Marrying Tendon and Nerve Gliding Exercises with Hydrodissection Following Injection for Carpal Tunnel Syndrome – A New Treatment Approach?

INTRODUCTION: Hydrodissection has been used during injection procedures to liberate median nerve from surrounding adhesions. This investigation examined clinical and neurophysiologic impact of ultrasound-guided injections in patient with bilateral carpal tunnel syndrome (CTS) serving as own control. Novel to this investigation was performance of active tendon and nerve gliding exercises following median nerve hydrodissection and injection. CASE REPORT: A 37-year-old male with 6-year history of bilateral CTS presented for treatment. Wrists randomly assigned to receive platelet-rich plasma (PRP) or equal volume saline injection and median nerve hydrodissection. The patient performed active tendon and nerve gliding exercises following injection procedures. Pain ratings, CTS-related disability scores, median nerve function, and median nerve cross-section area measurements for each wrist/hand collected at baseline 2, 4, 6, and 12 months following injection procedures. 6-month follow-up. The right (saline) and left (PRP) wrists showed improvements in disability and nerve function. The left wrist (PRP) also showed improvement in pain. 1-year follow-up. The right (saline followed by PRP at 6 months) and left (PRP) wrists showed improvements in pain, disability, and nerve function. CONCLUSION: Results suggest innovative treatment approach for CTS, namely, ultrasound-guided PRP injection including median nerve hydrodissection followed by performance of active tendon and nerve gliding exercises in immediate post-injection period. The patient demonstrated improvements in pain, CTS-related disability, and median nerve function comparable to surgical release and generally better than non-surgical interventions. Findings should stimulate further investigation into marrying mechanically based treatments with PRP to produce better long-term outcomes in patients with CTS.