The Benefits of Wide Awake Procedures

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Wide Awake Carpal Tunnel Release What is it like to be awake during a procedure?

You may have carpal tunnel syndrome or trigger finger. If so, you may be considering surgical treatment to cure the symptoms forever. Dr. Johnny Nelson is an expert in carpal tunnel release and trigger finger release with real-time ultrasound guidance. He also performs many other procedures around the hand and wrist.

It may sound crazy to some, but one option is to remain completely awake during your procedure.

If you are considering surgery, your surgeon should discuss different options for anesthesia. Wide-awake surgery is not possible or encouraged with some procedures. For example, major hip or knee surgery, spine surgery, or shoulder surgery requires at least sedation or “sleeping medicine.” Dr. Johnny T. Nelson is a Raleigh North Carolina shoulder specialist, and all patients who have shoulder surgery or rotator cuff repair have at least sedation during their procedure.

But wide-awake surgery is very common and for most small hand procedures is a very good option.

Dr. Nelson has performed over 700 carpal tunnel releases with real-time ultrasound guidance, and no patient has ever needed sedation or general anesthesia.

Being wide-awake during surgery does not mean that you will feel pain! Dr. Nelson uses numbing medicine, usually applied gently around the surgical site just before the procedure begins. The difference is that you will not need an IV, any sleeping medicine, and no tube will be placed down your throat to keep you asleep during the procedure.

The closest analogy is going to the dentist. Most patients go to the dentist and have dental work done without being asleep. If deeper work is necessary, there are situations where dentists give sleeping medicine. But usually the most that they need to do is inject some numbing medicine.

Thanks to new technology, carpal tunnel release can now be performed with real-time ultrasound guidance. This wide-awake procedure is more comfortable overall. There are no burning medicines given through an IV that leave you groggy and nauseated.

Also, with wide awake surgery there are little or no anesthesia risks. Many patients have medical conditions, such as heart or lung problems, that make traditional anesthesia higher risk or more difficult. As a result, no medical clearance is necessary from your medical doctor, and you do not need to stop blood thinners!

Finally, because of all these benefits, wide-awake surgery is perfect for the office setting. The anxiety caused by being in a hospital or operating room is a thing of the past!

If you have carpal tunnel syndrome, call 919-872-5296 or contact us to schedule your visit with Dr. Johnny T. Nelson MD, North Carolina’s premier carpal tunnel specialist.

The Benefits of Wide Awake Procedures Read More »

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.

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

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!

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

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.

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

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

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

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.

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

Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th

Do you wake up every night, shaking your hands out to make them stop hurting? Are you dropping things? Does pain or shooting electricity interruptsome of your favorite activities?

More importantly: are you ignoring or suffering through these symptoms because you are worried about what the doctor will say you need to make it better?

Dr. Johnny Nelson is hosting a free educational open house and scanning event at The Bone & Joint Surgery Clinic on Tuesday, September 13th at 6PM. Dr. Nelson will briefly help to explain carpal tunnel syndrome in simple, easy-to-understand terms and will explain a new ultrasound-guided technique for treating carpal tunnel symptoms with the UltraGuideCTR device. Dr. Nelson will then be available for informal consultation and a free ultrasound exam of your wrist to measure your carpal tunnel nerve and confirm your diagnosis.

Dr. Nelson is the first and remains the only orthopaedic surgeon in the Raleigh-Durham area to offer ultrasound-guided micro-invasive carpal tunnel release.

Are you interested in attending? Does someone you know or love have carpal tunnel syndrome and are avoiding treatment? Call 919-872-5296 to RSVP or visit www.DrNelsonCTR.com for more information.

sonex flyer — Call 919-872-5296 to RSVP or visit www.DrNelsonCTR.com for more information.

Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th Read More »

What are the Different Types of Carpal Tunnel Release?

Carpal tunnel, Hand Surgeon, Sonex, Ultrasound

What are the Different Types of Carpal Tunnel Release?

Do you have carpal tunnel syndrome?

While it is important to be properly evaluated and diagnosed by a fellowship trained upper extremity specialist such as Dr. Nelson, symptoms of carpal tunnel syndrome include numbness and tingling in the thumb, index, and middle finger, “shaking out” of the hands either at night or during the day, pain, cramping or weakness of the hands, dropping objects, and frequently being awoken by the symptoms.

If you do have carpal tunnel syndrome, chances are if your symptoms are bad enough, you will benefit immensely from carpal tunnel release. When treated with carpal tunnel release in a timely manner, your sensation will improve, your strength will likely improve, your sleep will improve, and your overall quality of life will improve.

But there are different ways of performing carpal tunnel release.

Traditional Open Carpal Tunnel Release Incision

Traditionally, carpal tunnel release was performed in an open fashion. This means that an incision is made over the base of your palm that is 1 to 2 inches in length, and through this incision, your surgeon will release the tight tissues that are pressing on the nerve in your wrist. While this is a time tested approach, this method is more painful and requires increased healing time after surgery. The incision usually requires sutures, there will be redness and bruising, and more soreness around the area of the surgery. If you do heavier things either at home or at work with your hands, it may take more time, even up to 6 weeks, to get back to work and activities that require gripping and lifting.

From the standpoint of early healing, endoscopic carpal tunnel release has fixed some of

endoscopic carpal tunnel surgery pt1b — Endoscopic Carpal Tunnel Release Incision

these early healing problems. Endoscopic carpal tunnel release is performed through a very small incision at the end of your wrist, not on the palm, and does not require an incision over the palm skin. While final outcome and patient satisfaction is the same compared to open release after 3 months, endoscopic release helps patients to get back to full activities, gripping, lifting and working much sooner with less pain, stiffness, scarring, and soreness after the surgery.

But wait, it gets better!

Recently, new techniques have become available to perform carpal tunnel release without anesthesia, under ultrasound guidance through a very tiny “poke” incision in the wrist. This procedure has been termed “micro-invasive CTR,” and soon will be offered by Dr. Nelson.

A large percentage of the American population has carpal tunnel syndrome, and many of those patients have moderate to severe carpal tunnel syndrome. Unfortunately, many patients avoid carpal tunnel release because they feel they do not have the time to heal after surgery or they are afraid of the soreness and pain that is part of the healing process.

Micro-invasive CTR under ultrasound guidance is a new answer for these patients. This procedure does not require anesthesia, it does not require a tourniquet, and eventually it will be offered in the office setting, even on the same day that you see Dr. Nelson to talk about your symptoms and confirm your diagnosis.

Do you or someone you know or love suffer from carpal tunnel symptoms? Make a visit to see Dr. Johnny Nelson today to discuss your diagnosis and her treatment options. Microinvasive CTR may be the right treatment for you!

What are the Different Types of Carpal Tunnel Release? Read More »

The Benefits of Wide Awake Procedures

It may sound crazy to some, but one option is to remain completely awake during your procedure.

Dr. Nelson has performed over 700 carpal tunnel releases with real-time ultrasound guidance, and no patient has ever needed sedation or general anesthesia.

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.

Will My Carpal Tunnel Come Back After Carpal Tunnel Release?

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

Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th

Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th

Dr. Nelson is the first and remains the only orthopaedic surgeon in the Raleigh-Durham area to offer ultrasound-guided micro-invasive carpal tunnel release.

What are the Different Types of Carpal Tunnel Release?

What are the Different Types of Carpal Tunnel Release?

But there are different ways of performing carpal tunnel release.

But wait, it gets better!

Book An Appointment

QUICK LINKS

OFFICE HOURS

OUR LOCATION

CONTACT US