When Can I Return to Work after My Carpal Tunnel Release?

When Raleigh, North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson, MD hears this question, he responds with a question: What do you do for work?

If you have carpal tunnel syndrome or are considering a carpal tunnel release, chances are you are planning to have a minimally invasive ultrasound-guided carpal tunnel release. Although there are other options, carpal tunnel release with ultrasound guidance allows for quick relief of carpal tunnel symptoms without the need for IVs, anesthesia, sutures, splinting, therapy, and…you guessed it: work restrictions!

But when it comes to returning to work after a carpal tunnel release, there are a few other things to consider.

Since 2022, North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD has performed over 700 carpal tunnel releases with ultrasound guidance. Many of these patients were very busy hairdressers, plumbers, welders, electricians, and delivery drivers. And many of these patients went back to work at 1 to 3 days after the procedure!

While many of these patients had mild soreness in the palm, they were able to return to work because even their heavy work activities cannot do “damage” to the work that was done. Some of these patients did use oral medications like Tylenol or anti-inflammatories at first to allow them to work in comfort. After a few weeks, most of these patients reported being back to normal and no longer needing any medication.

Patients who work “desk jobs,” such as clerks, secretaries, receptionists, salespeople, and other similar professionals can easily return to work after 24 hours.

Studies do show that after a carpal tunnel release, pinch and grip strength does decrease for a short time. During this time, if you work a heavy job, your performance may not be normal. As your hand continues to heal, pinch and grip strength returns to normal. Soon, your job performance will also return to normal.

Dr. Nelson also recommends that in the first 24 hours after carpal tunnel release with ultrasound guidance, the hand or hands are kept elevated and ice is used. During this time, it is not recommended to work. But after 24 hours, activities can be restarted “as tolerated,” meaning that as long as you are comfortable performing the activity, you can do it.

If you have carpal tunnel syndrome and are worried about the time it takes to return to work after a carpal tunnel release, call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD.

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How Does a Carpal Tunnel Release Work?

Carpal tunnel, Hand Surgeon, Ultrasound, Uncategorized

How Does a Carpal Tunnel Release Work?

To understand how carpal tunnel release works, it is important to understand the problem of carpal tunnel syndrome.

Carpal tunnel syndrome is caused by pressure on a very important nerve at the level of the wrist. This nerve is called the median nerve.

At the level of the wrist, the median nerve passes through a “tunnel,” along with several important tendons that move the fingers and the thumb. This tunnel cannot change in size, it cannot grow wider or more narrow as needed. Because of this, if there is swelling of the tendons and other structures in the tunnel, the nerve gets “crowded out.” The nerve is pinched and constricted in the carpal tunnel.

The pinching of this nerve is bad because a nerve is like an electrical cable: It works by sending signals back-and-forth between the hand and the brain. The signals are mostly “feeling” signals but also can be signals to the muscles in the thumb. If the electrical cable is crushed and loses its ability to send signals, the human brain notices this and experiences numbness, tingling, discomfort, pain which are together called carpal tunnel syndrome.

So how does a carpal tunnel release work?

A carpal tunnel release is a very simple idea. The “roof” of the tunnel is made of a ligament. A carpal tunnel release divides this ligament which allows the tunnel to slightly widen. This allows the nerve to have more “breathing room” so that it can work normally again. As a result, a patient who has a carpal tunnel release can sleep at night, hold a steering wheel without shaking their hands out, etc.

Ultrasound-guided carpal tunnel release, as performed by Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel specialist, widens the carpal tunnel in a very special way. It requires only a tiny “poke” incision about the size of a pea, and the ligament is released from the “inside out.”Therefore, there is no incision in the palm, no need for sutures, no need for splinting, no need for an IV or expensive anesthesia.

Do you have carpal tunnel symptoms? Have you tried splinting, injections, anti-inflammatories and you still have symptoms? Call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina’s carpal tunnel specialist!

How Does a Carpal Tunnel Release Work? Read More »

What If I Choose To Live With My Carpal Tunnel Syndrome And Not Have It Treated?

