Why Are Carpal Tunnel Symptoms Worse At Night?

If you have carpal tunnel syndrome, it is very likely that you are feeling discomfort. This discomfort is different in different patients. Raleigh, North Carolina, carpal tunnel expert Dr. Johnny T. Nelson, MD understands that carpal tunnel syndrome and similar nerve problems come in different “flavors.”

The most common symptom that patients feel is pain, numbness, tingling in the hands at night. Carpal tunnel syndrome and similar nerve problems are special in this way. They almost always bother you more at night.

But why does carpal tunnel syndrome and carpal tunnel symptoms seem to be worse at night?

The answer is complex, but there are several explanations.

First of all, during the day our brains are very active. Multiple signals are coming and going from the brain to the limbs, and from the limbs to the brain. There are external noises, people moving around this, work we need to do, and other feelings coming from all sides. However, at night, a lot of this “noise” quiets down. As a result, nerve problem such as carpal tunnel syndrome are no longer “drowned out” by the noise. As a result, the carpal tunnel “noise” seems louder and more painful. This is why patients with carpal tunnel syndrome report waking up at night, hanging their hands off the edge of the bed, and flicking or shaking their hands and fingers.

The second explanation has to do with being still while we sleep. During the day, we are using our hands, moving our arms to do things like to eat, drink, work, drive a car, and play with her children. This motion helps to keep fluid and blood from building up in her hands and feet. The movement of the muscles and joints actually helps to “pump” swelling back to the heart. But at night, when we are still, fluid and swelling tends to build up in our hands and feet. As a result, this small amount of swelling can “crowd out” the carpal tunnel nerve and make carpal tunnel symptoms worse.

Finally, when we sleep we tend to “curl up like a baby.” We like to clinch our fists, bend our wrists and elbows close to our body. These positions, although they are comfortable, actually increase pressure on the carpal tunnel nerve. In fact, when Dr. Johnny T. Nelson, MD is testing you for carpal tunnel syndrome, one of the movements he tests is to bend the wrist and hold it in this position. If this creates carpal tunnel symptoms or makes them worse, you have carpal tunnel syndrome.

If you have carpal tunnel syndrome and are having a hard time sleeping, call 919-872-5296 today to schedule a visit with North Carolina Carpal Tunnel Expert Dr. Johnny T. Nelson, MD.

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Carpal Tunnel Release Through A Tiny Skin Poke: How Is That Possible?

Carpal tunnel, Hand Surgeon, Ultrasound

Carpal Tunnel Release Through A Tiny Skin Poke: How Is That Possible?

If you have carpal tunnel syndrome or are thinking about a carpal tunnel release procedure, you may have questions about your incision!

Carpal tunnel release is a time-tested surgery that cures carpal tunnel syndrome for good. It has very high success rates. There are also many different ways to perform a carpal tunnel release. If you are scheduled to have a carpal tunnel release surgery, you should ask your surgeon what type of release will be performed and what your incision will look like.

Raleigh, North Carolina, Carpal Tunnel Specialist Dr. Johnny T. Nelson, MD specializes in advanced ultrasound-guided surgery. As a result, this special skill allows Dr. Nelson to perform a carpal tunnel release through a 5 mm “poke” in the skin of the wrist.

How is this possible?

All carpal tunnel release procedures do the same thing. The goal of a carpal tunnel release is to open a special band inside the wrist that allows the carpal tunnel to grow slightly wider. When the tunnel grows slightly wider, the carpal tunnel nerve has more room to “breathe.” So whether your surgeon performs an open carpal tunnel release or an ultrasound-guided carpal tunnel release, the goal is the same.

But what is different is how they get there!

Open carpal tunnel release arrives at the special ligament by going through the skin of the palm. To do this, an incision is necessary in the thick skin of the palm, which has more nerve endings. Other structures have to be cut through as well, including a special tissue called “fascia” deep to the skin. Dr. Johnny T. Nelson, MD describes the skin and the fascia as “innocent bystanders.” They do not cause carpal tunnel symptoms but need to be cut through for a open carpal tunnel release.

On the other hand, carpal tunnel release with ultrasound guidance allows the most targeted treatment possible. Through a tiny 5 mm poke incision, Dr. Nelson is able to release the special ligament only. There is no incision on the palm skin, and there is no “innocent bystander” tissue! Think of this as performing carpal tunnel release from the “inside out.” This is not possible without a special camera or an ultrasound machine.

So how is it possible? It is possible because of ultrasound!

If you have carpal tunnel syndrome, numbness, tingling at night or during the day, call 919-872-5296 today to schedule your visit with Dr. Johnny T. Nelson, MD.

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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 »

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.

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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 »

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.

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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 »

Why Are Carpal Tunnel Symptoms Worse At Night?

Why Are Carpal Tunnel Symptoms Worse At Night?

But why does carpal tunnel syndrome and carpal tunnel symptoms seem to be worse at night?

Carpal Tunnel Release Through A Tiny Skin Poke: How Is That Possible?

Carpal Tunnel Release Through A Tiny Skin Poke: How Is That Possible?