Ultrasound-Guided Dextrose Hydrodissection with 25G Needle Stabilization: An Innovative Nerve-Sparing Approach for the Removal of a Migrated Contraceptive Implant Causing Ulnar Neuropathy

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.