Carpal tunnel, Hand Surgeon, Ultrasound, Uncategorized

What If I Choose To Live With My Carpal Tunnel Syndrome And Not Have It Treated?

This is a question that Raleigh, North Carolina carpal tunnel specialist Johnny T. Nelson, MD thinks about a lot. He also spends a lot of time talking to patients about this question.

First, it is important to understand that carpal tunnel syndrome is not an emergency condition. It is not like a problem with your heart or lungs that can cause complete disability or even death. So living with carpal tunnel syndrome is an option. Before modern technology like carpal tunnel release using ultrasound guidance, every human being with carpal tunnel syndrome had to live there entire life with carpal tunnel syndrome.

Second, we do not have very much scientific information about what happens to patients who choose to live with their carpal tunnel syndrome. This is simply because no doctor or scientist has studied this in detail. Some scientific studies show that some patients improve over time while carpal tunnel symptoms worsen or become permanent and others.

But what we do know is that if you choose to live with carpal tunnel syndrome, you are taking a risk.

When the carpal tunnel nerve is pinched for a long time, it does not work properly. With a carpal tunnel release procedure, this pinching is relieved and the nerve is allowed to work properly again. If the nerve is pinched for a long time, the symptoms such as loss of feeling in the fingers, pain, and weakness can become permanent.

There is only so much pressure a nerve can take!

Some patients who choose to live with carpal tunnel learn to “live with it.” Raleigh, North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD does not recommend this. While the carpal tunnel syndrome may feel like it is improving, what is actually happening is the human brain is learning to “tune out” the pain signals coming from the nerve. The patient may not experience much discomfort and pain, and may even feel like they are sleeping better again, but the feeling in their fingertips does not come back, and their thumb muscles grow very weak. As a result, these individuals are clumsy and frequently drop objects and have weak hands.

If you have carpal tunnel syndrome but do not have the time or resources to have it treated with a carpal tunnel release procedure, you should schedule a visit with Dr. Johnny T. Nelson, MD. There are other ways to treat your symptoms and help you to live a good life temporarily until you have the ability to treat your symptoms for good. Call 919-872-5296 today to schedule your visit!

What If I Choose To Live With My Carpal Tunnel Syndrome And Not Have It Treated? Read More »

My Shoulder MRI Is Normal. Could There Still Be Something Wrong?

Shoulder, Shoulder Pain, Shoulder Surgeon, Sports Injuries, Ultrasound, Uncategorized

My Shoulder MRI Is Normal. Could There Still Be Something Wrong?

No imaging study is perfect. This is very important to understand when it comes to “MRI” studies of the shoulder.

Many patients with shoulder pain will try many treatments to make their pain better, including changing their activities, physical therapy, anti-inflammatory and other medications, and chiropractic adjustment. Often, these treatments can be successful, but when they are not and the pain continues, an MRI study may be helpful to look for a cause of the shoulder pain.

But sometimes even though your shoulder hurts, the MRI looks normal. How can this be?

It is very important to understand that an MRI, much like a photograph, is only a single “glimpse” of one moment in time. It does not show what happens to the structures of the shoulder, such as the rotator cuff, biceps, and labrum, during actual movement of the shoulder.

In other words, an MRI is like a photograph while you actually need a video recording to see the problem!

This is another reason why ultrasound is very helpful. Ultrasound can evaluate the structures of the shoulder during movement. The shoulder can also be re-positioned and structures can be looked at more closely with a simple movement of the ultrasound probe. Dr. Johnny T. Nelson, MD is the only fellowship trained shoulder specialist in the Raleigh Durham North Carolina area that uses ultrasound during clinic visits to evaluate the rotator cuff and other structures in the shoulder.

Because MRI studies can miss tears and other problems in the shoulder, there are situations where patients decide to move forward with a shoulder scope procedure even though very little is found on the MRI. Often in these situations, sizable tears are found in the rotator cuff, even though the MRI was normal! This is well-documented in the medical literature.

