I was performing a carpal tunnel hydrodissection yesterday using an ultra high resolution ultrasound trying to help a patient with carpal tunnel syndrome avoid carpal tunnel surgery when I thought to myself, this is pretty cool. I have a 1 inch tiny needle, the smallest caliber made in the US and I’m injecting our 3rd generation platelet lysate around a nerve that’s smaller than a pea in diameter, and up on the screen it looks like the needle and nerve are huge! I asked my assistant to save some video and I marked those up to help patients understand what’s happening.
First, the carpal tunnel is where the median nerve that goes to the thumb travels through a tight spot in the wrist. That nerve can become compressed or scarred down, leading to carpal tunnel syndrome or CTS. Symptoms can include numbness and tingling in the thumb and/or weakness and loss of the muscle at the base of the thumb. Sometimes blind steroid injections are used and when that doesn’t work and conservative treatment like physical or occupational therapy fails, the patient is sent for surgery where they cut through a ligament that makes up the roof of the “tunnel”. The problem there is that transecting that carpal tunnel ligament ligament can make the wrist unstable, leading to arthritis down the road. We’ve seen great success with an alternative treatment called nerve hydrodissection, where a tiny needle is used to precisely inject the growth factors isolated from the patient’s own platelets around the nerve. We believe this does two things. One, it frees up the scarred nerve and allows it to move more freely and two, it provides growth factors that can help the nerve function and build new blood supply.
In the video above, I’m using a 30 gauge 1 inch needle normally used to inject cosmetic Botox into the face. While this is technically more difficult for the doctor, my mantra is that small structures like this nerve deserve tiny needles. The GE S8 ultrasound unit is one of the only ones I’ve used with high enough resolution (due to an array type probe) that allows this type of extreme magnification and high detail. You can see the median nerve which is labelled and then the needle (which is one inch long and looks huge) coming off from the left. The dark stuff is the platelet lysate travelling around the nerve and breaking up the scar tissue. I’ve placed a circle the size of a pea for scale to get some idea of how small these structures are in real life.
The upshot? We can often help patients avoid carpal tunnel surgery with this procedure and hopefully that will happen with this gentleman. However, the video is really cool given that these structures are so minute and appear so huge and in such great detail!
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