Nerve Entrapment Release (Percutaneous Neuroplasty)

About Percutaneous Neuroplasty

Percutaneous neuroplasty, also called nerve hydrodissection, is used to treat painful nerves that are entrapped in scar tissue from surgery, trauma, or damaged from chronic repetitive movements. Percutaneous means “through the skin”. This precise ultrasound-guided treatment is a gentle technique that utilizes the injected fluid to mechanically push away scar tissue that is entrapping or pinching a nerve.

This versatile technique can be used on any peripheral nerve and even on spinal nerve roots. It can often prevent surgery or the need for medications. This procedure requires a very high level of knowledge of sonographic anatomy and a high level of skill with ultrasound needle guidance.

What to Expect

This is not a painful procedure, so there is nothing to worry about. First, you are comfortably positioned. Then the nerve is assessed with ultrasound and the nerve cross-sectional area is measured at the place where the nerve hurts the most. By carefully viewing a nerve with ultrasound, we can assess whether the nerve is being entrapped However, in some cases the nerve may look pretty normal despite your symptoms. The position of the nerve may be marked on the skin to help the procedure go smoothly.

The skin is then cleaned with a surgical skin cleanser and sterile ultrasound gel is put on the skin over the nerve. The skin is numbed with some lidocaine first, and then the needle used to perform the neuroplasty is guided down to the targeted nerve using constant ultrasound-guidance.

The ultrasound view of the nerve is often switched from a cross-sectional view to a view along the nerve while intravenous fluid is injected along the nerve in a precise and controlled fashion through the scar or entrapment area. Depending on the nerve, this procedure can take 15 to 40 minutes. In skilled hands there is very low risk of injuring the nerve.

Recovery

There may be temporary (1 to 2 hours) numbness or even some weakness in the treated limb. This is not a painful procedure and there is only mild soreness afterward. Usually very little or no pain medication is needed by most patients. Avoid NSAIDs like ibuprofen. Acetaminophen can be used for mild pain.

Avoid showering for 1 day and avoid immersion in water for 2 days. Any bandages can be removed after 1 day. Depending on the part of the body treated, you may need a sling or crutches for a few hours until the numbness or weakness wears off.

Ten minutes or less of heat or ice therapy will not hurt the therapy, but it is not required.

Benefits are usually seen within a few days. The procedure may need to be repeated if you have only partial relief or if symptoms return.