Dr. Johnny Nelson Featured on CBS17’s My Carolina

Carpal tunnel, Hand Surgeon, news, Sonex, Ultrasound

CBS17 stillshot Dr. Johnny T. Nelson was recently featured on CBS17’s My Carolina!

My Carolina, the Raleigh-Durham area’s only 1-hour lifestyle show, hosts guests from a wide variety of backgrounds to discuss topics of interest. Dr. Nelson’s segment focuses on his designation as a shoulder and hand orthopaedic specialist, carpal tunnel syndrome, ultrasound technology, and how ultrasound is used to both diagnose and treat hand and wrist problems.

Dr. Nelson is North Carolina’s carpal tunnel doctor. If you have symptoms of carpal tunnel, send us a message or call 919-872-5296 for an in-person evaluation or for a free carpal tunnel screening phone call.

For the full segment, visit Dr. Nelson’s YouTube page or visit CBS17’s My Carolina page.

Raleigh Upper Ex and The Bone & Joint Surgery Clinic Named Center of Excellence

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Johnny T. Nelson MD and Raleigh Upper Ex Named Center of Excellence!

Dr. Johnny T. Nelson MD, Raleigh Upper Ex, and the Bone & Joint Surgery Clinic were awarded the distinction of Center of Excellence by Sonex Health and the Institute of Advanced Ultrasound Guided Procedures! Read the press release here.

This award follows on the heels of Dr. Nelson performing the first trigger finger release with real-time ultrasound guidance in the RDU area. He was also part of the multi center ROBUST trial for in-office carpal tunnel release. Dr. Nelson was the first orthopaedic surgeon in the RDU area and remains one of only two orthopaedic surgeons in the state of NC to offer carpal tunnel release and trigger finger release with real-time ultrasound guidance.

If receiving your shoulder or hand care at a National Center of Excellence is important to you, Dr. Johnny T. Nelson, Raleigh North Carolina carpal tunnel specialist, is still accepting new patients. Call 919-872-5296 to schedule your appointment or send us a message and we will call you!.

When Can I Return to Work After Carpal Tunnel Release?

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

When can I return to work after carpal tunnel release?

This is the most common question patients ask while discussing carpal tunnel release surgery with their doctor. It is a very important question. Our ability to work is one reason to consider carpal tunnel release, since carpal tunnel syndrome can severely affect your ability to use your hands and work well. Our ability to work is how we pay rent, feet our families, and one way to find fulfillment in life.

But many patients avoid having carpal tunnel release!

This is understandable and not very surprising. After talking to friends, family, and co-workers who have had older forms of carpal tunnel release, many are afraid of how much time they will need to take off of work. They also worry about the pain of the healing process and the physical therapy that will be needed. But this fear is often caused by a misunderstanding of how quick, comfortable, and targeted modern carpal tunnel release techniques are!

Raleigh North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson offers carpal tunnel release under ultrasound guidance.

This requires only a small pea-sized “poke” over the wrist (not the palm), no IV or anesthesia is required, no painful tourniquet is required. Also, both sides often are performed on the same day if you have carpal tunnel syndrome in both hands. See here for a video where Dr. Nelson explains the healing after this procedure. Unlike other traditional methods of releasing the carpal tunnel, this technique does not require a long open incision in the palm or across the wrist. The “old” technique does work to relieve carpal tunnel symptoms, but there are “innocent bystanders” caught in the action. Skin and tissue is unnecessarily cut through and makes performing release on both sides too painful. With the ”old” technique patients often need therapy or weeks or months off of work.

Okay, that sounds good, but with the new technique, how much time off do I need?

First of all, the amount of time you need off of work really depends on what you do for work. Dr. Johnny T. Nelson does not usually restrict your activities after carpal tunnel release. This is because most activities, even heavier activities will not “ruin” the work that was done. It is however good to wait 3-5 days before doing very heavy gripping such as yard work, heavy tools, and lifting weights. This allows the hands to “cool down,” after the procedure.

