{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T00:21:47Z","timestamp":1793319707268,"version":"4.5.0"},"reference-count":34,"publisher":"MDPI AG","issue":"16","license":[{"start":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T00:00:00Z","timestamp":1755734400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background and Clinical Significance: Non-palpable migrated contraceptive implants pose significant challenges for removal and are associated with neurovascular complications. Traditional open surgery near nerves is associated with postoperative morbidity. Migrated or deeply embedded implants near critical structures can result in severe complications, such as neuropathy, and their removal typically requires open surgical intervention. Case Presentation: We report a novel, minimally invasive, ultrasound (US)-guided technique for removing a migrated etonogestrel Implanon\u00ae implant that caused ulnar neuropathy. A 38-year-old woman presented with severe neuropathic pain and paresthesia (NPRS 10\/10; QuickDASH 55) along her left ulnar nerve following multiple failed removal attempts that induced deep migration. US confirmed the proximity of the implant to the ulnar nerve. Initial US-guided removal exacerbated her symptoms. Hydrodissection (HD) with 50 mL of 5% dextrose in water (D5W) without local anesthetic (LA) was performed to reduce inflammation and achieve separation. The implant migrated proximally during extraction. An additional HD with 50 mL of D5W without LA distally repositioned the implant. Percutaneous stabilization using a 25-gauge needle enabled secure removal. The intact 4 cm implant was extracted under real-time US guidance without open surgery. The patient experienced immediate symptom relief (NPRS 2\/10; QuickDASH 4.5 at one month) and full resolution (NPRS 0\/10; QuickDASH 0) with no motor deficits at one year. Conclusions: This case represents the first documented percutaneous removal of a nerve-adherent implant using combined US-guided D5W HD and needle stabilization, marking a paradigm shift in the management of such cases. This approach confirms the safety of US-guided foreign body removal using HD for nerve-adjacent implants and demonstrates the efficacy of combining D5W HD with needle stabilization. Surgical morbidity was avoided, while excellent long-term outcomes were achieved.<\/jats:p>","DOI":"10.3390\/diagnostics15162106","type":"journal-article","created":{"date-parts":[[2025,8,21]],"date-time":"2025-08-21T14:46:04Z","timestamp":1755787564000},"page":"2106","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Ultrasound-Guided Hydrodissection with Needle Stabilization: An Innovative Nerve-Sparing Approach to Remove a Contraceptive Implant Causing Ulnar Neuropathy"],"prefix":"10.3390","volume":"15","author":[{"given":"Yeui-Seok","family":"Seo","sequence":"first","affiliation":[{"name":"Department of Anatomy, Catholic Institute for Applied Anatomy, College of Medicine, Soeul 06591, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HoWon","family":"Lee","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9141-9856","authenticated-orcid":false,"given":"Jihyo","family":"Hwang","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1207-348X","authenticated-orcid":false,"given":"Chanwool","family":"Park","sequence":"additional","affiliation":[{"name":"IncheonTerminalOrthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MinJae","family":"Lee","sequence":"additional","affiliation":[{"name":"IncheonTerminalOrthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8746-3718","authenticated-orcid":false,"given":"Yonghyun","family":"Yoon","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hallym University Gangnam Sacred Heart Hospital, 1 Singil-ro, Yeongdeungpo-gu, Seoul 07441, Republic of Korea"},{"name":"IncheonTerminalOrthopedics, Inha-ro 489beon-gil, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"International Association of Regenerative Medicine, Namdong-gu, Incheon 21574, Republic of Korea"},{"name":"MSKUS, 1035 E. Vista Way #128, Vista, CA 92084, USA"},{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"HyeMi","family":"Yu","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, BIO Plastic Surgery Clinic, Seoul 06035, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaeik","family":"Choi","sequence":"additional","affiliation":[{"name":"Choi\u2019s Rehabilitation Clinic, 159, Gwangdeok 1-ro, Danwon-gu, Ansan-si 15476, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gyungseog","family":"Ko","sequence":"additional","affiliation":[{"name":"Ko GyungSeog Orthopaedic Clinic, 551, Ogeum-ro, Songpa-gu, Seoul 05764, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8646-0918","authenticated-orcid":false,"given":"Daniel Chiung-Jui","family":"Su","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Chi Mei Medical Center, Tainan 710, Taiwan"},{"name":"A Tempo Regeneration Center for Musicians, Tainan 700, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2346-2326","authenticated-orcid":false,"given":"Keneath Dean","family":"Reeves","sequence":"additional","affiliation":[{"name":"Independent Researcher, Roeland Park, KS 66205, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-6722-0268","authenticated-orcid":false,"given":"Teinny","family":"Suryadi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, North Jakarta 14350, Indonesia"},{"name":"Department of Physical Medicine and Rehabilitation, Medistra Hospital, South Jakarta 17431, Indonesia"},{"name":"Physical Medicine and Rehabilitation, Synergy Clinic, West Jakarta 11520, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5795-0988","authenticated-orcid":false,"given":"Anwar","family":"Suhaimi","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Department of Rehabilitation Medicine, Universiti Malaya, Kuala Lumpur 50603, Malaysia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1392-829X","authenticated-orcid":false,"given":"King Hei Stanley","family":"Lam","sequence":"additional","affiliation":[{"name":"The Board of Clinical Research, The International Association of Musculoskeletal Medicine, Kowloon, Hong Kong"},{"name":"Faculty of Medicine, The University of Hong Kong, Hong Kong"},{"name":"Faculty of Medicine, The Chinese University of Hong Kong, New Territory, Hong Kong"},{"name":"The Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, Hong Kong"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,8,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"3","DOI":"10.1097\/00013644-200303000-00002","article-title":"Percutaneous ultrasound-guided injections in the musculoskeletal system","volume":"19","author":"Adler","year":"2003","journal-title":"Ultrasound Q."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1166","DOI":"10.1016\/j.arthro.2014.03.013","article-title":"Ultrasound-guided barbotage for calcific tendonitis of the shoulder: A systematic review including 908 patients","volume":"30","author":"Gatt","year":"2014","journal-title":"Arthroscopy"},{"key":"ref_3","first-page":"153","article-title":"Location and removal of non-palpable Implanon implants with the aid of ultrasound guidance","volume":"32","author":"Singh","year":"2006","journal-title":"BMJ Sex. 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