If you have had an MRI study of your shoulder and would like to have Dr. Johnny T. Nelson, MD review the MRI and examine your shoulder, call 919-872-5296 today to schedule a visit with North Carolina’s rotator cuff repair specialist!

My Shoulder MRI Is Normal. Could There Still Be Something Wrong? Read More »

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

Carpal tunnel, Hand Surgeon, Ultrasound, Uncategorized

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

You may have family or friends that had a carpal tunnel release procedure. Most likely they were placed into a splint for the early days of the healing process after the surgery.

This is actually quite common, since most carpal tunnel releases performed in the United States are done through an “open” incision in the palm. Because of the larger incision and the location of the incision, open carpal tunnel release is more painful, requires suture, and requires longer healing time. To avoid problems with the incision, a splint is placed for 10 days or 2 weeks after the procedure.

But ultrasound technology has changed all of this!

Raleigh, North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD treats carpal tunnel syndrome with ultra minimally invasive release under ultrasound guidance. This requires only a very small (5 mm, about the size of a pea) poke incision on the wrist, not the palm. This poke incision does not require suture and heals much quicker than an incision in the palm. Because of this, Dr. Nelson does not need to place carpal tunnel patients into a splint after their procedure.

That is right, after ultrasound-guided carpal tunnel release, no splint is necessary!

While Dr. Nelson will place a small, light soft dressing on the hand and wrist, this is removed 1 or 2 days after the procedure. Because it is soft and light, you are able to perform important activities right away: Eating, drinking, dressing, bathroom, hygiene, etc. After the dressing is removed, you may wash your hands and take a shower and get clean water on the site of the surgery.

If you are concerned about how long it will take you to heal after carpal tunnel release surgery, call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel expert!

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release? Read More »

I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

Carpal tunnel, Hand Surgeon, Ultrasound, Uncategorized

I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

If you have been told that you need to have nerve studies, also called “electrodiagnostic studies,” it is possible that you have been diagnosed with a nerve condition like carpal tunnel syndrome.

Nerve studies work by using electric signals and shocks to study how well nerves are working. They can be helpful in certain situations to tell if a nerve is not working correctly. While they can be useful, they can also be painful, expensive, and time-consuming.

And they also may be completely unnecessary!

Carpal tunnel specialists like Dr. Johnny T. Nelson, MD understand that nerve studies are not always necessary. For most patients, a few simple questions and a few simple examination signs will tell Dr. Nelson whether or not you have carpal tunnel. A very quick and painless 30 second ultrasound scan will further confirm the diagnosis.

Did you know that 1 out of every 5 patients with carpal tunnel syndrome have normal nerve studies?

It is a good idea to start with a carpal tunnel specialist, such as Dr. Johnny T. Nelson, MD, before you have your nerve studies completed. If nerve studies are truly necessary, he will order the nerve studies and review the results with you. If they are not necessary, Dr. Nelson diagnosed you properly and very likely perform a quick and painless ultrasound scan to confirm your diagnosis.

If you have carpal tunnel or are considering having a release procedure, make sure you call 919–872–5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel expert!

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

Patient Opportunity: Mission Clinical Registry

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound, Uncategorized

Patients in North Carolina experiencing the painful symptoms of carpal tunnel syndrome will soon be eligible to participate in the Mission Clinical Registry!

Dr. Johnny T. Nelson MD will soon be enrolling patients in the study. It will be the largest multi-center clinical study in the United States investigating the treatment of patients suffering from carpal tunnel syndrome.

For more information about the Mission Clinical Registry for Carpal Tunnel Syndrome, read a full press release here. Patients interested in information about the study may visit www.ctrstudy.com for more information.

This landmark study will collect real-world, long-term data on patients suffering from carpal tunnel syndrome who have a carpal tunnel release using the UltraGuideCTR™ using real-time ultrasound guidance (CTR-US). Patient enrolled in the study will be paid up to $600 for answering questions about their healing experience.

