As explained in previous sections, there are many situations resulting from trauma and operative interventions in which the sensory nerves become entrapped in scar tissue. The resulting pain is usually neuropathic in quality and can lead to severe despair.
Particularly common cases of nerve entrapment after trauma and operations occur after fractures of the ankles and knees, and operative intervention to both of these. Nerve entrapments in the upper limb are less common. Sometimes nerves can become entrapped in mesh implantation, as in the case of hernia repairs of various sorts; nerves can become entrapped in the mesh or in the surrounding scar tissue around the mesh. This is exceedingly common after inguinal or abdominal hernia repair.
Hydrodissection is based on the injection of relatively large volumes of fluid around the entrapped nerve with the aim of separating this from the scar tissue. This can only be done in open areas; if the entrapment is within a closed compartment, the approach is more complicated. All injections must be performed under ultrasound for the injection to be effective. The most important element of the injectate is simple sterile water in order than it can permeate through the tissues. Cortisone is not necessary. Several treatment sessions are required- the first one can last just a few days to a couple of weeks, and gradually each treatment lasts longer. I have patients with relief lasting for years.
Patients are extremely satisfied with the response and their quality of life has changed for the better.