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Hydrodissection
For carpal tunnel and other pinched nerves
Hydrodissection is an ultrasound-guided injection that gently frees the compressed nerve causing your numbness, tingling, and pain, so it can work normally again.
Here’s how we approach hydrodissection at OASIS, starting with the diagnosis that tells us whether it’s the right treatment for you in the first place.
What is hydrodissection?
If your fingers go numb at night, your hand falls asleep at your desk, or you wake up needing to shake it out, you may have already been told, correctly or not, that it's carpal tunnel. The same kind of trouble can show up at the elbow, as that “funny bone” feeling that won't quit. Whatever the label, the real issue is usually the same: a nerve that has lost its freedom to move.
Nerves are sensitive and particular. They don’t like being compressed or tethered to the structures around them, and they need room to glide. When that free movement is lost, these symptoms follow: numbness, tingling, burning, and pain.
Hydrodissection is a newer, ultrasound-guided technique that uses a controlled stream of fluid to lift the nerve away from whatever is compressing it, and leaves a cushion around it so it can move freely again.
Here’s what it looks like: We draw up a solution, often 5% dextrose with a little lidocaine, sometimes PRP, depending on the case. We place an ultrasound probe directly over the nerve and the spot where it’s being compressed. Then we advance a very fine needle close to the nerve without touching it, and inject slowly and deliberately. The fluid flows against the nerve and literally unpeels it from the surrounding tissue. The needle is barely larger than the one used for a routine immunization, and the amount of fluid is small, usually 5 to 20 mL, depending on the nerve and its location.
The procedure is minimally painful, requires no sedation, and is done in minutes. You drive yourself home afterward.
What conditions is hydrodissection used for?
Hydrodissection is used most often for nerve problems, and the two we see most are carpal tunnel syndrome (compression of the median nerve at the wrist) and cubital tunnel syndrome (irritation of the ulnar nerve at the elbow, a.k.a. the “funny bone”). In theory, almost any nerve in the body can be hydrodissected.
But the technique is only as good as the diagnosis behind it. Patients often say things like “my carpal tunnel is acting up.” That’s fine for everyday conversation, but it’s imprecise, and it’s my job to confirm whether your symptoms are actually coming from that nerve or from something that mimics it. We hydrodissect a nerve only once we’re confident that specific nerve is the real source of the problem.
This is still a new enough technique that most patients have never heard of it and don't know to ask if they're a candidate. A consultation at OASIS gives you an accurate diagnosis and a clear explanation of your treatment options, including whether hydrodissection is on the table given your results and goals.
How do we decide who's a candidate?
As with everything we offer, an accurate diagnosis is the non-negotiable foundation. Before we discuss any treatment, we have to be confident we know what we’re treating.
For carpal tunnel syndrome and cubital tunnel syndrome, getting to that confidence is usually straightforward. Patients describe numbness, tingling, burning, or pain in the hand and fingers, sometimes at the elbow. It’s often worse first thing in the morning, when you wake up needing to shake the hand out, or after leaning on the elbow at a desk. There are usually telltale findings during your exam, like sensitivity over specific points at the wrist or elbow. Using an ultrasound in our office, we can show you whether the nerve is enlarged and irritated — looking at it lengthwise, like a noodle, we can often see exactly where it’s being choked off.
Source: The Ultrasound Site
In most cases, we can make the diagnosis without a treatment trial. Once in a while, though, it stays genuinely uncertain, and how you respond to a treatment becomes the thing that settles it. The analogy I give patients: imagine you had two sprays, one that only kills roaches and one that only kills flies. If you're not sure what bug is in your house, the spray that takes it out tells you what you were dealing with. Treatment can work the same way: If an injection aimed at one specific nerve relieves your symptoms, that points back to that nerve as the cause. It isn’t how we prefer to reach a diagnosis, but in genuinely ambiguous cases, it’s sometimes the only way to be sure.
