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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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How Do I Know If I Have a Rotator Cuff Tear?

US shoulderHow do I Know If I Have a Rotator Cuff Tear?

Shoulder pain is very common, and many of those with shoulder pain wonder and worried about why they have pain.  They would also like to take steps to figure out the cause of their shoulder pain and ask themselves: how do I know if I have a rotator cuff tear? And most importantly, they want to know what it will take to make their shoulder stop hurting.

If you have shoulder pain, and you are trying to figure out why, seeing a shoulder specialist like Dr. Johnny T. Nelson MD is a great place to start.

Before you start working on trying to make your shoulder feel better, it is usually a good idea to be evaluated by a specialist and make sure that you have the correct “diagnosis” before you start treating the condition.  If you do not have a correct diagnosis, sometimes you can be performing the wrong treatment. Think of it like driving a car: if you were trying to get somewhere, you need to know where you are starting, or else, the directions you are, following will not take you to the right place.

Typically it is a good idea to start with simple things like an x-ray, physical examination, and several questions about the history of your pain: When did it start?  How bad is it?  What movements make the pain worse?  Do any movements make the pain better? Have any treatments you tried made it better?

With these pieces of information, a highly trained shoulder specialist like Johnny T. Nelson, MD is able to give you more information about your specific diagnosis, and most importantly, the best treatment for that diagnosis.  From there, you might consider anti-inflammatory medicine, physical therapy or chiropractic care, anti-inflammatory injections, simple home exercises or watchful waiting.

Sometimes Dr. Nelson may recommend an MRI of your shoulder.  This is if there is more concern for a more major problem, or if you have been having severe pain for a long time and other treatment methods have not helped.

However Dr. Nelson is one of the only orthopedic surgeons in the Raleigh Durham area to offer in-office ultrasound for the evaluation of the rotator cuff.

How is in-office ultrasound helpful?

In office ultrasound is a great way to determine the health of your rotator cuff.  While x-rays can be very helpful to shows US RC tearthe bones, x-rays do not show us the health of the rotator cuff.  Sometimes a specialist can get information on the health of the rotator cuff with a physical exam, but still rotator cuff tears can be missed.  In-office ultrasound helps shoulder specialist such as Dr. Johnny T. Nelson see rotator cuff tears quickly and easily.  Furthermore, ultrasound gives you and Dr. Nelson peace of mind that you do not have a rotator cuff tear, and performing simple nonsurgical treatment is probably the best way to go.

Ultrasound to check for rotator cuff tears takes only a few minutes, and you are able to see the results as they happen in real-time.  Dr. Johnny T. Nelson loves to point out the findings on ultrasound as he sees them, and teaches patients about the anatomy of the rotator cuff.

Sometimes if a rotator cuff tear is found, an MRI examination is ordered to get more information.  Because ultrasound is not a perfect tool, if there are signs that there is a tear of the rotator cuff, an MRI is able to give us much more information and confirm the findings on ultrasound.

Do you have shoulder pain?  Are you worried that you have a rotator cuff tear?  Are you interested in ultrasound examination of your shoulder?  Call 919-872-5296 today to schedule an appointment with Dr. Johnny T. Nelson, MD, Raleigh shoulder specialist!

How Do I Know If I Have a Rotator Cuff Tear? 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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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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Free Scanning Open House at Bone & Joint Surgery Clinic – September 13th

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 interruptsonex cropsome 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.

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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 »

traditional vs micro invasive ctr

What are the Different Types of Carpal Tunnel Release?

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.

Micro-Invasive CTR Incisions

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 »

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