Ultrasound

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What Doctors Wish Patients Knew About Carpal Tunnel Syndrome

1024px AMA logo (2).svgIn October 2023, the American Medical Association published a very interesting article entitled, “What Doctors Wish Patients Knew About Carpal Tunnel Syndrome.”

Find the full article HERE.

This article gives useful points of information about carpal tunnel syndrome. As an orthopaedic shoulder and hand specialist, Dr. Johnny T. Nelson MD is very dedicated to patient education and awareness.

The key points of the article include:
1.  Numbness is a more important symptom than pain
2.  It is worse at night
3.  It is more common in women
4.  Other health conditions play a role (thyroid, diabetes)
5.  Pregnancy can bring on the symptoms
6.  Do not blame the keyboard
7.  Carpal tunnel syndrome is not hereditary
8.  Physical exam helps the diagnosis
9.  Sometimes cortisone shots help
10.  Try wearing a brace at night
11.  Take frequent rest breaks
12.  Practice good wrist posture
13.  Know when it is time for surgery
14.  Some may need further surgery
15.  Carpal tunnel syndrome in both hands is concerning
16.  Do not wait to get diagnosed!

While some of these points require further explanation and may not apply to every person, they are helpful to help guide patients and inform them about carpal tunnel syndrome.

Dr. Johnny T. Nelson, MD is the North Carolina carpal tunnel doctor!  If you or anyone you know or love is experiencing symptoms you think might be carpal tunnel syndrome, do not hesitate to call 919-872-5296 to make a visit with Dr. Nelson.  A visit with him does not necessarily mean surgery.  However if surgery is necessary, he offers minimally invasive techniques such as carpal tunnel release with real-time ultrasound guidance that are not available anywhere else in the region.

What Doctors Wish Patients Knew About Carpal Tunnel Syndrome Read More »

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Accepted for Publication: Dr. Johnny T. Nelson MD Published in Journal of Hand Surgery

cover.tifCongratulations to Dr. Johnny T., Nelson M.D., who, along with several other investigators, will be published and the esteemed Journal of Hand Surgery Global Online!

Raleigh North Carolina carpal tunnel expert Dr. Johnny T. Nelson M.D. was part of a multi-center clinical trial investigating “in-office” carpal tunnel release. “In-office” carpal tunnel release means that the procedure was performed in the office where the doctor normally examines and sees patients, instead of a surgery center or hospital.

The study is titled: “Office-based Carpal Tunnel Release with Ultrasound Guidance: 6-month Outcomes from the Multicenter ROBUST Trial.”

 

It investigates the outcomes and experiences of nearly 150 patients undergoing minimally invasive carpal tunnel release with ultrasound guidance in the office setting. Many of these patients had both hands treated at the same time. 94% of the patients reported being satisfied with the procedure at six months.Due to his expert use of ultrasound and ultra-minimally invasive techniques, Dr. Nelson was asked to participate in this study.

Dr. Nelson is dedicated to improving patient care, performing research, and finding ways to treat painful conditions like carpal tunnel syndrome in the easiest way possible.

 

There were several other very interesting findings. The average length of the incision was only 5 mm! This is basically the size of a small pea or pebble. Not a single patient required any anesthesia, IVs, or sedation during the procedure. All were wide awake and almost all reported very minimal discomfort during the procedure.

Do you have carpal tunnel syndrome? Do you wake up at night shaking your hands out? North Carolina carpal tunnel doctor Johnny T. Nelson MD is accepting new patients! Call 919-872-5296 today to schedule your consultation!

Accepted for Publication: Dr. Johnny T. Nelson MD Published in Journal of Hand Surgery Read More »

US RC tear

How Do I Know If I Have a Rotator Cuff Tear?

US shoulderHow do I Know If I Have a Rotator Cuff Tear?

Shoulder pain is very common, and many of those with shoulder pain wonder and worried about why they have pain.  They would also like to take steps to figure out the cause of their shoulder pain and ask themselves: how do I know if I have a rotator cuff tear? And most importantly, they want to know what it will take to make their shoulder stop hurting.

If you have shoulder pain, and you are trying to figure out why, seeing a shoulder specialist like Dr. Johnny T. Nelson MD is a great place to start.

Before you start working on trying to make your shoulder feel better, it is usually a good idea to be evaluated by a specialist and make sure that you have the correct “diagnosis” before you start treating the condition.  If you do not have a correct diagnosis, sometimes you can be performing the wrong treatment. Think of it like driving a car: if you were trying to get somewhere, you need to know where you are starting, or else, the directions you are, following will not take you to the right place.

Typically it is a good idea to start with simple things like an x-ray, physical examination, and several questions about the history of your pain: When did it start?  How bad is it?  What movements make the pain worse?  Do any movements make the pain better? Have any treatments you tried made it better?

With these pieces of information, a highly trained shoulder specialist like Johnny T. Nelson, MD is able to give you more information about your specific diagnosis, and most importantly, the best treatment for that diagnosis.  From there, you might consider anti-inflammatory medicine, physical therapy or chiropractic care, anti-inflammatory injections, simple home exercises or watchful waiting.

