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Perineural Injections: Innovative Non-Surgical Nerve Pain Treatment in Portland, Oregon

Nerve pain treatment, perineural injection

Why Perineural Injections?

Perineural hydrodissection is a procedure that involves injecting either D5W or PRP around a compressed or irritated nerve to help alleviate pain and improve mobility. The solution is intended to create a pocket of fluid around the nerve, which can reduce pressure and inflammation on the nerve and allow it to move more freely.

The procedure is done with a small needle under Ultrasound-Guidance for precise placement of the medicine. 

Nerves/Conditions that can be effectively treated: 

  • Carpal Tunnel Syndrome

  • Cubital Tunnel Syndrome

  • Sciatica

  • Posterior Interosseous Nerve

  • Cluneal Nerves

  • Peroneal Nerve 

  • Suprascapular Nerve

  • Brachial Plexus Nerves

  • Any nerve that can be identified as a pain generator


Pricing information can be found here.

Nerve Pain

While injured bone, tendon, ligament, and cartilage are often the source of pain, the nerves themselves can also generate pain. Peripheral nerve dysfunction and/or entrapment is a common cause of pain that can be effectively treated with precise, ultrasound-guided, perineural injections. It is also often overlooked as a cause of painful conditions and is another way in which Cascade Regenerative Medicine treats the entire cause of your pain. 


Perineural Injections are done very precisely under Ultrasound Guidance so that the injection solution is placed around the nerve, encircling the structure and freeing it from points of entrapments, scar tissue, and adhesions. This cannot be accomplished with Ultrasound. Carpal Tunnel Syndrome is the most common condition in the nerve entrapment category but the same type of issue can occur in the elbow, shoulder, knee, ankle, or anywhere where an injury has occurred. 

Double Benefit

A Perineural Injection has 2 primary benefits: 

  • It physically separates and cushions the nerve from the surrounding tissue, reducing friction and improving nerve glide.

  • It chemically alters the nerve so that it’s less inflamed and less sensitive to pain and pressure signals, normalizing its response. 

This is what allows this therapy to have a wide range of applications from big nerves to small nerves. 

Scientific Evidence


How Many Treatments Will I Need?

The vast majority of patients need just 1-2 treatments. For nerve entrapment conditions, symptom relief tends to occur within just a few days once the nerve has been freed from the surrounding tissue. For mild conditions this can be all one needs, and for more severe conditions, a repeat may be necessary for full symptom relief. 

Are The Treatments Painful?

There is often temporary discomfort/pressure associated with the treatment as fluid is placed into small spaces. We offer a full array of options to ensure and prioritize patient comfort:  

  • Local and Regional anesthetic

  • Nerve Blocks when indicated

  • Nitrous Oxide Sedation

  • Pain Medication (Opioids and/or natural supplements)

  • Anxiolytics (Rx or natural supplements)

The majority of patients experience minimal pain with these measures. All patients will be provided instructions for post-treatment care that outlines additional comfort measures.

Is There A Recovery Period After A Treatment? 

For perineural injections, the recovery period is usually about 1 day. During this period the treated area may feel increased achiness and/or stiffness that can be treated with heat applications and Tylenol (not anti-inflammatories). You do not need to be immobilized or non-weight bearing but you should not do any strenuous activity during this period. After the post-treatment soreness has resolved you may begin slowly increasing your physical activity as tolerated. 

Are There Medications Restrictions During Treatment?

Most medications do not need to be stopped and do not interfere with the treatments. There are some exceptions and Dr. Oltman will address your specific needs as a part of your treatment plan. 

What Is The Cost Of A Treatment?

We require payment at the time of service. We provide you with a Superbill that you can submit to your insurance company for reimbursement. HSA accounts can also be used to pay for our services.

See our Pricing page for the full details on treatment cost and insurance coverage.

Are The Treatments Image-Guided?

Yes. Every treatment and every injection a patient receives is ultrasound-guided for the highest possible precision. The target is visualized and Dr. Oltman guides the needle directly into the area where the medicine needs to go for maximum results. There is no guess work. Dr. Oltman's RMSK credential is "Registered in Musculoskeletal Ultrasound" and distinguishes him as an expert in the technique that only a few doctors in the entire state of Oregon have. Read more about Ultrasound Expertise here.

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