Disclosures: Michael D. Smith, DO: No financial relationships or conflicts of interest

Case Description: Our patient underwent left ulnar nerve neurolysis and anterior translocation 6 years prior for severe ulnar nerve compression confirmed by electromyography. Shortly after she started to develop left upper extremity numbness and allodynia in the ulnar and median nerve distributions in her forearm and hand. Her left hand and forearm were noted to be swollen with a mottled appearance. Left grip strength and 5th digits opposition was weakened with manual muscle testing of 4/5. She failed conservative treatment including medications prescribed such as gabapentin, amitriptyline, duloxetine, topiramate, and various narcotics. She underwent two Stellate ganglion blocks which provided relief for less than a day. In an attempt to avoid escalating to a spinal cord stimulator, we performed hydrodissection of the ulnar and median nerves under ultrasound guidance.

Setting: An outpatient spine and sport medical rehabilitation center.

Patient: A 64-year-old female with a 6-year-history of complex regional pain syndrome, type 2. Assessment/

Results: Ultrasound guidance was used to localize the left ulnar and median nerves prior to hydrodissection. Injectate consisted of 5cc of 1% lidocaine, 1cc of 40mg/ml methylprednisolone, and 4cc of normal saline, totaling 10cc for each hydrodissection. Post-procedurally, hypersensitivity and pain was completely gone and lasted for 12 weeks. The procedure has been repeated multiple times over the last 3 years with entire resolution of symptoms ranging from 3 to 12 weeks post procedure.

Discussion: This is the first case, to our knowledge, of using ultrasound guided median and ulnar nerve hydrodissection to treat type 2 CRPS secondary to median and ulnar nerve neuropathies.

Conclusion: This novel procedure has potential to be a viable treatment option in those with CRPS type 2 who have failed conventional treatments. Further studies are needed to assure it is a feasible and efficacious treatment option in this population.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/a-novel-treatment-for-type-2-complex-regional-pain-syndrome-caused-by-median-and-ulnar-compressive-neuropathies-a-case-report/