It is also important to understand that every patient is a little bit different and heals differently. There is no “one size fits How to Stop Hand and Wrist Pain When Typing all” healing after carpal tunnel release. Some patients are comfortable enough to perform heavy gripping, pushing, and pulling 3 days after carpal tunnel release, while some patients those activities may take several weeks to return. Many plumbers, electricians, and mechanics have their carpal tunnel release on a Thursday, and are back to work the following Monday! In a few patients, return to full grip and pinch strength may take 1-2 months.

If you work at a desk during the day, and perform other light activities such as answering phones and handling papers and light paperwork, you can return to work immediately, even the day after the procedure.

If you perform repetitive activities, such as assembly line, cutting fabric, factory work, or hairdressing, you may need to take more time off of work, such as 2 to 4 weeks. Again, this is not because your job will interfere with your healing or ruin the surgery, but because you may be uncomfortable performing repetitive activities all day long. Most patients with these types of jobs are able to return with restrictions right away, or “play things by ear” and returned to work when they feel good enough.

There are special jobs where patients need more time due to the nature of their work. For example, police officers do and perform certain activities that need to be 100% expertly performed before they can return to work. The same applies to lifeguards.

Do you have carpal tunnel syndrome? Are you worried about how long you will need to stay out of work? Call 919-872-5296 today to schedule a visit with Raleigh North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson, MD. He will discuss your condition and situation in detail and together you will form a plan on how to treat your carpal tunnel symptoms with minimal interruption to your life and work.

Do I Need Nerve Studies If I Have Carpal Tunnel Syndrome?

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Do I Need Nerve Studies If I Have Carpal Tunnel Syndrome? The short answer is: NO!

What is a nerve study?

If you have carpal tunnel syndrome, many doctors order a test called a “nerve study.” These are also called “EMGs” or “electrodiagnostic studies.” Do not worry about the name, just know that it is a test performed by a doctor or other trained medical provider. It looks closely at the different nerves in your arm to see if there are any problems with the “signals” being sent along the nerve. These include the signals being sent from your brain to your hand, and also the signals going in

EMG pic

the other direction, from your hand to your brain. Think of the nerve like an electrical cord sending signals back and forth.

Nerve studies usually take about 30 minutes to perform, and sadly can be very uncomfortable. It requires multiple needles
inserted through your skin and deep into your muscles with many electrical shocks along the length of your arm.

If they are painful, why do doctors still order nerve studies?

There are still some hand doctors and hand surgeons that require nerve studies to prove that you have carpal tunnel syndrome. Because of this, many doctors still order these studies. In some situations, nerve studies can be very helpful. For example, sometimes it is hard even for an experienced doctor to tell exactly what your problem is. In the past, nerve studies were the only way to test for carpal tunnel syndrome.

However, most recent evidence shows that for carpal tunnel syndrome, nerve studies are not important or necessary to get.

For example, Raleigh North Carolina Carpal Tunnel Specialist Johnny T. Nelson uses a special scoring system called the CTS-6, which is equal to or better than nerve studies at detecting carpal tunnel syndrome. The CTS-6 includes a few simple questions about your symptoms and a few physical exam findings. If you have carpal tunnel, the CTS-6 is part of your visit with Dr. Nelson, and takes only 1-2 minutes to complete.

Dr. Nelson also performs in-office ultrasound.

There is new evidence that simply measuring the swelling of the carpal tunnel nerve at the wrist is EVEN BETTER than nerve studies at showing carpal tunnel syndrome. In office ultrasound

Only takes Dr. Nelson about 30 seconds to perform
Is COMPLETELY painless
Is a FRACTION of the cost of nerve studies!

You have carpal tunnel syndrome? Do you wake up at night and shake your hands out? Do you drop things during the day because you cannot feel your fingers well? If so, you probably do not need expensive and painful nerve studies. You DO need a visit with Dr. Johnny T. Nelson, MD, Raleigh North Carolina Carpal Tunnel Expert! Call 919-872-5296 to make your visit today!

Dr. Nelson Now Offering Free Telephone Carpal Tunnel Screening!

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Screenshot 2023 10 04 at 5.30.49 PM North Carolina Carpal Tunnel Specialist Dr. Johnny Nelson MD now offers free telephone screening for those who think they have carpal tunnel.

For those who struggle with hand or wrist pain, sometimes knowing where to start is the hardest part. That’s why you should start with a board-certified, fellowship-trained carpal tunnel expert like Dr. Nelson. With a few simple questions over the phone, Dr. Nelson’s team at Raleigh Upper Ex and The Bone & Joint Surgery Clinic will tell you whether an in-person clinic visit is right for you.

Carpal tunnel syndrome is so common that most patients can diagnose the condition. However there are some other conditions with similar symptoms to carpal tunnel syndrome that can cause confusion. These problems include pinched nerves in the neck and elbow, thumb arthritis, and hand and wrist tendon inflammation. But even if you feel certain you have carpal tunnel, it is best to discuss your problems with a specialist before attempting self-treatment.

Dr. Johnny Nelson is the first and only orthopaedic surgeon in the RDU area to offer minimally-invasive carpal tunnel release with ultrasound guidance (US-CTR). Unlike other methods of carpal tunnel release, this procedure requires only a tiny poke incision on the wrist, not the hand. It does not require expensive anesthesia or painful tourniquet, and both hands are often treated in one session.

Simply call the front desk at The Bone & Joint Surgery Clinic at 919-872-5296 and ask for the free telephone carpal tunnel screening. Dr. Nelson is also available for in-person visits through the same number.

Is It Normal To Have Pain After Carpal Tunnel Release?

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

painful hand Carpal tunnel release surgery, especially minimally invasive ultrasound-guided carpal tunnel release offered by carpal tunnel specialist Dr. Johnny Nelson, is a great way to cure your carpal tunnel for good. The numbness, pain, tingling, waking up at night, difficulty with activities you love can all be treated with this procedure. It uses a simple “poke” incision, with NO anesthesia or IVs, NO painful tourniquet, taking 5-10 minutes, and both sides can be treated at the same time.

But is it normal to have pain after carpal tunnel release surgery?

Yes! But to fully answer that question you should understand what happens during carpal tunnel release surgery.

Carpal tunnel is caused by pressure at the wrist and base of the palm. Here an important nerve called the median nerve runs through a tight tunnel with several tendons. Because there is limited space in this tunnel, any swelling leads to problems with the nerve in this narrow tunnel.

Carpal tunnel release surgery slightly “widens” the tunnel and gives the nerve and tendons more “room to breathe.” To do this Dr. Nelson releases a ligament that is the “ceiling” of the tunnel. This is very effective in relieving your carpal tunnel symptoms. For example, patients who have the symptom of waking up at night will notice that this symptom is gone even on the night following the procedure.

**However, it is normal to experience discomfort or pain at the base of the palm after carpal tunnel release surgery. This is commonly called “pillar pain.”**

There is no “one size fits all” healing after carpal tunnel release. While Dr. Nelson does not restrict your activities after ultrasound-guided release, every patient is a little bit different. While some patients go back to using heavy tools at 3 or 5 days after surgery, some patients even at 2 or 3 months may have some fatigue, soreness, and aching pain with heavier, repetitive activities. However these cases are the exception rather than the rule, since the vast majority of patients will have this “pillar pain” for only 1 to 3 weeks after the procedure.

The other reason that pillar pain happens is that the muscles at the base of the thumb attach on to the ligament that is being released. Because the thumb is very important in the use of your hand, many activities that cause the thumb muscles to move may lead to discomfort especially in the weeks following carpal tunnel release.

How painful is pillar pain?

