Nerve hydrodissection — freeing an entrapped nerve, precisely.
Ultrasound-guided fluid placed around a trapped nerve to free it from surrounding tissue — minimally invasive and image-guided.
What it is
Hydrodissection uses precisely placed fluid to separate an irritated or entrapped nerve from the tissue compressing it — done under real-time ultrasound.
What it’s used for here
For nerve entrapment and irritation where imaging shows a nerve bound down by surrounding tissue or scar.
Precision is the point
The whole procedure depends on ultrasound guidance — the fluid is placed exactly around the nerve, watched in real time.
Where the experience comes from
Dr. Paul trained in hydrodissection with Dr. Stanley Lam of Hong Kong, who first published on the technique. The two have taught it together — at TOBI and the Interventional Orthopedics Foundation (IOF) labs, and in Tokyo.
Patients often ask how long he has done this. He has performed hydrodissection since 2010, and was among the first physicians in the world to perform percutaneous tenotomy (Tenex), beginning in 2012, and intraosseous injection — delivering biologics into the bone — since 2015, now well over 800 cases.
Honest about evidence
Hydrodissection helps many patients with the right diagnosis and not all. It is applied after the cause is clear, as one part of a plan.
Common questions
Asked and answered
Is nerve hydrodissection the same as a nerve block?
No. A nerve block delivers anesthetic to quiet a nerve’s signal. Hydrodissection uses the volume of the fluid itself to physically separate the nerve from the tissue or scar binding it. Both are often done under ultrasound guidance, which is why the two are frequently confused — and why it is worth reviewing prior records to see which one was actually performed.
Can a nerve be compressed in more than one place?
Yes. Compression at two or more points along the same nerve pathway is sometimes described as double crush. When only one site is addressed, symptoms may improve only partially — which is why the whole pathway is examined, not just the spot that hurts.
What fluid is used for hydrodissection?
Several are used in practice, including 5% dextrose (D5W) and platelet-derived preparations. The choice follows the diagnosis rather than a fixed recipe, and the evidence base differs between them.
How long has Dr. Paul performed nerve hydrodissection?
Since 2010 — before the technique became widely known. He trained in it with Dr. Stanley Lam of Hong Kong, who first published on it, and the two have taught it together at TOBI, the Interventional Orthopedics Foundation labs, and in Tokyo.
Is nerve hydrodissection painful?
The needle is fine and the site is numbed first, so most people describe pressure and a feeling of fullness as the fluid opens the plane around the nerve. Comfort is planned for here: nitrous oxide, oral sedation, and advanced regional and specific peripheral nerve blocks are available, alongside breath work, meditation, and procedural music tuned to 528 Hz.
How much does hydrodissection cost, and is it covered by insurance?
For orthopedic use this is generally considered elective and is usually not covered by insurance or Medicare. Cost is discussed openly at your evaluation.
Educational information, not medical advice or a diagnosis. Care is individualized; not every treatment is right for every patient, and results vary.