Do you or someone you know or love suffer from carpal tunnel syndrome? Are you ready to put carpal tunnel syndrome behind you for good? Call 919-872-5296 or contact us to schedule a visit with Dr. Johnny T. Nelson MD, North Carolina’s Carpal Tunnel Specialist!

Patient Opportunity: Mission Clinical Registry Read More »

How Long Do I Have to Wear A Sling After Rotator Cuff Repair?

Arthroscopy, Rotator Cuff, Shoulder, Shoulder Pain, Shoulder Surgeon, Shoulder Surgery, Sports Injuries, Uncategorized

Screenshot 2024 02 27 at 11.22.26 AM How long do I have to wear a sling after rotator cuff repair?

You recently discussed rotator cuff repair with your orthopedic shoulder specialist and you are moving forward with repair. Hopefully you are seeing a talented specialist. A talented specialist will spend time with you and discuss the details of the after-surgery healing process.

One of these details is the use of an arm sling after your rotator cuff repair. After rotator cuff repair, your arm will be immobilized in an arm sling, sometimes called a “UltraSling.” It usually consists of a durable, high-quality, well-padded sling. It also has an extra “pillow” piece that will help keep your arm and elbow from moving too much.

For more information on use of your sling, see Dr. Nelson’s YouTube channel. You may also download and print this important document, Shoulder Arthroscopy: What You Need to Know. Or you may visit Dr. Nelson’s main rotator cuff repair page.

After surgery, the rotator cuff repair must be protected. If your arm hangs free, the movement in the early weeks after the surgery will be uncomfortable. However it also places too much stress and tension on the rotator cuff repair. If too much stress and tension is placed on the rotator cuff repair, there is a risk that the repair will come loose and fail.

The sling also serves as an important reminder. It reminds you as a patient that you should not be using the arm, and it reminds others around you that you had surgery and should not be expected to use the arm.

But how long do I have to wear the sling?

The answer to this question is different for different doctors. Dr. Johnny T. Nelson follows a very simple protocol. Rotator cuff repair patients will need to wear their sling full-time for 4 weeks after the procedure. Of course, Dr. Nelson will have you come out of the sling for simple hand, wrist, and elbow exercises and sometimes some very gentle movement exercises of the shoulder. However you will be wearing your sling 24 hours per day, including sleep. After 4 weeks, Dr. Nelson will permit you to remove the sling while at home only and use the arm for very gentle activities

Dr. Johnny T. Nelson will still have you wear the sling when you leave the house up until 6 weeks after surgery. This is because it is important that you do not use the arm to do things like open doors, drive a car, carry grocery bags, etc.

In the first 4 weeks, there are a few reasons to remove your sling.

For example, if you are taking a shower or getting dressed, it is necessary to remove your sling. In these situations, it is still important to be careful with the arm and not use it for grasping, pushing, or pulling, or lifting.

It is also okay to remove your sling if you are sitting or lying down, such as on a sofa or armchair. It is acceptable to remove the straps and remove the sling for comfort, allowing the arm to rest at your side. You may do this only if you are awake. Remember, the sling is a reminder above all else, which is most important when you are up and especially when you are out of the house.

If Dr. Nelson does not perform a rotator cuff repair, and shoulder surgery targets other problems (such as the biceps tendon or bone spurs), he may allow you to remove your sling earlier and begin using your arm earlier.

If you have shoulder pain, if you have a rotator cuff tear, if you are in need of an orthopedic shoulder doctor, call 919-872-5296 today to schedule your visit with Dr. Johnny T. Nelson, MD.

How Long Do I Have to Wear A Sling After Rotator Cuff Repair? Read More »

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

Carpal tunnel, Hand Surgeon, news, Sonex, Ultrasound, Uncategorized

cover.tif Congratulations 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 »

Why Did My Rotator Cuff Tear?

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You may have had a visit with a doctor, physical therapist, chiropractor, or orthopedic surgeon recently and learned that you have rotator cuff tear. Or perhaps you had an MRI or ultrasound exam that found a rotator cuff tear.

In addition to wondering what to do next, you probably also want to know how it happened.

