Get Answers to Your Questions in Our Nerve Damage and Surgery FAQ
Why does my foot look different after my knee replacement surgery? Should it hurt to have sex after a C-section? How can I relieve the pressure on a trapped nerve? Our FAQ page has the answers you need to kick chronic pain for good.
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How do I know if my ankle pain is neuropathic?
When you sprain your ankle, the pain you feel generally falls into the category of orthopedic pain—which simply means it is related to the muscles, bones, and connective tissues in and around your ankle.
Neuropathic pain is different. Pain is said to be neuropathic if it is caused by injured, stretched, or compressed nerves. You may experience neuropathic pain as a result of an ankle injury or after ankle surgery. This sort of pain is generally chronic—meaning it lasts for more than six months after an injury or surgery.
Symptoms of Neuropathic Pain
When asked to describe their pain, our patients have used some striking comparisons:
- It feels as though you are walking on sharp rock or shards of glass.
- It feels as though bees are stinging or fire ants are biting your foot constantly.
- It feels as though your entire foot is wrapped in barbed wire.
- It feels like a serious sunburn on the top of your foot.
- It feels like an electric current is shooting down your leg.
In addition, you may experience discomfort or pain (often severe) simply because you are wearing shoes or socks—or even when your foot is touched by something light like a bedsheet.
Sometimes the Solution Is Surgery for Your Neuropathic Pain
If it is clear that the pain you are experiencing is not orthopedic in nature, it is time to be evaluated for neuropathic pain and to discuss potential solutions.
In some cases, there are non-surgical approaches that might help. In other instances, surgery to release the compressed nerve or otherwise repair nerve damage may be the best solution.
One thing that is not an option is to simply try to ignore neuropathic pain. It will upend your day-to-day life, keeping you from enjoying your active lifestyle. Finding the best solution for relieving neuropathic pain is essential.
Dr. Williams Can Help You Find Relief. Contact Our Nerve Pain Specialist Today.
Dr. Eric H. Williams is committed to listening to you and to finding the best solutions to address ongoing pain. Known for both his skill as a surgeon and his compassion for his patients, Dr. Williams will make sure you understand all of your options and are comfortable with the proposed solutions. To learn more about neuropathic pain, request our free whitepaper. When you are ready to get relief from your chronic pain, contact us to make an appointment.
Could my pain have been misdiagnosed as sciatica?
Superior cluneal nerve entrapment is hard to diagnose and is often misdiagnosed as sciatica.
If you are experiencing pain in low back and buttock, it may be related to a problem with a nerve. The nerve may be the sciatic nerve, which is located fairly low on the body beneath the sacrum and pelvic bone. Or it may be the cluneal nerve, which is located outside the spot where the sacrum and pelvic bone come together.
Okay, so two different nerves in two different spots. So far, so good.
But brace yourself for another unusual word: the cluneal nerve travels through a fibro-osseus tunnel (we warned you!) tunnel. That tunnel is not unlike the carpal tunnel in the wrist and the cluneal nerve is not unlike the median nerve. That is to say: just like the median nerve can get squeezed in the carpal tunnel, the cluneal nerve can get squeezed in its fibro-osseus tunnel.
The result is easy to understand: pain.
Diagnosis of Superior Cluneal Dearve Entrapment Is All About Location
We’ve noted the different locations of the sciatic nerve and the cluneal nerve. Those different locations mean they can cause pain in different parts of the body. Sciatica generally involves pain in the lower part of the buttock radiating down the back of the leg. Superior cluneal nerve entrapment generally involves pain in the lower back through the buttock—but not into the leg.
