Background and Clinical Significance: Radial nerve palsy typically presents as wrist drop due to nerve compression, with conventional management often yielding prolonged recovery. We report a case where ultrasound-guided hydrodissection (HD) with 5% dextrose in water (D5W) achieved immediate functional restoration, suggesting neurapraxia as the underlying pathology. Case Presentation: A 54-year-old diabetic female presented with acute left wrist drop without trauma. Examination confirmed radial nerve palsy (MRC grade 0 wrist extension), while radiographs ruled out structural causes. Ultrasound revealed fascicular swelling at the spiral groove. Under real-time guidance, 50 mL D5W (no local anesthetic) was injected to hydrodissect the radial nerve. Immediate post-procedure assessment showed restored wrist extension (medical research council (MRC) grade 4+). At one- and three-month follow-ups, the patient maintained complete resolution of symptoms and normal function. Conclusions: This case highlights two key findings: (1) HD with D5W can serve as both a diagnostic tool (confirming reversible neurapraxia through immediate response) and therapeutic intervention, and (2) early HD may circumvent prolonged disability associated with conservative management. The absence of electrodiagnostic studies limits objective severity assessment, though ultrasound localized the lesion. While promising, these observations require validation through controlled trials comparing HD to standard care, particularly in diabetic patients with heightened compression susceptibility. Technical considerations—including optimal injectate volume and the role of adjuvant therapies—warrant further investigation. US-guided HD with D5W emerges as a minimally invasive, surgery-sparing option for acute compressive radial neuropathies, with potential to redefine treatment paradigms when applied at symptom onset.

Background and Clinical Significance: Non-palpable migrated contraceptive implants pose significant challenges for removal and are associated with neurovascular complications. Traditional open surgery near nerves is associated with postoperative morbidity. Migrated or deeply embedded implants near critical structures can result in severe complications, such as neuropathy, and their removal typically requires open surgical intervention. Case Presentation: We report a novel, minimally invasive, ultrasound (US)-guided technique for removing a migrated etonogestrel Implanon^® implant that caused ulnar neuropathy. A 38-year-old woman presented with severe neuropathic pain and paresthesia (NPRS 10/10; QuickDASH 55) along her left ulnar nerve following multiple failed removal attempts that induced deep migration. US confirmed the proximity of the implant to the ulnar nerve. Initial US-guided removal exacerbated her symptoms. Hydrodissection (HD) with 50 mL of 5% dextrose in water (D5W) without local anesthetic (LA) was performed to reduce inflammation and achieve separation. The implant migrated proximally during extraction. An additional HD with 50 mL of D5W without LA distally repositioned the implant. Percutaneous stabilization using a 25-gauge needle enabled secure removal. The intact 4 cm implant was extracted under real-time US guidance without open surgery. The patient experienced immediate symptom relief (NPRS 2/10; QuickDASH 4.5 at one month) and full resolution (NPRS 0/10; QuickDASH 0) with no motor deficits at one year. Conclusions: This case represents the first documented percutaneous removal of a nerve-adherent implant using combined US-guided D5W HD and needle stabilization, marking a paradigm shift in the management of such cases. This approach confirms the safety of US-guided foreign body removal using HD for nerve-adjacent implants and demonstrates the efficacy of combining D5W HD with needle stabilization. Surgical morbidity was avoided, while excellent long-term outcomes were achieved.