Rotator cuff tears are usually divided into 2 separate groups. The first group, which is certainly the most common and largest group, is called “degenerative” or simply “wear and tear.” As you see with other parts of your body as you age, including your skin and your spine, muscles and tendons go through wear and tear changes over the years. Some of this may include activity related changes, such as overuse and repetitive motions, some of these are more genetic and “hereditary” changes much like male pattern hair loss. These changes add up over time and lead to fraying and minor tearing, which over the years may add up to more advanced tearing of the rotator cuff.

Scientists have looked at larger populations of patients and found that first and second-degree relatives of patients with rotator cuff tears are much more likely to have rotator cuff tears themselves.

We do know from scientific studies that the older you are, the more likely you are to have a rotator cuff tear. One study showed that 25% of patients aged 60 or older have rotator cuff tears, while over 50% of patients over age 80 have rotator cuff tears. Of course, these include probably many tears that did not cause pain or symptoms, but you get the point.

The second group, which is smaller and less common, is called “traumatic” or more sudden onset, injury related rotator cuff tears. These are easier to understand from a medical and scientific standpoint. Simply put, the muscle and tendon of the rotator cuff are torn from the arm bone by a sudden injury at a specific point in time that is usually felt by the patient. Perhaps the patient had a bad car or motorcycle accident, or was lifting something very heavy and felt a “pop” followed by weakness and pain.

The final point to keep in mind is that many rotator cuff tears may be partially degenerative and age-related and partially traumatic or injury-related. There is certainly overlap, and multiple factors can work together to create a rotator cuff tear.

Regardless of why or how it happened, it is important that shoulder specialist be involved in your decision-making regarding how to treat your rotator cuff tear. Whether it includes physical therapy, chiropractic care, home exercise program, injections, oral anti-inflammatory medications, or repairing the rotator cuff with arthroscopic surgery, Dr. Johnny T. Nelson, Raleigh Upper Ex, and The Bone & Joint Surgery Clinic are here for you.

Visit our Rotator Cuff Tear information page for more information.

References:

Hsu J, Keener JD. Natural History of Rotator Cuff Disease and Implications on Management. Oper Tech Orthop. 2015 Mar 1;25(1):2-9. doi: 10.1053/j.oto.2014.11.006. PMID: 26726288; PMCID: PMC4695395.

Why Did My Rotator Cuff Tear? Read More »

When Can I Return to Work after My Carpal Tunnel Release?

When Can I Return to Work after My Carpal Tunnel Release?

But when it comes to returning to work after a carpal tunnel release, there are a few other things to consider.

Patients who work “desk jobs,” such as clerks, secretaries, receptionists, salespeople, and other similar professionals can easily return to work after 24 hours.

How Does a Carpal Tunnel Release Work?

How Does a Carpal Tunnel Release Work?

So how does a carpal tunnel release work?

What If I Choose To Live With My Carpal Tunnel Syndrome And Not Have It Treated?

What If I Choose To Live With My Carpal Tunnel Syndrome And Not Have It Treated?

But what we do know is that if you choose to live with carpal tunnel syndrome, you are taking a risk.

There is only so much pressure a nerve can take!

My Shoulder MRI Is Normal. Could There Still Be Something Wrong?

My Shoulder MRI Is Normal. Could There Still Be Something Wrong?

But sometimes even though your shoulder hurts, the MRI looks normal. How can this be?

In other words, an MRI is like a photograph while you actually need a video recording to see the problem!

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

But ultrasound technology has changed all of this!

That is right, after ultrasound-guided carpal tunnel release, no splint is necessary!

I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

And they also may be completely unnecessary!

Did you know that 1 out of every 5 patients with carpal tunnel syndrome have normal nerve studies?

Patient Opportunity: Mission Clinical Registry

How Long Do I Have to Wear A Sling After Rotator Cuff Repair?

But how long do I have to wear the sling?

In the first 4 weeks, there are a few reasons to remove your sling.

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

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

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.

Why Did My Rotator Cuff Tear?

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