It is often misdiagnosed as sciatica, but also SI joint dysfunction, arthritis, and lumbar spine degenerative disease. It is very important and even needed for the patients to have a differential diagnosis explored by their physician. They can try to compare the results of different blocks that they have and their effect on their pain. It is important not to let the doctor tell the patient if the block was successful. It is important that the patient tell the doctor if it worked or not. Because spinal joint disease is so common, we frequently only see what we know. So, if someone has "an okay" response with one injection, but a superior cluneal nerve block is not tried to compare the result to the facet block or the epidural injection, or nerve root injection, or SI joint injection, then the patient may miss the opportunity to compare the results. They may actually find out before they have a failed spinal fusion or laminectomy, or SI joint fusion, that the superior cluneal nerve may actually be the culprit. It is also very possible that the patient may have both! This does happen more than we think, and it is one reason why patients may not see the results they wanted with one diagnosis is completely treated. If they are still having pain after spinal fusion or SI joint fusion, the patient can either "accept" the outcome or keep looking. One of the things to look for is compression or injury to the superior cluneal nerves.
The nerve is located lateral to midline, at the low back, and crosses only into the upper buttock, though it can radiate down as far as the posterior hip. Patients may be able to find it themselves by pressing at the low back at the location of their posterior pelvic bones.
Let’s Talk About AblationIf physical therapy, stretching, heat, ice, anti-inflammatories, and conservative measures do not help, and nerve blocks of the superior cluneal nerves have provided good evidence that this is the cause of pain, then ablation of the nerves is an option. There are several ways to ablate these nerves. Some pain management teams will "burn" the nerves with radiofrequency ablation; some may freeze them with cryoablation. This is great when they work. The only problem I have seen with these modalities is trying to cover all of the anatomic variations of where these nerves are located. So, we prefer as surgeons to take a more direct approach: surgical resection. We prefer surgically exploring the region, finding the nerves, no matter where they are located, and surgically removing them. We have seen many variations in the anatomy which can easily explain why the RFA and Cryo approaches may not be as successful in some patients as others. While the surgical approach is more invasive, it tends to provide a much better view of these nerves than the current imaging modalities such as ultrasound. Because this is essentially an operation on the skin, recovery tends to be rapid.Other options for treatment may include "electrical stimulation." Some may try to "stimulate" the nerve to try to stop hurting with peripheral or spinal cord stimulators. Again, due to the same anatomic variations that can make the ablation procedures challenging, this make the result of stimulators challenging as well. Also these techniques require the permanent implant of a foreign body in the lumbar region which many patients would like to avoid.
Get the Right Diagnosis and Clarity About Treatment
We understand that just reading this FAQ may have given you a headache—so here’s the long and short: if you are having pain in your posterior, you need to get the right diagnosis so that you can get the correct treatment. Dr. Eric H. Williams can diagnose the specific cause of your pain and explain the best course of action to correct the problem. Contact us today so that we can get started putting a stop to your pain.
Can carpal tunnel syndrome cause neck pain?
It might seem quite unlikely that the pain you are experiencing in your neck could have anything to do with what is going on in your wrist. After all, there is quite a lot of real estate between your wrists and your neck, and they are engaged in quite different activities when it comes to moving various parts of your body.
But the fact is, carpal tunnel syndrome can, in some cases, lead to a literal pain in the neck.
Carpal Tunnel and It's Connection to Neck Pain
Carpal tunnel syndrome develops when the median nerve is pinched in the carpal tunnel at the base of the hand. The median nerve is quite long—running all the way from the tips of the fingers through the wrist, forearm, elbow, humerus, shoulder, and into the neck. With that in mind, it is easier to understand how an issue down near your hands can be causing pain up near your head.
It Is Important to Get the Diagnosis Right With Your Neck Pain
Of course, carpal tunnel syndrome is far from the only thing that could be causing pain in your neck. That is why it is essential that you see a doctor with expertise in nerve issues so that you receive the correct diagnosis.
An incorrect diagnosis might lead to the wrong treatments, which in the end could make the problems you are experiencing far worse rather than better.
What Can Be Done If My Neck Pain Is Carpal Tunnel Syndrome?
If your doctor determines that you are suffering from carpal tunnel syndrome, they may recommend ultrasound-guided carpal tunnel release. This procedure can repair the tunnel that is pinching your medial nerve, which can lead to significant relief from pain—no matter where along the median nerve you have been experiencing that pain.
Dr. Williams Can Help. