Ultrasound-Guided Nerve Entrapment Release

About the Procedure

Percutaneous neuroplasty, also called nerve hydrodissection, is used to treat painful nerves that are entrapped in scar tissue from surgery, trauma, or damage from chronic repetitive movements. This ultrasound-guided technique uses injected fluid to mechanically separate scar tissue from the trapped nerve.

Dr. Mulvaney published the first medical literature paper describing this approach in 2011. The technique can address any peripheral nerve, and even spinal nerve roots, potentially avoiding surgery or medication dependency. It demands extensive knowledge of ultrasound anatomy and advanced needle guidance skills, which Dr. Mulvaney has been teaching nationally and internationally for two decades.

What to Expect and How to Prepare

No special preparation is required, since this is a mechanical technique unaffected by medications. Temporary numbness or weakness may occur for up to two hours after treatment, so a driver may be necessary, or crutches might be needed briefly. Tobacco use restricts blood vessels essential for healing, and alcohol impairs cellular repair — both should be avoided.

What Happens During the Procedure?

“This is not a painful procedure and is in fact quite comfortable.” The nerve is first assessed and measured at the symptomatic location using ultrasound. The skin receives surgical cleansing and sterile ultrasound gel application, and lidocaine numbs the skin before the needle advances under ultrasound guidance.

Fluid is injected along the nerve through the entrapment area, with the ultrasound view switching between cross-sectional and longitudinal planes. The procedure takes fifteen to forty minutes, with minimal risk of nerve injury.

What to Do After Your Procedure

Temporary numbness or mild weakness may occur. There is generally only mild soreness afterward — acetaminophen can address any discomfort; avoid NSAIDs. Don't shower for one day or immerse the area in water for two days, and remove bandages after one day. Depending on the treatment location, a sling or crutches might be temporarily necessary. Benefits typically appear within days, though repeat procedures may be needed for partial relief or if symptoms recur.