Enhancing Nerve Function and Reviving the Unrecordable: A Comprehensive Analysis of the Effects of a Dual Hydrodissection Protocol on Clinical and Nerve Conduction Parameters in Mild-Moderate and Severe Carpal Tunnel Syndrome.

OBJECTIVE

This study evaluates the efficacy of a sequential dual one-month interval hydrodissection (HD) protocol in mild-moderate as well as severe carpal tunnel syndrome (CTS) cases, with a comprehensive analysis of clinical and electrophysiological outcomes.

METHODS

A retrospective analysis was conducted on 286 patients (379 wrists) treated between 2021 and 2024 at two centers in India. The enrolled patient population was divided into mild-moderate and severe CTS subgroups. The dual HD protocol comprised an initial HD with methylprednisolone acetate followed by another with 5% dextrose in water (D5W) one month later. Clinical and electrophysiological characteristics were assessed and compared at baseline and three months after initiating the treatment. Outcomes were measured in terms of Visual Analog Scale (VAS) scores, Boston Carpal Tunnel Questionnaire (BCTQ) scores, and nerve conduction studies (NCS) parameters.

RESULTS

The number of patients categorized into mild-moderate and severe subgroups was 239 (321 wrists) and 47 (58 wrists), respectively. Significant improvements were noted among both subgroups. In the mild-moderate subgroup, mean VAS scores decreased from 2.03 to 0.12 (p<0.001). BCTQ functional and severity scores also showed a significant improvement (p<0.001). In the severe subgroup, mean VAS scores decreased from 7.43 to 2.12 (p<0.001), and BCTQ scores also decreased significantly (p<0.001). The key highlight of the study was significant electrophysiological improvement, with 71% of the severe CTS patients showing recordable sensory nerve action potentials (SNAPs) that were non-recordable at baseline.

CONCLUSION

The dual HD protocol was efficacious in improving clinical as well as electrophysiological outcomes in both mild-moderate and severe CTS patients. This study presents the dual HD strategy as a potentially effective minimally invasive alternative to surgery in severe cases where surgical intervention is the conventional treatment. Further randomized controlled trials with a longer follow-up period are warranted to validate these findings.