Restricted accessResearch articleFirst published online 2026
Short-term effectiveness of 5% dextrose injection with ultrasound-guided nerve hydrodissection method in carpal tunnel syndrome: A randomized controlled study
Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy. The effects of ultrasound-guided nerve hydrodissection in the treatment of CTS are controversial.
Objective
To evaluate the short-term effectiveness of 5% dextrose (D5 W) injection with ultrasound-guided nerve hydrodissection method together with wrist orthosis treatment in mild and moderate CTS patients and the contribution of this treatment to wrist orthosis treatment.
Methods
In this prospective randomized controlled trial, forty-four participants with mild to moderate CTS were randomly assigned the wrist orthosis treatment group (control) and wrist orthosis with D5 W injection treatment group (study) using stratified block randomization. All patients were evaluated via the Visual Analog Scale (VAS), Boston Carpal Tunnel Questionnaire (BCTQ), grip strength (GST), and median nerve cross-sectional area (CSA).
Results
Within-group analysis demonstrated statistically significant improvements in VAS, BCTQS, and BCTQF scores in the control group, and in all evaluated parameters in the study group (p < 0.05). Between-group comparisons of change scores revealed no statistically significant differences for VAS (MD −0.8, 95% CI −1.74 to 0.14), BCTQS (MD −2.95, 95% CI −6.38 to 0.48), CSA (MD −0.46, 95% CI −1.20 to 0.28), or GST (MD 1.33, 95% CI −0.43 to 3.09). However, a statistically significant between-group difference was observed for the BCTQF score, favoring the study group (MD −1.65, 95% CI −3.65 to −0.35; p < 0.05).
Conclusion
USG-guided hydrodissection injection with D5 W in CTS improves wrist orthosis treatment. This injection helps patients perform functions that affect daily activities, such as grasping more effectively. For patients who use wrist orthoses but do not achieve sufficient improvement in their functions, hydrodissection injection with D5 W can be recommended.
PaduaLCuccagnaCGiovanniniS, et al.Carpal tunnel syndrome: updated evidence and new questions. Lancet Neurol2023; 22: 255–267.
2.
MiddletonSDAnakweRE. Carpal tunnel syndrome. Br Med J2014; 349: g6437.
3.
ChenYTWilliamsLZakMJ, et al.Review of ultrasonography in the diagnosis of carpal tunnel syndrome and a proposed scanning protocol. J Ultrasound Med2016; 35: 2311–2324.
YoshiiYZhaoCAmadioPC. Recent advances in ultrasound diagnosis of carpal tunnel syndrome. Diagnostics (Basel)2020; 10: 96.
6.
EversSBryanAJSandersTL, et al.Effectiveness of ultrasound-guided compared to blind steroid injections in the treatment of carpal tunnel syndrome. Arthritis Care Res (Hoboken)2017; 69: 1060–1065.
7.
Jiménez Del BarrioSBueno GraciaEHidalgo GarcíaC, et al.Conservative treatment in patients with mild to moderate carpal tunnel syndrome: a systematic review. Neurologia (Engl Ed)2018; 33: 590–601.
8.
HuisstedeBMFridénJCoertJH, et al.Carpal tunnel syndrome: hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline—results from the European HANDGUIDE study. Arch Phys Med Rehabil2014; 95: 2253–2263.
9.
KarjalainenTVLusaVPageMJ, et al.Splinting for carpal tunnel syndrome. Cochrane Database Syst Rev2023; 2: CD010003.
10.
BuntragulpoontaweeMChangKVVitoonpongT, et al.The effectiveness and safety of commonly used injectates for ultrasound-guided hydrodissection treatment of peripheral nerve entrapment syndromes: a systematic review. Front Pharmacol2021; 11: 621150.
11.
AshworthNLBlandJDPChapmanKM, et al.Local corticosteroid injection versus placebo for carpal tunnel syndrome. Cochrane Database Syst Rev2023; 2: CD015148.
12.
BurtonCRathod-MistryTBlackburnS, et al.The effectiveness of corticosteroid injection versus night splints for carpal tunnel syndrome: 24-month follow-up of a randomized trial. Rheumatology (Oxford)2023; 62: 546–554.
13.
MarshallSTardifGAshworthN. Local corticosteroid injection for carpal tunnel syndrome. Cochrane Database Syst Rev2007; 2: CD001554.
14.
OhMWParkJIShimGY, et al.Comparative efficacy of 5% dextrose and corticosteroid injections in carpal tunnel syndrome: a systematic review and meta-analysis. Arch Phys Med Rehabil2025; 106: 300–310.
15.
ChenYHanBZhangX, et al.Conservative treatments of carpal tunnel syndrome: a systematic review and network meta-analysis. Arch Phys Med Rehabil2025; 106: 1447–1458.
16.
LamSKHReevesKDChengAL. Transition from deep regional blocks toward deep nerve hydrodissection in the upper body and torso: method description and results from a retrospective chart review of the analgesic effect of 5% dextrose water as the primary hydrodissection injectate to enhance safety. Biomed Res Int2017; 2017: 7920438.
17.
EllisRBlythRArnoldN, et al.Is there a relationship between impaired median nerve excursion and carpal tunnel syndrome? A systematic review. J Hand Ther2017; 30: 3–12.
18.
EversSThoresonARSmithJ, et al.Ultrasound-guided hydrodissection decreases gliding resistance of the median nerve within the carpal tunnel. Muscle Nerve2018; 57: 25–32.
19.
WuYTChenSRLiTY, et al.Nerve hydrodissection for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial. Muscle Nerve2019; 59: 174–180.
