Ultrasound-Guided Perineural Corticosteroid Injection and Dextrose Hydrodissection for Carpal Tunnel Syndrome: Current Evidence and Clinical Considerations.

Carpal tunnel syndrome (CTS) is the most common entrapment neuropathy and represents a substantial source of pain, disability, and healthcare expenditure. Ultrasound-guided perineural corticosteroid injection (CSI) remains the most established injectable treatment for CTS; however, hydrodissection with 5% dextrose in water (D5W) has emerged as a promising alternative that may address both inflammatory and mechanical contributors to median nerve entrapment. Our objective is to review the current evidence comparing ultrasound-guided perineural CSI and D5W hydrodissection for the nonoperative treatment of CTS and to discuss clinical considerations regarding their use. A narrative review of the literature was performed using PubMed/MEDLINE and Google Scholar through January 2026. Search terms included "carpal tunnel syndrome," "median nerve," "corticosteroid injection," "hydrodissection," "perineural injection," "dextrose," and "D5W." Priority was given to randomized controlled trials, systematic reviews, meta-analyses, clinical practice guidelines, and prospective cohort studies evaluating CSI, D5W hydrodissection, or direct comparisons between these interventions. CSI remains supported by a robust body of evidence demonstrating reliable short-term improvements in pain, paresthesias, and functional outcomes in patients with mild-to-moderate CTS. D5W hydrodissection has demonstrated favorable clinical and sonographic outcomes, with several studies reporting sustained symptom improvement beyond the time frame typically observed with CSI. Direct comparative studies suggest that D5W hydrodissection may provide longer-lasting symptom relief in some patients; however, current evidence remains limited by small sample sizes, heterogeneity in hydrodissection techniques, and a lack of large multicenter randomized controlled trials. Both ultrasound-guided perineural CSI and D5W hydrodissection are effective nonoperative treatment options for CTS. CSI remains the current first-line injectable therapy because of its extensive evidence base and established efficacy. D5W hydrodissection represents a promising alternative that may provide longer-lasting symptom improvement while avoiding corticosteroid-related adverse effects. Additional high-quality comparative studies are needed to further define optimal patient selection and the long-term role of D5W hydrodissection in CTS management.