Clinical Pain

Korean Association of Pain Medicine (대한임상통증학회)
권호 표지
DOI QR코드

DOI QR Code

Effect of Ultrasound-Guided Perineural Injection with Dextrose for Direct Traumatic Injury of Median Nerve

정중신경 손상에서 초음파 유도 하 신경주위 포도당 용액 주사치료의 효과

  • Jung, Yu Sang (Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine) ;
  • Park, Hyerin (Department and Research Institute of Rehabilitation Medicine, Yonsei University College of Medicine) ;
  • Park, Jung Hyun (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Park, Hee Jae (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine) ;
  • Cho, Han Eol (Department of Rehabilitation Medicine, Gangnam Severance Hospital, Rehabilitation Institute of Neuromuscular Disease, Yonsei University College of Medicine)
  • 정유상 (연세대학교 의과대학 재활의학교실) ;
  • 박혜린 (연세대학교 의과대학 재활의학교실) ;
  • 박중현 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소) ;
  • 박희재 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소) ;
  • 조한얼 (연세대학교 의과대학 재활의학교실 및 희귀난치성 신경근육병 재활연구소)
  • Received : 2021.05.21
  • Accepted : 2021.09.27
  • Published : 2021.12.31
⟨ Previous Next ⟩

Abstract

Ultrasound (US)-guided hydrodissection (HD) is a widely applied therapeutic method to release the entrapped peripheral nerve. However, this therapy has only been studied for the nerve entrapments such as carpal tunnel syndrome, and there are no reports of its effect on direct nerve injuries with incomplete axonal damage. Here, we report a case of direct traumatic injury of a median nerve with incomplete axonal injury in a 28-year-old man. He presented hypoesthesia and weakness along with the median nerve territory of the left hand after a laceration wound of the wrist. The patient underwent a surgical procedure, but did not experience prominent improvement for the next six months. Symptoms improved after we performed the US-guided HD with dextrose. We propose this procedure as one of the new treatment methods for direct axonal injury of nerves including the median nerve.

Keywords

References

  1. Cass SP. Ultrasound-Guided Nerve Hydrodissection: What is it? A Review of the Literature. Curr Sports Med Rep 2016;15:20-2. https://doi.org/10.1249/jsr.0000000000000226
  2. Lam KHS, Hung CY, Chiang YP, Onishi K, Su DCJ, Clark TB, et al. Ultrasound-Guided Nerve Hydrodissection for Pain Management: Rationale, Methods, Current Literature, and Theoretical Mechanisms. J Pain Res 2020;13:1957-68. https://doi.org/10.2147/JPR.S247208
  3. Wu YT, Ho TY, Chou YC, Ke MJ, Li TY, Tsai CK, et al. Six-month Efficacy of Perineural Dextrose for Carpal Tunnel Syndrome: A Prospective, Randomized, Double-Blind, Controlled Trial. Mayo Clin Proc 2017;92:1179-89. https://doi.org/10.1016/j.mayocp.2017.05.025
  4. Seddon HJ. A Classification of Nerve Injuries. Br Med J 1942;2:237-9. https://doi.org/10.1136/bmj.2.4260.237
  5. Sunderland S. The anatomy and physiology of nerve injury. Muscle Nerve 1990;13:771-84. https://doi.org/10.1002/mus.880130903
  6. Robinson LR. Traumatic injury to peripheral nerves. Muscle Nerve 2000;23:863-73. https://doi.org/10.1002/(SICI)1097-4598(200006)23:6<863::AID-MUS4>3.0.CO;2-0
  7. Chang KV, Wu WT, Ozcakar L. Ultrasound imaging and guidance in peripheral nerve entrapment: hydrodissection highlighted. Pain Manag 2020;10:97-106. https://doi.org/10.2217/pmt-2019-0056
  8. Dam-Hieu P, Lacroix C, Said G, Devanz P, Liu S, Tadie M. Reduction of postoperative perineural adhesions by Hyaloglide gel: an experimental study in the rat sciatic nerve. Neurosurgery 2005;56:425-33; discussion -33. https://doi.org/10.1227/01.NEU.0000156845.41626.E9
  9. Chen SR, Shen YP, Ho TY, Chen LC, Wu YT. Ultrasound-guided perineural injection with dextrose for treatment of radial nerve palsy: A case report. Medicine (Baltimore) 2018;97:e10978. https://doi.org/10.1097/md.0000000000010978