The Nerve Center
Carpal Tunnel Syndrome:
The most common symptoms of Carpal Tunnel Syndrome (CTS) are numbness, tingling and
pain into the extremities/hands. These symptoms can cause significant concern and anxiety.
Neuropathies, such as pinched nerves/entrapment neuropathies, are the most common cause
of symptoms; especially in the hands and feet.
The most common neuropathy in the upper extremities is Carpal Tunnel Syndrome.
It is a result of repetitive use brought about especially by texting and typing. Interestingly, it is
also more common in patients with low thyroid and diabetes.
Symptoms can be quite disabling and cause painful burning in the hands at night time
interrupting the sleep. Diagnosis of Carpal Tunnel Syndrome is established with the use of a
nerve conduction test as well as Neuromuscular Ultrasound. The combination of these two tests
provide the most accurate diagnosis. The entrapped nerve, along with any other structures
which may be compromising the wrist, can be clearly visualized for any inflammation or
This information gives us the best diagnostic information possible so that we target our
approach using a very effective, nonsurgical treatment.
Surgery should be reserved only for severe cases. Most patients can be treated without surgery.
Injecting corticosteroid in the carpal tunnel area has been shown to reduce inflammation,
however, the benefit is short lasting and it can negatively alter immunity of the tissue.
Crystal formation is another complication of steroid. Repeated steroid injections are not
There are other various treatment methods. For example, hand therapy, a splint worn at
night, a procedure called hydro-dissection or our preferred method of treatment; a
biologic such as amniotic fluid or platelet rich plasma (PRP). This is a material that does
not change immunity of the tissue while providing a more potent, longer lasting anti-
inflammatory and regenerative effect.
We take a rather specialized approach. With a small needle, using ultrasound guidance, we
place the liquid amnion around the inflamed nerve. The needle guidance ensures highly
specific, very accurate needle placement which leads to very successful outcomes for patients.
This procedure is safe and painless and is performed in the office.
In most cases, one injection may be all you need but it can be repeated in six months if
necessary. If you are experiencing pain, numbness or tingling in your hands especially at night
time, please contact us for evaluation.
The second most common neuropathy in the upper extremities is the ulnar nerve. This is the nerve that crosses the inside (funny bone) area at the elbow.
This long nerve can be compressed or injured with repetitive physical activities that involve the elbow including; exercise, weightlifting or overhead use. This type of condition is very common in athletes, especially baseball pitchers and golfers.
This type of neuropathy causes tingling, numbness and pain generally in the last two fingers of the hand and can worsen with activities that require frequent bending of the elbow as well as at night time.
This Neuropathy can be evaluated in great detail with electrical nerve conduction testing and ultrasound. With these technologies, we c
an precisely locate where the nerve is inflamed or pinched. We can also visualize in real-time if the nerve moves or slips out from its normal position (subluxation). This occurrence can be a source of significant pain in the elbow.
If left untreated, ulnar neuropathy can cause significant pain and weakness involving the very important hand muscles, including loss of hand function.
Surgical intervention is quite extensive and should be avoided if possible.
Our Nerve Center will provide comprehensive evaluation and the most modern and effective nonsurgical treatment for this important condition.
THORACIC OUTLET SYNDROME
This neurological and musculoskeletal problem affects the upper extremities. This is a complex
and often difficult to diagnose problem.
This term or diagnosis, Thoracic Outlet Syndrome, is loosely used by different healthcare
providers including physicians, physical therapists and chiropractors.
Precise diagnosis is the key to successful treatment. Thoracic Outlet Syndrome (TOS) occurs
more often in females. In many cases, it’s related to abnormal or poor posture of the shoulder
As an example, prolonged sitting or excessive computer use creates abnormal curvature in the
cervical and thoracic spine and causes forward rounding up the shoulders.
This abnormal posture causes asymmetrical tightness and shortening of the neck and shoulder
blade muscles. An important network of nerves called Brachial Plexus and subclavian blood
vessels which are responsible for nerve and blood supply to the upper extremities, ultimately get
compressed. This can create severe symptoms including pain, weakness and tingling in the
shoulders, arms and hands.
We have the expertise to evaluate this complex area very thoroughly as well as provide a
customized, individual treatment plan resulting in very good outcomes.
PERONEAL (FIBULAR) NERVE IRRITATION/ENTRAPMENT:
The Peroneal (Fibular) Nerve is one of the two main branches of the Sciatic Nerve. It travels
from the spine through the buttock area and runs down the back of the thigh and then exits just
below the knee on the outside. It then courses along the lateral side of the leg to the foot and
supplies the skin and several important muscles.
This nerve can be injured and sometimes compressed as it crosses over the bone on the
outside of the knee joint.
The main deficit that occurs from this particular nerve entrapment or injury is a foot drop and
numbness in the foot. This is a disabling condition causing difficulty walking due to foot drop.
It can easily be diagnosed with electrodiagnostic studies along with neuromuscular ultrasound
and should be treated promptly.
If left undiagnosed and untreated, the foot drop deficit can become permanent.
TARSAL TUNNEL SYNDROME:
The tarsal tunnel is located at the ankle on the inside/medial side. A thick ligament stretches
across the ankle to the heel forming a tunnel. Several structures pass through the tarsal
tunnel including a large nerve called, the tibial nerve.
Tarsal tunnel syndrome can develop in persons who have flat foot arches. The foot turns
inward too much during walking causing over pronation. This posture of the foot causes
pressure on the tarsal tunnel area and compresses the nerve and other structures
Injuries and arthritis of the ankle can also create this syndrome.
Patients with this condition can experience pain along the bottom of the foot along with
tingling, pins and needles. Symptoms become worse with walking or exercising, especially if
the footwear is not supportive. Symptoms can also be more prominent at night just like with
carpal tunnel syndrome.
A thick membrane- like structure under the foot called the planter fascia can also become
tight and perpetuate even worse symptoms.
Similar to other Neuropathies, Ultrasound and a Nerve conduction study are the best
methods of diagnosis.
Treatment options could include; wearing proper supportive footwear, stretching the plantar
fascia and calf muscles or a Regenerative injection in the tarsal tunnel which has shown to
be very effective.
Surgery is rarely necessary and should be avoided.