Working Diagnosis:
Lateral Sural Cutaneous Nerve Entrapment

Treatment:
Patient underwent an ultrasound-guided, perineural injection with 15mL of D5W to hydrodissect the lateral sural cutaneous nerve circumferentially from surrounding tissue. He has had complete resolution of symptoms, unable to provoke with running or any activity.

Outcome:
The patient returned to running the week of the procedure without limitations or side effects and has had no recurrence of his symptoms to date (6 months out). He was pleased with the results of the procedure and would have the procedure again if symptoms recurred.

Author's Comments:
Cutaneous sural nerve entrapment is challenging to diagnose when not caused by discrete trauma. Current, limited treatment options include removal of external compressive forces and symptom-based medications.
There is significant anatomic variability of the nerve among individuals making diagnosis based on location of symptoms and findings on ultrasound challenging.
D5W perineural hydrodissection is a relatively new treatment modality that here successfully treated a longstanding, local nerve entrapment. The mechanical separation from surrounding tissue causing entrapment appears to be potentially augmented by the action of the injectate. Understanding of D5W's pharmacologic action on peripheral nerves is still emerging, The risks & benefits of long-term treatment outcomes of D5W perineural hydrodissection are being studied in a large case review by our clinic.

References:
Wu, Y. , Ke, M. , Ho, T. , Li, T. , Shen, Y. and Chen, L. (2018), Randomized double‐blinded clinical trial of 5% dextrose versus triamcinolone injection for carpal tunnel syndrome patients. Ann Neurol., 84: 601-610.

Kasper, Korey. Research Poster Presentation, Poster Session 2, AMSSM 2019. Case Series: Outcomes of Ultrasound-Guided Peripheral Nerve. Hydrodissection in a Primary Care Sports Medicine Clinic

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