Ultrasound-Guided 5% Dextrose Hydrodissection Procedures for Persistent and Recurrent Post-Surgical Carpal Tunnel Syndrome: A Prospective Single-Center Cohort Study.

Background/Objectives: Persistent and recurrent symptoms after carpal tunnel release remain challenging, and non-surgical options for post-surgical carpal tunnel syndrome (CTS) are poorly defined. This study evaluated 6-month treatment success after ultrasound-guided 5% dextrose in water (D5W) hydrodissection in persistent or recurrent post-surgical CTS and compared outcomes between subgroups. Methods: In this prospective single-center interventional cohort study, 100 patients with post-surgical CTS were enrolled: 50 with persistent disease and 50 with recurrent disease. All underwent 1-4 treatments with ultrasound-guided D5W hydrodissection using a standardized protocol. Treatment success at 6 months was defined as Patient Global Impression of Change (PGIC) scores of 6-7 together with clinically meaningful improvement in at least two of three domains: ≥30% reduction in 0-10 VAS pain, ≥0.8-point reduction in BCTQ-SSS, and ≥0.5-point reduction in BCTQ-FSS. Secondary outcomes included 12-month durability; longitudinal clinical, ultrasonographic, and electrodiagnostic changes; predictors of treatment success; treatment exposure; and safety. Results: Treatment success at 6 months occurred in 58 of 100 patients (58.0%) and was more frequent in recurrent than persistent CTS (70.0% vs. 46.0%, p = 0.015). At 12 months, treatment success persisted in 52.0% of the cohort (64.0% vs. 40.0%, p = 0.017). Clinical and ultrasonographic outcomes improved significantly over time, with greater improvement in recurrent CTS. Electrodiagnostic improvement was more modest. Recurrent CTS independently predicted success (adjusted OR 2.58, 95% CI 1.10-6.03), whereas severe electrodiagnostic involvement and greater baseline median nerve cross-sectional area were associated with lower odds of success. No serious treatment-related adverse events occurred. Conclusions: Ultrasound-guided D5W hydrodissection was associated with meaningful improvement in post-surgical CTS, particularly recurrent disease.