Ultrasound-Guided Hydrodissection for Peripheral Neuropathy: An Evidence-Based Intervention Whose Time Has Finally Come.

Peripheral neuropathy remains a prevalent and challenging clinical condition, with management strategies traditionally centered on pharmacologic and neuromodulatory approaches. While these interventions play essential roles, an additional minimally invasive, evidence-based procedure warrants greater recognition: ultrasound-guided perineural hydrodissection. This editorial presents a contemporary perspective on hydrodissection as a key tool within the peripheral neuropathy treatment algorithm. High-resolution ultrasound enables precise injection of solutions, such as 5% dextrose, to release nerves from surrounding compressive structures. The rationale is supported by animal models demonstrating the vulnerability of nerves to even mild compression, and the therapeutic goal is to restore the function of the nervi nervorum and vasa nervorum through mechanical release and potential metabolic effects. Recent systematic reviews and meta-analyses have established hydrodissection as a safe and effective intervention, particularly for focal entrapment neuropathies such as carpal tunnel syndrome. Its role as a bridge between conservative care and invasive surgery is especially relevant for patients with length-dependent peripheral neuropathies who develop superimposed entrapments. Wider recognition of this technique is essential for providing a complete and contemporary picture of interventional options for refractory neuropathic pain.