20.
WuYTKeMJHoTY, et al.Randomized double-blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol2018; 84: 601–610.
21.
SolmazIOrscelikAKorogluO. Modified prolotherapy by 5% dextrose: two years experiences of a traditional and complementary medicine practice center in Turkey. J Back Musculoskelet Rehabil2022; 35: 763–770.
22.
KimHKimHJJungYH, et al.The effect of perineural injection therapy on neuropathic pain: a retrospective study. J Dent Anesth Pain Med2024; 24: 47–56.
23.
LinMTLiaoCLHsiaoMY, et al.Volume matters in ultrasound-guided perineural dextrose injection for carpal tunnel syndrome: a randomized, double-blinded, three-arm trial. Front Pharmacol2020; 11: 625830.
24.
BijurPESilverWGallagherEJ. Reliability of the visual analog scale for measurement of acute pain. Acad Emerg Med2001; 8: 1153–1157.
25.
SezginMIncelNASerhanS, et al.Assessment of symptom severity and functional status in patients with carpal tunnel syndrome: reliability and functionality of the turkish version of the Boston questionnaire. Disabil Rehabil. 2006; 28: 1281–1285.
26.
DuWCornettKMDDonlevyGA, et al.Variability between different hand-held dynamometers for measuring muscle strength. Sensors (Basel)2024; 24: 1861.
27.
KaymakBOzçakarLCetinA, et al.A comparison of the benefits of sonography and electrophysiologic measurements as predictors of symptom severity and functional status in patients with carpal tunnel syndrome. Arch Phys Med Rehabil2008; 89: 743–748.
28.
GotoRMascie-TaylorCG. Precision of measurement as a component of human variation. J Physiol Anthropol2007; 26: 253–256.
29.
GeorgiewFSFlorekJJanowiecS, et al.The use of orthoses in the treatment of carpal tunnel syndrome. A review of the literature from the last 10 years. Reumatologia2022; 60: 408–412.
30.
Geler KülcüDBursaliCAktaşİ, et al.Kinesiotaping as an alternative treatment method for carpal tunnel syndrome. Turk J Med Sci2016; 46: 1042–1049.
31.
SoHChungVCHChengJCK, et al.Local steroid injection versus wrist splinting for carpal tunnel syndrome: a randomized clinical trial. Int J Rheum Dis2018; 21: 102–107.
32.
GüvenSCÖzçakarLKaymakB, et al.Short-term effectiveness of platelet-rich plasma in carpal tunnel syndrome: a controlled study. J Tissue Eng Regen Med2019; 13: 709–714.
33.
WuYTHoTYChouYC, et al.Six-month efficacy of platelet-rich plasma for carpal tunnel syndrome: a prospective randomized, single-blind controlled trial. Sci Rep2017; 7: 94.
34.
RoomizadehPEftekharsadatBAbediniA, et al.Ultrasonographic assessment of carpal tunnel syndrome severity: a systematic review and meta-analysis. Am J Phys Med Rehabil2019; 98: 373–381.
35.
El MiedanyYMAtySAAshourS. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?Rheumatology (Oxford)2004; 43: 887–895.
36.
WalkerWCMetzlerMCifuDX, et al.Neutral wrist splinting in carpal tunnel syndrome: a comparison of night-only versus full-time wear instructions. Arch Phys Med Rehabil2000; 81: 424–429.
37.
LewisKJCoppietersMWRossL, et al.Group education, night splinting and home exercises reduce conversion to surgery for carpal tunnel syndrome: a multicentre randomised trial. J Physiother2020; 66: 97–104.
38.
CelikBPakerNCelikEC, et al.The effects of orthotic intervention on nerve conduction and functional outcome in carpal tunnel syndrome: a prospective follow-up study. J Hand Ther2015; 28: 34–38.
39.
AtroshiITadjerbashiKMcCabeSJ, et al.Treatment of carpal tunnel syndrome with wrist splinting: study protocol for a randomized placebo-controlled trial. Trials2019; 20: 31.
40.
OzgeODeryaG. Perineural 5% dextrose versus corticosteroid injection in non-surgical carpal tunnel syndrom treatment. Ideggyogy Sz2024; 77: 121–129.
41.
LinMTLiuICSyuWT, et al.Effect of perineural injection with different dextrose volumes on median nerve size, elasticity and mobility in hands with carpal tunnel syndrome. Diagnostics (Basel)2021; 11: 49.
42.
WuYTHoTYChouYC, et al.Six-month efficacy of perineural dextrose for carpal tunnel syndrome: a prospective, randomized, double-blind, controlled trial. Mayo Clin Proc2017; 92: 1179–1189.
43.
LiTYChenSRShenYP, et al.Long-term outcome after perineural injection with 5% dextrose for carpal tunnel syndrome: a retrospective follow-up study. Rheumatology (Oxford)2021; 60: 881–887.
44.
EyvazNAdarSAkçinAİ, et al.Comparison of ultrasound-guided hydrodissection with Various volumes of 5% dextrose for carpal tunnel syndrome: a prospective randomized controlled double-blind trial. Am J Phys Med Rehabil2025; 104: 596–604.
45.
SinghGKSrivastavaS. Grip strength of occupational workers in relation to carpal tunnel syndrome and individual factors. Int J Occup Saf Ergon2020; 26: 296–302.
46.
BakerNAMoehlingKKDesaiAR, et al.Effect of carpal tunnel syndrome on grip and pinch strength compared with sex- and age-matched normative data. Arthritis Care Res (Hoboken)2013; 65: 2041–2045.
