ultrasound

Sling after surgery; how long?

How Long Do I Have To Wear My Sling after Shoulder Surgery?

How Long Do I Have To Wear My Sling after Shoulder Surgery?

If you are reading this, you have probably had shoulder pain for a long time. Perhaps you have tried many treatments to help this shoulder pain, including changing your activities, physical therapy, medicines and anti-inflammatories, or even injections. It is also possible that you had an MRI or ultrasound that showed a rotator cuff tear, and you may be considering surgery as an option to treat your shoulder pain for good.

A shoulder scope or “arthroscopy” procedure, like that performed by shoulder specialist Dr. Johnny T. Nelson, MD, is a time-tested procedure with excellent outcomes. After a period of healing, a very high percentage of patients are happy with their shoulder for the rest of their lives. However, there is a period of healing after the procedure where resting the arm and shoulder is very important.

And this is where a shoulder sling is very helpful.

Most patients who have shoulder surgery want to know how long they will have to wear their sling. This is an excellent question, since if you are wearing a sling, it isn’t easy to use the arm. If you are not able to use one arm, some activities such as dressing, going to the bathroom, driving a car, or working can be difficult.

In brief, the answer to this question depends on the type of surgery that is performed.

There are some shoulder scope procedures that are very simple. These can include “cleanout” procedures or procedures where the only problem is the biceps tendon or “labrum” around the socket. After these procedures, Dr. Johnny T. Nelson, MD, usually allows his patients to begin to use their operated arm for light activities like eating and drinking whenever they are comfortable doing so. This is because the things that were repaired or cleaned out in the shoulder do not need much protection.

Other shoulder procedures are more complex. Rotator cuff repair, for example, is much more complex and requires more healing time. If you have a small tear, Dr. Nelson may allow you to return to gentle activities with the operated arm 4 weeks after the procedure. For very large tears or “redo” operations, Dr. Nelson may request that you avoid using the arm for up to 6 weeks!

For this reason, it is important to discuss your shoulder procedure with your shoulder surgeon. Raleigh, North Carolina, shoulder specialist Johnny T. Nelson, MD, spends time discussing the healing process with every patient who decides to undergo a shoulder procedure. How long he would have to wear your sling after shoulder surgery depends on the problem that you have and what type of procedure needs to be performed.

Do you have shoulder pain? Are you worried that you have a rotator cuff tear? Call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, at Raleigh, North Carolina Shoulder Specialist!

How Long Do I Have To Wear My Sling after Shoulder Surgery? Read More »

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Can I Have Carpal Tunnel Release On Both Sides At Once?

Can I Have Carpal Tunnel Release On Both Sides At Once?

Unfortunately, carpal tunnel syndrome is very common. One out of every 20 adult Americans has this condition, which can interfere with sleep, work, and free-time activities. Worse still, many have severe problems in both hands.

Sometimes simple treatments for carpal tunnel can help to quiet down the symptoms, especially if the symptoms came on recently. These include oral anti-inflammatories such as steroids or NSAIDs, wearing a wrist splint at night, avoiding activities that make the symptoms worse, and even injections performed by a hand surgeon such as Dr. Nelson.

But what do I do when carpal tunnel on both sides does not get better?

Carpal tunnel release is the time-tested treatment for carpal tunnel syndrome. It reliably and quickly relieves the numbness, tingling, and especially night pain and gripping pain due to carpal tunnel syndrome. And in most patients, it does this permanently!

However, patients with carpal tunnel on both sides, also known as “bilateral carpal tunnel syndrome,” worry about having surgery on both hands at the same time. Some are concerned that they will not be able to take care of themselves. For example, they are worried that dressing, going to the bathroom, picking up a small child will become too difficult. Simply put, they feel they need to have one “good hand” to help out while the operated hand heals.

But with new technology and a technique offered by North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson, MD, this is no longer the case.

For many years, carpal tunnel release was done with an open incision in the palm. While this treats and cures the symptoms of carpal tunnel syndrome, the incision in the palm can be painful, especially in the early days after surgery. This can require a prolonged healing time, where heavy or even simple, light activities around the house can be difficult.

However, Dr. Johnny T. Nelson is an expert in the treatment of carpal tunnel syndrome under ultrasound guidance!

Due to the extremely small “poke” incision on the wrist, without an incision on the palm, the same release and relief of symptoms can be done “inside-out” while shortening the period of healing pain after the surgery. With ultrasound-guided carpal tunnel release, most 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 heavy or repetitive labor.

Since 2022, 50% of patients treated by Dr. Johnny T. Nelson, MD have both carpal tunnels released at the same time!

If you have carpal tunnel on both sides and you are ready to be free of your symptoms, ultrasound-guided carpal tunnel release on the same day for both hands is often the best option for you. But remember, every patient is different! Your treatment plan depends on a one-on-one consultation with Dr. Johnny T. Nelson MD, North Carolina Carpal Tunnel Specialist. Call 919-872-5296 for an appointment.

Can I Have Carpal Tunnel Release On Both Sides At Once? Read More »

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When Can I Return to Work after My Carpal Tunnel Release?

When Can I Return to Work after My Carpal Tunnel Release?

When Raleigh, North Carolina Carpal Tunnel Specialist Dr. Johnny T. Nelson, MD hears this question, he responds with a question: What do you do for work?

If you have carpal tunnel syndrome or are considering a carpal tunnel release, chances are you are planning to have a minimally invasive ultrasound-guided carpal tunnel release.  Although there are other options, carpal tunnel release with ultrasound guidance allows for quick relief of carpal tunnel symptoms without the need for IVs, anesthesia, sutures, splinting, therapy, and…you guessed it: work restrictions!

But when it comes to returning to work after a carpal tunnel release, there are a few other things to consider.

Since 2022, North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD has performed over 700 carpal tunnel releases with ultrasound guidance.  Many of these patients were very busy hairdressers, plumbers, welders, electricians, and delivery drivers.  And many of these patients went back to work at 1 to 3 days after the procedure!

While many of these patients had mild soreness in the palm, they were able to return to work because even their heavy work activities cannot do “damage” to the work that was done.  Some of these patients did use oral medications like Tylenol or anti-inflammatories at first to allow them to work in comfort.  After a few weeks, most of these patients reported being back to normal and no longer needing any medication.

Patients who work “desk jobs,” such as clerks, secretaries, receptionists, salespeople, and other similar professionals can easily return to work after 24 hours.

Studies do show that after a carpal tunnel release, pinch and grip strength does decrease for a short time.  During this time, if you work a heavy job, your performance may not be normal.  As your hand continues to heal, pinch and grip strength returns to normal.  Soon, your job performance will also return to normal.

Dr. Nelson also recommends that in the first 24 hours after carpal tunnel release with ultrasound guidance, the hand or hands are kept elevated and ice is used.  During this time, it is not recommended to work.  But after 24 hours, activities can be restarted “as tolerated,” meaning that as long as you are comfortable performing the activity, you can do it.

If you have carpal tunnel syndrome and are worried about the time it takes to return to work after a carpal tunnel release, call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD.

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

Why Is It Important for a Shoulder Specialist to Use Ultrasound?

Why Is It Important for a Shoulder Specialist to Use Ultrasound?

If you are reading this, it is likely that you or someone you know has shoulder pain. It is possible that you tried treatments to improve your shoulder pain without success and are considering a visit with an orthopedic shoulder specialist.

This is certainly a good place to start.

An orthopedic shoulder specialist is expert in the evaluation, diagnosis, and treatment of all shoulder problems including rotator cuff tears, bursitis, instability, and biceps problems. An orthopedic specialist can order and read x-rays, CT scans, MRI studies and has more in-depth knowledge of the shoulder and shoulder problems than any other healthcare provider, including primary care physicians, physical therapists, chiropractors, and nonsurgical sports medicine doctors. Not only can an orthopedic shoulder specialist evaluate your shoulder, but they also provide treatment. It is also important to know that a visit with an orthopedic shoulder specialist does not always mean you will have surgery.

But there are many options out there! It is important that you see a shoulder specialist that uses ultrasound as part of evaluation and treatment of shoulder pain.

If you live in North Carolina, you are in luck! Dr. Johnny T. Nelson, MD is one of those shoulder specialists!

At The Bone and Joint Surgery Clinic, Dr. Johnny Nelson has state-of-the-art ultrasound equipment that allows a high-resolution scan of the rotator cuff and other structures in the shoulder. Along with a physical exam, x-rays, and a short discussion, Dr. Nelson can give you important information about the cause of your shoulder pain.

Doctors that do not use ultrasound are not able to see or evaluate the rotator cuff at the time of evaluation. This often requires an MRI study, which insurance companies will often deny, are expensive, require complicated scheduling, and multiple other visits to obtain. As a result, patients with big rotator cuff tears may possibly be treated with physical therapy, injections, or observation when they should be undergoing rotator cuff repair.

Dr. Johnny T. Nelson is also able to use ultrasound to perform targeted injections that are not possible without ultrasound. These include biceps injections and suprascapular nerve injections, which can be very helpful and more effective than “traditional” blind injections performed without ultrasound.

Do you have shoulder pain? Are you worried that you have a rotator cuff tear? Call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, Raleigh North Carolina shoulder specialist.

Why Is It Important for a Shoulder Specialist to Use Ultrasound? Read More »

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Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release?

