carpal tunnel

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Does Redness Around My Carpal Tunnel Incision Mean Infection?

Photo of patient's hand two weeks after carpal tunnel release with real-time ultrasound guidanceDoes redness around my carpal tunnel incision mean infection?

The short answer to this question is: usually not.

Before we explain this, it must be clarified. If you are experiencing redness around an incision, you must notify your physician. This blog post is not specific medical advice about your wrist, but about the healing process in general.

Redness around an incision can mean different things. This includes the small 5 mm “poke” incision performed for carpal tunnel release with real–time ultrasound guidance. Raleigh Hand Specialist Johnny T. Nelson MD performs this procedure. 

There are times where redness does mean infection.  Raleigh North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD discusses the risk of infection with every patient.  This risk is extremely low.  The risk of infection is higher in patients with certain medical conditions, especially diabetes.  Other signs that suggest infection include fevers, chills, the overall feeling of aches or “feeling sick,” increasing pain and swelling of the entire hand, wrist, and forearm.

However, there are other times where redness is a very natural and normal part of the healing process.

 

After a procedure such as carpal tunnel release, the human body’s immune system does not “understand” what has happened. It only sees that there is a cut in the skin that places the body at risk for invasion by bacteria and infection.  So it does what it is designed to do, which is to send immune cells to the area to prevent infection from setting in.

This process is not called infection but rather “reaction.”  So Dr. Nelson may mention that your poke incision appears “reactive.”

This reactive redness is sometimes accompanied by a small amount of fluid.  This fluid is not “pus” but is usually a clearish fluid.  This is the part of the blood that contains many of the immune cells sent to the area to keep infectious organisms away.

If you have concerns about your incision, contact Dr. Nelson or the doctor who performed your surgery.

 

If you have carpal tunnel syndrome, if you have numbness and tingling in your hands that wakes you up at night, please visit www.raleighupperex.com or call 919-872-5296 to schedule a visit with Dr. Johnny T. Nelson, MD, Raleigh North Carolina carpal tunnel specialist.

Visit Dr. Nelson’s YouTube Channel or follow him on Instagram.

Does Redness Around My Carpal Tunnel Incision Mean Infection? Read More »

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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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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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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 »

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Will My Carpal Tunnel Come Back After Carpal Tunnel Release?

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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.

Will My Carpal Tunnel Come Back After Carpal Tunnel Release? Read More »

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

0127b 1What 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 smallsonexhealed 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.

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

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Announcing: January 10th Carpal Tunnel Open House

image2Join Dr. Nelson for a free, no obligation scanning open house on January 10th from 6-8PM at the Bone & Joint Surgery Clinic!

While many struggle with hand and wrist problems, it is very difficult to get personalized, trustworthy advice. What is my diagnosis? What should I do? Who can I trust?

NOW IS YOUR CHANCE!

Dr. Nelson will give a short talk about the two most common conditions of the hand and wrist: carpal tunnel syndrome and trigger finger. This will be followed by individual “mini consultations.” You will have an informal chat with Dr Nelson and he will tell you your most likely diagnosis. If desired, Dr. Nelson will also have an ultrasound machine to scan your wrist and measure your carpal tunnel nerve to confirm the diagnosis for you.

Visit www.drnelsonctr.com for more information or to RSVP. You may also call his office directly and RSVP at 919-872-5296.

Announcing: January 10th Carpal Tunnel Open House Read More »

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October 18th Carpal Tunnel Education Event – A Huge Sucess!

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The October 16, 2022 scanning open house at the bone and joint surgery clinic with Dr. Johnny T. Nelson was a huge success!

The lobby of the bone and joint surgery clinic was filled with attendees, some of whom drove several hours for the event, to educate themselves about carpal tunnel syndrome and for the opportunity for a free one-on-one consultation with Dr. Nelson.

Many were also very curious to learn about ultrasound-guided carpal tunnel release, new technology being offered by Dr. Nelson.  This ultra–minimally invasive technique of relieving carpal tunnel symptoms is changing the way that carpal tunnel syndrome is treated.

Dr. Nelson, one of the only orthopedic surgeons in the Raleigh Durham area to utilize in office ultrasound, also used ultrasound to confirm the diagnosis for many patients.  This was a special teaching and learning opportunity, Dr. Nelson was able to teach each attendee about the anatomy of the carpal tunnel, the surrounding tendons and blood vessels, and signs on ultrasound that the carpal tunnel nerve may be abnormal.

If you or someone you know or love has carpal tunnel syndrome, and you are not able to attend the scanning open house, call 919-872-5296 to schedule visit with Dr. Johnny T. Nelson.

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October 18th Carpal Tunnel Education Event – A Huge Sucess! Read More »

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