100 - Non-Surgical Management of Superficial Radial Nerve Neuroma with an Ultrasound-guided Nerve Hydrodissection

Thursday, February 19, 2026

5:00 PM - 6:30 PM AST

Presenting Author(s)

DP

Dev P. Patel, MD

Resident Physician - PGY2
Memorial Healthcare
Hollywood, Florida, United States

Co-Author(s)

TH

Tahreem Hashmi, D.O.

Resident Physician PGY-3
Memorial Healthcare System
Cooper City, Florida, United States
GN

Giorgio A. Negron, MD

Physician
Memorial Healthcare System
Hollywood, Florida, United States

Submitter(s)

DP

Dev P. Patel, MD

Memorial Healthcare
Miami, Florida, United States

Case Diagnosis: Traumatic iatrogenic right superficial radial nerve neuroma following radial artery harvest for coronary artery bypass grafting (CABG).

Case Description: A 70-year-old male underwent CABG utilizing a radial artery graft harvested from his right forearm six years ago. Postoperatively, he developed persistent dysesthesia and neuropathic pain localized to the dorsolateral forearm and thumb, consistent with the superficial radial nerve (SRN) distribution. Neurological examination revealed sensory deficits over the dorsal thumb, otherwise, normal motor function. Diagnostic ultrasound demonstrated evidence of SRN swelling, hypoechogenicity, and loss of fascicular nerve architecture with adjacent hyperechoic surgical material consistent with traumatic iatrogenic SRN neuroma. Thereafter, the patient underwent an ultrasound-guided nerve hydrodissection with dextrose 5% in water (D5W). Within one month post-procedure, he reported progressive reduction in pain and improvement in sensory deficits, with significant improvement in function and ability to play golf.

Discussions: Neurologic complications following radial artery harvest for CABG recognized sequelae, but the development of a persistent, painful neuroma is rare. For these debilitating cases, a clear management consensus is lacking. Treatment options such as surgical excision, neurolysis, and regenerative therapies have been described for peripheral nerve injuries, though evidence for managing post-harvest radial nerve neuromas specifically is limited. Prolotherapy, a regenerative nerve hydrodissection injection technique and in this case with D5W, was shown to provide therapeutic pain relief and restoration of hand function in this case. However, its role in post-CABG neuroma management has not been well established in larger studies.

Conclusions: Iatrogenic radial nerve neuroma is a rare, but potentially disabling complication of radial artery harvest for CABG. This case demonstrates that prolotherapy may serve as a safe, effective, and minimally invasive option for symptomatic neuroma, offering both pain relief and sensory improvement. Further research is warranted to clarify its role and establish evidence-based protocols for this challenging clinical entity.