What are Perineural Superficial/Deep Injections?

Perineural Superficial Injections (PSI) treat inflamed and injured nerves. This is an effective treatment for patients suffering from chronic nerve pain as a result of trauma, arthritis, sports, overuse, occupational, and surgical injuries. 

Irritated nerves often cause neuropathic inflammation and neuropathic pain. When PSI are used to treat this, a substance is injected around skin nerves to provide pain relief. The focus of this treatment is to nourish and reset nerves in order to relieve or eliminate pain and restore mobility.

Neuropathic pain tends to be a dull, burning pain that is felt over a wide area of the body or it can take the form of deep aching. PSI can decrease nerve impingement and inflammation, which improves the mobility of muscles and the musculoskeletal system while reducing pain, spasms, and tightness.

Perineural Superficial Injections are a safe, non-surgical, and minimally invasive treatment for neuropathic pain. PSI can be used to treat neuropathic conditions such as the following:

• Carpal tunnel
• Regularly spasming muscles
• Nerve pain 
• Pinched nerve
• Nerve compression
• Herniated disc 
• Ulnar neuropathy
• Whiplash

What to Expect From Perineural Superficial Injections

Perineural Superficial Injections involve injecting a solution just under the skin to provide a mechanical local effect on tissue within the fascia and create additional space for the affected nerve as well as potentially breaking up adhesions contributing to neuropathic pain.

There are three solutions that are most commonly used in these injections.

• Hyaluronic acid, to aid in restoring normal nerve gliding between fascial planes.
• Lidocaine, which temporarily shuts down nerve response.
• Dextrose, a solution that causes nerves to require more stimulus in order to fire the nerve and send pain signals. Dextrose also affects TRPV-1, a nerve receptor. Over time, this effect on TRPV-1 may be able to reset the nerve, making it less inflammatory or reactive. It also supplies nutritional energy that the nerve may be lacking.  Dextrose helps shrink a swollen, inflamed and entrapped nerve to allow normal nerve function.

Patients suffering from chronic pain or limited mobility can benefit greatly from Perineural Superficial Injections. As opposed to other treatments, in PSI, the area around the nerve is the target rather than a tendon or ligament. Perineural Superficial Injection treatment usually takes place over the course of six to eight weeks with one injection per week. For the superficial type of injection or once every 4 plus weeks for deeper nerve (hydrodissection) treatments. Patients will usually feel less and less pain with each treatment and in some patients, pain is eliminated completely.