Patient Opportunity: Mission Clinical Registry

Mission Clinical Registry for Carpal Tunnel SyndromePatients 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!


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

Screenshot 2024 02 27 at 11.22.26 AMHow 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

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 »

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Why Did My Rotator Cuff Tear?

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A Rotator Cuff Tear on MRI

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.



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 »

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