Once we're confident in the diagnosis, hydrodissection is often an excellent option. Where you start depends on your priorities:
Most of my patients report at least 50% lasting relief after hydrodissection.
The patients I most often have to turn away are the ones whose diagnosis turns out to be something else. Numbness and tingling in the hand can come from nerve compression in the neck after a car accident, or from a problem higher up in the arm, none of which a hydrodissection at the wrist will fix. If the diagnosis isn’t right, the treatment won’t work. The one exception: when the history, exam, and ultrasound can’t fully pin the diagnosis down, hydrodissection can be a safe, sensible treatment trial. A good response essentially confirms the diagnosis after the fact; no response helps point us elsewhere.
Because this is still an injection, even with a tiny needle placed barely a centimeter or two deep, there’s always some risk of bleeding or infection. Patients with serious health conditions, such as uncontrolled diabetes or a need to stay on blood thinners after a heart attack or stroke, aren’t automatically ruled out, but they do warrant a much more careful risk-benefit conversation. Uncontrolled diabetes raises the risk of infection and lowers the odds of success; blood thinners raise the risk of bleeding even from a shallow needle.
So candidacy isn’t a simple yes or no. It rests on three things: the right diagnosis, your treatment priorities, and any health conditions that affect safety. The consultation isn’t there to sort you into a “yes” pile or a “no” pile. It’s there to find out what the underlying cause of your symptoms is, and what it will take to get you the result you deserve. That’s what sets us apart from other offices that offer these injections: we don’t just perform a procedure, we help you take full ownership of your health, including the commitment to rehabilitation and total health that keeps the problem from coming back.
How does hydrodissection compare to the alternatives?
This is a question I have strong opinions on, both from my own experience and from the published positions of expert medical societies. Let’s use carpal tunnel syndrome as the example.
Start where everything starts: the diagnosis. Most clinics in the country don’t confirm carpal tunnel with ultrasound. They make an educated guess from your history and exam. In a world without ultrasound, that guess used to be the best available. But ultrasound can now look directly at the nerve in a couple of seconds and tell us whether we’re even on the right track, so I no longer find guessing acceptable.
When the guess wasn’t enough, the old path was a test called an EMG/nerve conduction study: electrodes on the arm, sometimes fine needles into the muscles, small electrical pulses to measure how the nerves are firing. It diagnoses; it doesn’t treat. And it isn’t especially sensitive or specific for carpal tunnel, so it can read positive in people who don’t actually have it and negative in people who do.
Other clinics go straight to a blind cortisone injection, feeling for bony landmarks at the wrist, and placing the needle without ever seeing the nerve. Before ultrasound, that was the best anyone could do. But this way of doing things has many points of uncertainty. If you never see where the needle's going under ultrasound, you don't actually know if you got into the carpal tunnel, or missed and went somewhere else. If your injection didn't work, is it because it didn't go where it was supposed to, or was it because your doctor didn't have the right diagnosis?
Secondly, cortisone is a blunt instrument. The analogy I use: if an ultrasound-guided injection is a spray aimed at a single bug, cortisone is like carpet bombing the entire house. It may kill the bug, but it flattens the neighborhood around it, too. Think of this collateral damage as your side effects from the cortisone, which can range from skin depigmentation all the way to exacerbating underlying diabetes. Destroying the entire neighborhood to take out a single bug may have worked for decades in the past, but it doesn’t make it the best option today. Finally, because cortisone produces such a massive, non-specific anti-inflammatory effect, even a good response won't always reveal what the original problem was.
Hydrodissection does something none of these do. We can see the needle right next to the nerve, so we can place it with millimeter precision and improve the safety of our intervention. We mechanically separate the nerve from the tissue binding it. And we restore the nerve’s gliding motion. That last part matters more than it sounds. A large, under-recognized part of carpal tunnel syndrome isn’t just compression, it’s the loss of the nerve’s normal ability to glide. You can’t see that on an MRI. The only way to diagnose it is to watch the nerve move under ultrasound, and the only treatment that directly restores it is hydrodissection. Not bracing, not pills, not cortisone, and not surgery.