Usually patients are so happy to be free of carpal tunnel symptoms that they are not very bothered by pillar pain. They can sleep a full night again! Even in cases of more severe pillar pain, patients are able to take care of themselves: They can dress themselves, use the bathroom independently, perform simple food preparation and chores around the house, etc. The activities that they notice are limited are usually heavier activities (using heavy tools, opening a very tight bottle cap, wringing out a dish rag) or repetitive activities (brushing hair, cutting fabric).

To understand the healing process, it is helpful to think of it in terms of “hardening”. This is the name given to the healing process after carpal tunnel release. As mentioned, carpal tunnel release involves dividing a ligament, over time other tissues near the ligament “pick up the slack” and perform the duties of the old ligament, however it takes time for the new tissue to harden and reorient the tissue fibers to perform this activity well.

Are you or someone you love suffering from effects of carpal tunnel syndrome? Call 919-872-5296 today to make a visit with Dr. Johnny T. Nelson, the North Carolina Carpal Tunnel Specialist, to see if you are a candidate for ultra minimally invasive carpal tunnel release with real-time ultrasound guidance!

Dr. Nelson Selected to Serve on the Executive Committee of the MSK Ultrasound Forum

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Dr. Nelson Selected to Serve on the Executive Committee of the MSK Ultrasound Forum in Toronto, Ontario this October.

The forum will feature discussion and hands-on teaching by many thought leaders in the field of musculoskeletal ultrasound, including Dr. Nelson. His involvement reflects Dr. Nelson’s commitment to educating other surgeons on how to use ultrasound to bring the highest quality care to patients. In 2022, Dr. Nelson became the first and remains the only orthopaedic surgeon in the RDU area to offer ultrasound-guided carpal tunnel release, and in 2023 performed the first ultrasound-guided trigger finger release in the RDU area. He remains the only shoulder specialist in the RDU area to perform in-office complete real-time ultrasound examinations of the shoulder to help patients avoid costly MRI studies.

For more information on the ultrasound forum, you can find it here.

Will My Carpal Tunnel Come Back After Carpal Tunnel Release?

Carpal tunnel, Hand Surgeon

website

Will my carpal tunnel come back after carpal tunnel release? A quick online search of carpal tunnel and carpal tunnel release may leave you with more questions than answers.

Many of the top listings on major search engines, usually sponsored advertisements to online businesses trying to sell carpal tunnel splints, provide very misleading and false information for those suffering from carpal tunnel syndrome. Rather than encouraging patients to seek treatment from highly trained specialists, these websites use anxiety and fear to sell expensive splints that have very low success rates.

For example, one website called mycarpaltunnel.com quotes only 50 to 60% success rate for carpal tunnel release, with 85% of patients having their symptoms come back after surgery. Unfortunately, this website does not provide any source of information on where these numbers come from.

Most likely, they are pulling these numbers out of thin air and making them up so that you will buy their $185 splinting product.

These sites say things like “…most patients report permanent tenderness over the point of incision for years after surgery. Patients also report a permanent loss of grip strength for years.” Again, this is nothing more than gossip and does not reflect the reality of undergoing carpal tunnel release or healing after a carpal tunnel release procedure.

On the other hand, the real peer-reviewed scientific data on carpal tunnel syndrome and carpal tunnel release tells a different story.

The most quoted value for recurrence of carpal tunnel syndrome has been since the 90s between 5% to 20%. However as time goes and more high-quality studies are performed, many are questioning if there is truly such a problem as “recurrent carpal tunnel syndrome.” As in most fields of medicine and surgery, there are many factors that go into the success rate of a surgery. For example, how long was the carpal tunnel present prior to surgery? How damaged was the nerve from years living with carpal tunnel syndrome? What medical problems does the patient have? Does the patient have diabetes and thyroid disease? In properly conducted studies where these factors are accounted for, carpal tunnel syndrome does not seem to recur at all.

While recurrent carpal tunnel syndrome does exist and is a risk, if you have carpal tunnel symptoms, and you decide to have a carpal tunnel release, as a general rule you should not expect your symptoms to come back, ever.

