

Senior Author: Suspa Das

IASP 2026 Global Year theme of Neuropathic Pain: Yes

• Gautam Das - Daradia: The Pain Clinic
• Bindiya Devi Kangujam - Daradia: The Pain clinic