Surgery can relieve the pressure, and for some people it’s the right call. But it always leaves some scar tissue, and that scar tissue can occasionally tether the nerve worse than the original compression did.
One more difference worth naming: we don’t hydrodissect with cortisone. We use medications with far fewer side effects. A favorite is a simple mix of 5% dextrose and a little lidocaine, both well tolerated with minimal side effects. In studies of carpal tunnel, dextrose hydrodissection has improved symptoms and function,¹² and early, preclinical research suggests dextrose may also quiet the nerve-driven inflammation that can accompany these conditions.³
In my own practice, I’ve seen the full range of responses. Some patients don’t respond, sometimes because the diagnosis was wrong, sometimes for reasons we still can’t explain. At the other end, I think of a patient who’d had carpal tunnel surgery twice with no relief, been seen by three hand surgeons, and been told to live with a hand she could barely use. Under ultrasound, we could see scar tissue and adhesions wrapped around the median nerve. We hydrodissected her twice and got her to about 50% relief, more than either surgery ever had. If we’d reached her before the problem festered for years, we might have done even better. That’s the honest pattern: more often than not, my patients find it genuinely helpful, and they value having options besides cortisone or surgery.
The expert societies don’t agree with each other, and I’d rather be straight with you about that. The American Academy of Orthopaedic Surgeons currently recommends against it.⁴ The non-surgical physiatry societies, more recently, advocate for it, especially as a step to try before anyone reaches for surgery. Same evidence, opposite conclusions. The technique is new, the evidence base is still thin, and that is the real price of being on the leading edge.
So when the benefit is genuinely debated, I fall back to what we can all agree on: the risks. The risks of surgery aren’t trivial. General anesthesia carries its own dangers. Surgery has a higher infection risk and more potential for collateral damage than an injection, recovery is longer, and scarring can undo the work. Hydrodissection doesn’t carry that same risk profile and may offer comparable benefit. When two options offer similar potential upside but very different risk, I’ll steer you toward the path of least risk every time.
Ready for an answer?
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Request a consultation with Dr. Kiok to find out if you're a candidate for hydrodissection.
What does treatment look like?
For the patient, this is an easy appointment. You arrive with no driver and no special preparation needed. For a median nerve hydrodissection at the wrist, we position you in a semi-reclined chair with the wrist exposed, relaxed enough that you can watch the live ultrasound on a TV mounted on the wall. We clean the area and bring the median nerve into view. Then a very fine needle goes into the carpal tunnel under ultrasound guidance while you watch on screen, and we slowly inject the medication above and below the nerve, watching it lift away from the surrounding tissue in real time. It’s a little mesmerizing, and patients love watching it happen. Most barely feel anything, and the whole thing takes minutes.
We place a small bandage over the site, and you’re done. No restrictions, you drive yourself home, and you use the hand normally. The effects begin almost immediately and build to their full extent over a few weeks. If relief is only partial, we can repeat the injection; I’ve never needed more than two.
Step 1: Consultation
Interview, exam, and an in-office ultrasound confirm that the nerve is the real source of the problem. Required first step, $500.
Step 2: Day of procedure
Semi-reclined with the wrist exposed, watching the live ultrasound on screen. No driver and no prep needed.
Step 3: The injection
A fine, ultrasound-guided needle slowly lifts the nerve free, above and below, in a matter of minutes.
Step 4: Aftercare
A small bandage, no restrictions. You drive yourself home and use the hand normally.
Step 5: Follow-up
Effects build over a few weeks. Staff check in within days, and we repeat once if relief is only partial.
What are the risks?