References:

Kilinc F, Behmanesh B, Seifert V, Marquardt G. Does Recurrence of Carpal Tunnel Syndrome (CTS) after Complete Division of the Transverse Ligament Really Exist? J Clin Med. 2021 Sep 17;10(18):4208. doi: 10.3390/jcm10184208. PMID: 34575319; PMCID: PMC8470114.

Botte MJ, von Schroeder HP, Abrams RA, Gellman H. Recurrent carpal tunnel syndrome. Hand Clin. 1996 Nov;12(4):731-43. PMID: 8953292.

Dr. Nelson’s Research Published in December Issue of HAND

Carpal tunnel, Hand Surgeon, news

HAND Cover Along with Dr. Richard Singer and a team of researchers including Samuel Gay, Scott Diamond MD, and and Mitchell Gauger MD, Dr. Nelson recently published their findings from a retrospective study investigating the relationship between common hand conditions, such as carpal tunnel syndrome and trigger finger, and undiagnosed or “pre” diabetes.

Their study, titled “Warning Signs: Occult Diabetes and Dysglycemia in the Hand Surgery Patient Population,” was originally delivered as a podium presentation by Dr. Nelson at the 2020 Annual Meeting for the American Society for Surgery of the Hand. It suggests a strong link between carpal tunnel syndrome on both sides and early, undiagnosed, or impending diabetes or pre-diabetes. Male patients with elevated BMI and bilateral carpal tunnel syndrome were most at risk of having diabetes or pre-diabetes and not even knowing it!

It is well known that patients who have a diagnosis with diabetes are more likely to suffer from carpal tunnel syndrome and trigger finger, more likely to need surgery, and more likely to have continued nerve problems even if successful surgery is performed. What is NOT known, however, is how often patients have diabetes or pre-diabetes and don’t even know it, and the first “warning sign” is carpal tunnel symptoms.

“Hand surgeons encounter a patient population with high rates of undiagnosed prediabetes and diabetes, with some presentations as much as 6 times higher than the general population. Certain patient presentations should prompt appropriate diagnostic testing and referral, especially those presenting with bilateral compression neuropathy and elevated body mass index.” (Excerpt from Manuscript)

If you would like to read the manuscript, contact us here to request a free copy. Congratulations to Drs. Nelson, Singer, Gay, Diamond, and Gauger, and thank you for your contributions to our understanding of musculoskeletal conditions.

Can I Have My Carpal Tunnel Released on Both Sides at the Same Time?

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

What do I do if I have carpal tunnel on both sides?

Unfortunately, carpal tunnel syndrome is very common. 1 out of every 20 adult Americans has this condition, which can interfere with sleep, the quality of life, the use of the hands both at home and at work. Symptoms include numbness and tingling, especially in your thumb, pointer, and middle finger, waking up at night to shake your hands out, pain and numbness/tingling with activities that require gripping and repetitive wrist motions (holding a steering wheel, using tools, knitting, etc.).

Worse still, many have severe problems in both hands, and that may be YOU.

Sometimes simple treatments for carpal tunnel can help to quiet down your symptoms, especially if your symptoms came on recently. These include oral anti-inflammatories such as steroids or NSAIDs, wearing a wrist splint at night, avoiding activities that make your symptoms worse, and even injections performed by a hand surgeon such as Dr. Nelson.

But what happens when you have carpal tunnel on both sides that does not respond to these measures?

Carpal tunnel release is a great treatment for carpal tunnel syndrome. No matter how it is performed, it reliably relieves your numbness, tingling, and especially night pain and gripping pain due to carpal tunnel syndrome.

However, you may be worried about having surgery on both hands at the same time, also called “bilateral” carpal tunnel release. Maybe you have concerns that you will not be able to take care of yourself or others (children, elderly parents), dress yourself, use the bathroom, prepare food, and participate in other activities of daily life. Or perhaps you are concerned that you will have to take too much time off of work, and that is something you can’t afford. Simply put, you may feel the need to have one “good hand” to help out while the operated hand heals.