You may have family or friends that had a carpal tunnel release procedure. Most likely they were placed into a splint for the early days of the healing process after the surgery.

This is actually quite common, since most carpal tunnel releases performed in the United States are done through an “open” incision in the palm. Because of the larger incision and the location of the incision, open carpal tunnel release is more painful, requires suture, and requires longer healing time. To avoid problems with the incision, a splint is placed for 10 days or 2 weeks after the procedure.

But ultrasound technology has changed all of this!

Raleigh, North Carolina carpal tunnel specialist Dr. Johnny T. Nelson, MD treats carpal tunnel syndrome with ultra minimally invasive release under ultrasound guidance. This requires only a very small (5 mm, about the size of a pea) poke incision on the wrist, not the palm. This poke incision does not require suture and heals much quicker than an incision in the palm. Because of this, Dr. Nelson does not need to place carpal tunnel patients into a splint after their procedure.

That is right, after ultrasound-guided carpal tunnel release, no splint is necessary!

While Dr. Nelson will place a small, light soft dressing on the hand and wrist, this is removed 1 or 2 days after the procedure. Because it is soft and light, you are able to perform important activities right away: Eating, drinking, dressing, bathroom, hygiene, etc. After the dressing is removed, you may wash your hands and take a shower and get clean water on the site of the surgery.

If you are concerned about how long it will take you to heal after carpal tunnel release surgery, call 919-872-5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel expert!

Do I Need to Wear a Splint after I Have My Carpal Tunnel Release? Read More »

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I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

I Think I Have Carpal Tunnel Syndrome. Do I Need Nerve Studies?

If you have been told that you need to have nerve studies, also called “electrodiagnostic studies,” it is possible that you have been diagnosed with a nerve condition like carpal tunnel syndrome.

Nerve studies work by using electric signals and shocks to study how well nerves are working. They can be helpful in certain situations to tell if a nerve is not working correctly. While they can be useful, they can also be painful, expensive, and time-consuming.

And they also may be completely unnecessary!

Carpal tunnel specialists like Dr. Johnny T. Nelson, MD understand that nerve studies are not always necessary. For most patients, a few simple questions and a few simple examination signs will tell Dr. Nelson whether or not you have carpal tunnel. A very quick and painless 30 second ultrasound scan will further confirm the diagnosis.

Did you know that 1 out of every 5 patients with carpal tunnel syndrome have normal nerve studies?

It is a good idea to start with a carpal tunnel specialist, such as Dr. Johnny T. Nelson, MD, before you have your nerve studies completed. If nerve studies are truly necessary, he will order the nerve studies and review the results with you. If they are not necessary, Dr. Nelson diagnosed you properly and very likely perform a quick and painless ultrasound scan to confirm your diagnosis.

If you have carpal tunnel or are considering having a release procedure, make sure you call 919–872–5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel expert!

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

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Is It Normal to Have Redness around My Incision after Ultrasound-Guided Carpal Tunnel Release?

The short answer is: Yes!

Before we explain, it is important to understand that if you have questions about your surgery, your incision, or any concerns about redness, swelling, pain, etc., it is very important to consult the surgeon who performed your procedure. While redness can be a normal response of the human body to a procedure, including carpal tunnel release for carpal tunnel syndrome, it could also represent the signs or symptoms of an infection.

sonexhealedWhen a surgeon, such as Dr. Johnny T. Nelson, MD, performs a carpal tunnel release procedure, it is necessary to make a small opening in the skin. This opening, called and “incision,” allows the hand specialist to introduce a special device into the carpal tunnel. This allows the carpal tunnel to be released from the “inside out.”

It is important to understand that when a cut or injury happens by accident, the human body responds right away. This response ensures that bacteria and bugs from the outside world do not find their way inside the body and cause an infection. The signs of this response include warmth, redness, and swelling.

But the human body cannot tell the difference between an accidental cut and a surgical incision.

Because the human body sees the surgical incision the same as an accidental cut, it is normal to see some of the same signs. These include warmth, redness, and swelling. This is often called the “inflammatory” steps of healing. Your hand specialist, Dr. Johnny T. Nelson, MD, will counsel you on what to expect after your ultrasound-guided carpal tunnel release procedure.

And most importantly, if you undergo a carpal tunnel release procedure, Dr. Nelson will follow you closely to make sure that you are healing well.

If you have carpal tunnel or are considering having a release procedure, make sure you call 919–872–5296 today to schedule a visit with Dr. Johnny T. Nelson, MD, North Carolina carpal tunnel expert!

Is It Normal to Have Redness around My Incision after Ultrasound-Guided Carpal Tunnel Release? Read More »

Wide Awake Carpal Tunnel Release

The Benefits of Wide Awake Procedures

Wide Awake Carpal Tunnel ReleaseWhat 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 »

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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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