Any time a needle goes anywhere in the body, there’s some risk of bleeding, infection, or hitting something it shouldn’t, no matter how carefully we prep. We lower that risk by screening for conditions that raise it unnecessarily, like immune suppression or regular aspirin use, and by doing the entire procedure under sterile conditions.
This is where hydrodissection actually has an edge: The ultrasound probe lets us choose the safest approach to the nerve and confirm it in real time, knowing exactly where the needle is and where the nerve is, down to the millimeter. No other form of image guidance gives that kind of live confidence. The risk of the needle hitting something it shouldn’t is lower than with a standard cortisone injection done without ultrasound, like the ones performed in many hand surgeons’ offices.
The medications themselves are very well tolerated and carry far fewer side effects than cortisone. The most any patient usually reports afterward is a temporary feeling of fullness in the wrist, which makes sense, since we just placed a small volume of fluid there. Even so, we always walk you through the warning signs of bleeding or infection so you know when to call, and my staff follows up within a few days to make sure you’re healing the way you should.
How much does it cost?
Treatment plans for hydrodissection depend on your diagnosis and what we're injecting.
All of our hydrodissection plans are all-inclusive. You won’t be nickel-and-dimed for follow-up visits, phone calls, or text messages. We’re with you from beginning to end, and the plan reflects that.
The path there starts with a consultation, which is $500 for a full hour with Dr. Kiok. If you book your treatment that same day, that $500 is credited toward your plan.
Is it covered by insurance?
No. Like most of the newest and most precise tools in medicine, hydrodissection isn’t covered.
It’s worth understanding why we’re comfortable with that: When you ask whether something is covered, what you’re really asking is whether you’d like to give an insurance company the chance to deny the treatment you and your physician arrived at after a full hour of evaluation. We don’t take insurance because we don’t believe a coverage desk should shape your care. Treatment plans are created in person, with you and Dr. Kiok, and carried out on a timeline that fits your goals; no delays, no denials. The same can’t be said for any insurance company. No exceptions.
Learn more about why regenerative medicine isn't covered by insurance.
How can I find out if hydrodissection is right for me?
It starts and ends with the right diagnosis. Without it, hydrodissection is beside the point. A well-founded diagnosis rests on three things:
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A comprehensive, one-hour medical interview
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A full physical examination
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A musculoskeletal ultrasound performed by a trained expert
If you’re not sure whether this is for you, that’s exactly what the consultation is for. You’ll leave with diagnostic certainty, a clear picture of how close you are to the result you’re after, and an honest plan for what it will take to get you there.
Hydrodissection outcomes vary from patient to patient, and individual results cannot be guaranteed. The information on this page is educational and is not a substitute for an in-person evaluation and diagnosis at OASIS Regenerative Medicine.
References
1. Wu Y-T, Lam KHS, Lai C-Y, et al. Novel Motor-Sparing Ultrasound-Guided Neural Injection in Severe Carpal Tunnel Syndrome: A Comparison of Four Injectates. BioMed Research International. 2022;2022:9745322. (link: doi.org/10.1155/2022/9745322)
2. Colorado B, McNeill D, Norbury J. Ultrasound-Guided Nerve Hydrodissection for Peripheral Entrapment Neuropathies. Muscle & Nerve. 2025;72(5):1052–1059. (link: doi.org/10.1002/mus.28471)
3. Han D-S, Lee C-H, Shieh Y-D, et al. A role for substance P and acid-sensing ion channel 1a in prolotherapy with dextrose-mediated analgesia in a mouse model of chronic muscle pain. Pain. 2022;163(5):e622–e633. (link: doi.org/10.1097/j.pain.0000000000002440)
4. American Academy of Orthopaedic Surgeons. Management of Carpal Tunnel Syndrome: Evidence-Based Clinical Practice Guideline. 2024. (link: https://www.aaos.org/globalassets/quality-and-practice-resources/carpal-tunnel/carpal-tunnel-2024/cts-cpg.pdf)