But with new technologies and techniques, this is no longer the case.

In years past, carpal tunnel release was always done through an open incision in the palm. While this can reliably treat and cure the symptoms of carpal tunnel syndrome, the incision in the palm can be painful especially in the early days and weeks after surgery. This can require prolonged periods of healing where heavier activities or even simple activities around the house can be difficult for you or need to be avoided altogether.

However, Dr. Johnny T. Nelson uses a new technology to treat your carpal tunnel syndrome under ultrasound guidance. Due to the extremely small sonexhealed incision (about the size of a pea!) further back on the wrist, and no incision on the palm, the same release and relief of your symptoms can be performed while minimizing the period of healing pain after the surgery.

With ultrasound guided carpal tunnel release, almost all patients with carpal tunnel on both sides have it treated on the same day. With ultrasound-guided carpal tunnel release, you may return to all activities immediately, including cooking, hygiene, dressing, and even work, including manual labor. There is no splinting or casting required, there is no heavy anesthesia on the day of surgery. Some patients who do very heavy work with their hands (for example, mechanics, plumbers, and other heavy laborers) may need to allow for 5-7 days for the area to heal.

In Dr. Nelson’s experience, he has yet to encounter a patient who has had ultrasound-guided carpal tunnel release done on both sides who wishes that they had it done only on one side. However, many patients who had it done on one side only for fear of the healing process wish they had it performed on both sides.

So to answer your question: YES! If you have carpal tunnel on both sides, and your symptoms are bad enough to need surgery, ultrasound-guided carpal tunnel release on the same day for both hands is often the best option for you. Click here for a complimentary printable handout about what to expect from ultrasound-guided carpal tunnel release.

Remember, every patient is different, your treatment depends on a one-on-one consultation with Dr. Johnny T. Nelson which includes a physical exam and discussion of your symptoms. If you are a candidate for ultrasound-guided carpal tunnel release, even if on both sides at the same time, he will let you know. Call 919-872-5296 for an appointment, or visit www.drnelsonctr.com to learn more.

Dr. Johnny Nelson Featured on CBS17’s My Carolina

Raleigh Upper Ex and The Bone & Joint Surgery Clinic Named Center of Excellence

When Can I Return to Work After Carpal Tunnel Release?

When can I return to work after carpal tunnel release?

But many patients avoid having carpal tunnel release!

Raleigh North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson offers carpal tunnel release under ultrasound guidance.

Okay, that sounds good, but with the new technique, how much time off do I need?

Do I Need Nerve Studies If I Have Carpal Tunnel Syndrome?

Do I Need Nerve Studies If I Have Carpal Tunnel Syndrome? The short answer is: NO!

What is a nerve study?

If they are painful, why do doctors still order nerve studies?

However, most recent evidence shows that for carpal tunnel syndrome, nerve studies are not important or necessary to get.

Dr. Nelson also performs in-office ultrasound.

Dr. Nelson Now Offering Free Telephone Carpal Tunnel Screening!

Is It Normal To Have Pain After Carpal Tunnel Release?

But is it normal to have pain after carpal tunnel release surgery?

**However, it is normal to experience discomfort or pain at the base of the palm after carpal tunnel release surgery. This is commonly called “pillar pain.”**

How painful is pillar pain?

Dr. Nelson Selected to Serve on the Executive Committee of the MSK Ultrasound Forum

Dr. Nelson Selected to Serve on the Executive Committee of the MSK Ultrasound Forum in Toronto, Ontario this October.

Will My Carpal Tunnel Come Back After Carpal Tunnel Release?

Dr. Nelson’s Research Published in December Issue of HAND

Can I Have My Carpal Tunnel Released on Both Sides at the Same Time?

What do I do if I have carpal tunnel on both sides?

Worse still, many have severe problems in both hands, and that may be YOU.

But what happens when you have carpal tunnel on both sides that does not respond to these measures?

But with new technologies and techniques, this is no longer the case.

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