Sometimes Dr. Nelson may recommend an MRI of your shoulder.  This is if there is more concern for a more major problem, or if you have been having severe pain for a long time and other treatment methods have not helped.

However Dr. Nelson is one of the only orthopedic surgeons in the Raleigh Durham area to offer in-office ultrasound for the evaluation of the rotator cuff.

How is in-office ultrasound helpful?

In office ultrasound is a great way to determine the health of your rotator cuff.  While x-rays can be very helpful to shows US RC tearthe bones, x-rays do not show us the health of the rotator cuff.  Sometimes a specialist can get information on the health of the rotator cuff with a physical exam, but still rotator cuff tears can be missed.  In-office ultrasound helps shoulder specialist such as Dr. Johnny T. Nelson see rotator cuff tears quickly and easily.  Furthermore, ultrasound gives you and Dr. Nelson peace of mind that you do not have a rotator cuff tear, and performing simple nonsurgical treatment is probably the best way to go.

Ultrasound to check for rotator cuff tears takes only a few minutes, and you are able to see the results as they happen in real-time.  Dr. Johnny T. Nelson loves to point out the findings on ultrasound as he sees them, and teaches patients about the anatomy of the rotator cuff.

Sometimes if a rotator cuff tear is found, an MRI examination is ordered to get more information.  Because ultrasound is not a perfect tool, if there are signs that there is a tear of the rotator cuff, an MRI is able to give us much more information and confirm the findings on ultrasound.

Do you have shoulder pain?  Are you worried that you have a rotator cuff tear?  Are you interested in ultrasound examination of your shoulder?  Call 919-872-5296 today to schedule an appointment with Dr. Johnny T. Nelson, MD, Raleigh shoulder specialist!

How Do I Know If I Have a Rotator Cuff Tear? Read More »

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Is Bruising Normal After Carpal Tunnel Release?

bruisingRaleigh North Carolina Carpal Tunnel Release Expert Johnny T. Nelson, MD hears this question often.  If you are asking this question, you are not alone and chances are you recently had a carpal tunnel release procedure.  Perhaps you had a traditional open carpal tunnel release, or perhaps you had the ultra-minimally invasive carpal tunnel release with real-time ultrasound guidance.

So is bruising normal?

 

The short answer to the question is: Yes!  Bruising is simply the human body’s response to surgery.

When Dr. Johnny T. Nelson, MD performs a carpal tunnel release, the human body and the skin, bones, and ligaments in the area do not “understand” what surgery is.  To these structures, surgery is seen as an injury.  In response to this, it is normal for the human body to bring fluid, blood, swelling, and redness to the area and response to the surgery.  This is normal.

But what is the bruising?  Where does it come from?

 

Bruising is simply the body taking the blood and fluid from the surgery location and breaking it down in preparation for clearing it out and sending it back to your liver.  Anyone that has fallen and sustained a “charley horse” or bad bruise understands this process.  Right after the injury, the site overall looks quite normal except for some swelling and may be some redness.  But the day after, and over the week following, bruising appears.  It is common for bruising to turn different colors, often going from purple to brown to yellow.  Eventually it will fade away completely, which is a sign that the body’s immune cells have eaten up and cleared away the blood cells that were left behind.

What if I have bruising on my palm and on my forearm?  What if the bruising is spreading?

This is also common after carpal tunnel release surgery.  It is very normal to have bruising in the palm as well as over the front of the forearm, at times even extending into the fingers or towards the elbow.  This does not mean that anything is wrong.  Some patients may even have bruising visible on the top of the hand or forearm.  It is also normal for the bruising to start close to the site of surgery and grow in size over the days and weeks following the procedure.

Why do some patients have more bruising than others?

This is difficult to understand.  Some patients do not bruise at all after carpal tunnel release.  Some patients bruise more, there are many reasons for this but most remain unclear.  Some patients are on blood thinners, and these patients should expect to have more bruising.  Again, this does not mean that there is a problem.

You have carpal tunnel syndrome?  Do you wake up at night, shaking her hands out?  Do your hands fall asleep during the day when performing certain activities?  If so, call 919-872-5296 to schedule an appointment with Dr. Johnny T. Nelson, MD, North Carolina Carpal Tunnel Specialist.

Is Bruising Normal After Carpal Tunnel Release? Read More »

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Dr. Johnny Nelson Featured on CBS17’s My Carolina

CBS17 stillshotDr. 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.

 

Dr. Johnny Nelson Featured on CBS17’s My Carolina Read More »

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

IMG 0419Johnny 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!.

 

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

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When Can I Return to Work After Carpal Tunnel Release?

hand holding wrench vectorWhen 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 fitsHow 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.

When Can I Return to Work After Carpal Tunnel Release? Read More »

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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 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

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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!

Do I Need Nerve Studies If I Have Carpal Tunnel Syndrome? Read More »

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Dr. Nelson Now Offering Free Telephone Carpal Tunnel Screening!

Screenshot 2023 10 04 at 5.30.49 PMNorth 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.

Dr. Nelson Now Offering Free Telephone Carpal Tunnel Screening! Read More »

painful hand

Is It Normal To Have Pain After Carpal Tunnel Release?

painful handCarpal 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!

Is It Normal To Have Pain After Carpal Tunnel Release? Read More »

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