Introduction: Radial nerve palsy, often manifesting as wrist drop, is a peripheral neuropathy typically resulting from compression. While conservative management is often employed, recovery can be prolonged. It has been commonly taught that cases like this involve a conduction block, which significantly limits diagnostic physical examination or electrodiagnosis. However, if hydrodissection (HD) can immediately restore function, it may indicate that the injury is merely neurapraxia, and highlight its degree of reversibility, profoundly influencing the course of recovery. We present a case of acute radial nerve palsy successfully treated with ultrasound-guided (US-guided) HD. Case Presentation: A 54-year-old woman with diabetes presented with sudden onset of left wrist drop with no apparent trauma. Physical examination revealed an inability to actively extend her wrist, and plain radiographs were unremarkable. Given the clinical presentation suggestive of radial nerve palsy, US-guided HD was performed at the proximal spiral groove using 50 mL of 5% dextrose in water (D5W) with no local anesthetic (LA). Immediate post-procedural assessment showed marked improvement in wrist extension. At one-month follow-up, the patient reported complete resolution of wrist drop and restoration of normal daily activities, with no loss of work, which was maintained at a three-month telephone review. Electrodiagnostic studies were not performed due to the retrospective nature of this case report. Discussion: This case demonstrates the potential for rapid and nearly complete clinical recovery from acute compressive radial nerve palsy following a single US-guided HD injection using D5W without LA, confirming the presence of neuropraxia and its nearly complete reversibility. However, an electromyogram (EMG) showing the pattern of motor fiber recruitment post injection was not available. Conclusion: US-guided HD with D5W with no LA may be a promising therapeutic option for selected patients with acute compressive radial nerve palsy. However, further research - including controlled trials and electrodiagnostic confirmation - is needed to determine the frequency in which immediate diagnostic and therapeutic HD with D5W is expected to be therapeutically valuable in altering function and optimizing rehabilitation

Background: Ultrasound is increasingly used in plastic surgery for real-time guidance in minimally invasive procedures. However, standardized approaches for targeting the facial nerve (FN) trunk, particularly for motor nerve interventions, remain limited. This study aimed to evaluate the anatomical feasibility of an ultrasound-guided approach to the FN trunk using the posterior belly of the digastric muscle (PBDM) as a landmark. Methods: An exploratory feasibility design was used with a single fresh-frozen cadaver to perform ultrasound-guided dye injections targeting the anterior and posterior surfaces of the PBDM. Subsequent layer-by-layer dissection evaluated dye distribution relative to the facial and hypoglossal nerves. Additionally, real-time Doppler ultrasound in a live participant was conducted to visualize adjacent vascular structures, including the occipital and vertebral arteries. Results: The FN trunk was located deep to the PBDM and near the stylomastoid foramen. Anterior injections reached the FN trunk, whereas posterior injections followed the trajectory of the hypoglossal nerve. Doppler ultrasound enabled clear visualization of major vascular structures, supporting safe needle trajectory planning. Conclusions: This cadaveric feasibility study demonstrates a potentially reproducible ultrasound-guided anatomical approach to the FN trunk using consistent musculoskeletal and vascular landmarks. Incorporating Doppler vascular mapping enhances procedural safety and accuracy, providing a practical framework to facilitate clinical translation of image-guided motor nerve interventions in plastic and reconstructive surgery.

Non-palpable migrated contraceptive implants (3-5%) pose significant removal challenges and neurovascular risks. Traditional open surgery near nerves carries postoperative morbidity. We report a novel minimally invasive ultrasound (US)-guided removal of a migrated etonogestrel Implanon® implant causing ulnar neuropathy. A 38-year-old woman presented with severe neuropathic pain and paresthesia (Numeric Pain Rating Scale [NPRS] 10/10; Quick Disabilities of the Arm, Shoulder, and Hand [QuickDASH] 55) along her left ulnar nerve after multiple failed removal attempts elsewhere induced deep migration. US confirmed the implant adjacent to the ulnar nerve within the medial arm neurovascular bundle, with direct nerve contact on dynamic imaging. Initial US-guided removal exacerbated symptoms, prompting hydrodissection (HD) using 50 mL dextrose 5% in water (D5W) without local anesthetic (LA) to reduce inflammation and achieve mechanical separation. Despite pain reduction, the slippery implant iatrogenically migrated proximally during extraction, confirmed fluoroscopically and sonographically. Additional HD (50 mL D5W) repositioned the implant distally. Percutaneous stabilization of the proximal tip with a 25-gauge needle then enabled secure grasping and complete extraction through the original incision under real-time US-guidance. The intact 4-cm implant was retrieved without open surgery. Immediate pain reduction (NPRS 2/10) and functional improvement (QuickDASH 4.5 at one month) occurred, with complete symptom resolution (NPRS 0/10; QuickDASH 0) and no motor deficits sustained at one year. This first documented percutaneous removal of a nerve-adherent implant using combined US-guided D5W HD and needle stabilization achieved durable success while avoiding open surgery, signifying a paradigm shift and possibly confirming: (1) safety of US-guided HD for nerve-adjacent implants, (2) efficacy of combined D5W HD and needle stabilization, and (3) elimination of surgical morbidity.