Focus of Report: The focus of this Health Technology Assessment is to evaluate the effectiveness and safety of ultrasound-guided hydrodissection (HD) compared with alternative therapies for the treatment of carpal tunnel syndrome (CTS) in adults.

Technology Description: HD is a procedure that involves injecting fluid in the vicinity of peripheral nerve entrapments to treat neuropathic pain. This procedure aims to release entrapped nerves from the surrounding tissue, fascia, or adjacent structures via the targeted flow of an injectate, such as anesthetics, 5% dextrose water, corticosteroids, hyaluronidase, platelet-rich plasma (PRP), or saline solution. Ultrasound is used to guide the HD needle, minimizing the risk of damage to arteries, tendons, and nerves.

Controversy: HD may be useful for patients with chronic mild to moderate CTS unresponsive to medical treatment that is not severe enough to undergo carpal tunnel release. Whether the mechanism of action for improvement in CTS symptoms is due to the HD itself or the effect of injectates used needs to be established. In addition, the optimal treatment parameters, including type of injectate, approach, and volume, are unknown.

Key Questions:

  1. Is UG HD effective for improving pain and function in adults with CTS?

  2. How does UG HD compare with alternative therapies for the treatment of CTS, and how do different injectates used for UG HD compare with each other?

  3. Is UG HD in patients with CTS safe?

  4. Have definitive patient selection criteria been identified for UG HD for CTS?