First appearance of localized induration over the left arm, described as rough, leathery tissue overlying peripheral nerves. Symptoms are limited at this time.
2015–2024
Progressive spread of induration to multiple limbs with increasing diffuse burning pain, paresthesia, asthenia, dizziness, and cold-induced exacerbation. Functional decline develops, including impaired hand use and limping from common fibular nerve involvement.
Early 2024
Worsening paresthesia in all extremities, marked mechanical sensitivity along peripheral nerves, and increasing difficulty performing daily tasks such as grasping, walking, and maintaining static positions. Patient reports severe symptoms with nerve compression and stretching.
Initial consultation (2024)
Comprehensive evaluation performed. Physical exam identifies widespread nerve-related pain, palpable indurations encasing nerves, trigger points, and mechanical allodynia. Ultrasound confirms nerve thickening, altered echotexture, fascial stiffness, and identifiable trigger points. Diagnosis: diffuse peripheral nerve entrapment due to sclerotic tissue in scleroderma. Patient consents to diagnostic hydrodissection.
Week 0 (first procedure)
Ultrasound-guided dextrose hydrodissection was performed on the arms, legs, and right foot nerves. Trigger points treated with 15% dextrose. Immediate mechanical decompression achieved (nerve “floating”).
Weeks 1–6
Weekly ultrasound-guided hydrodissection sessions continued. Progressive reduction in pain, decreased induration, improved limb mobility, and resolution of trigger-point responses were noted.
6 weeks post-treatment
Patient reports near-complete symptom resolution. Palpation no longer elicits pain or paresthesia. Functional abilities in the hands and legs significantly improved.
1-year follow-up
Patient remains asymptomatic. Sustained reduction in induration, normalized nerve glide, and resolution of neuropathic symptoms confirmed clinically and by ultrasound.
The authors declare that there are no conflicts of interest.
Ethical approval
Ethical approval was not required, as this study describes a single patient case report and does not involve experimental intervention. This observational study was exempted by the International Sonoguide Pain School. All procedures were conducted in accordance with the principles of the Declaration of Helsinki (2013 revision).
Consent to participate
Informed consent for participation was obtained from the patient.
Consent to publication
Written informed consent was obtained from the patient for publication of anonymized clinical data and accompanying images.
Availability of data and materials
The data supporting the findings of this case report are not publicly available to protect patient confidentiality, but can be obtained from the corresponding author upon reasonable request.
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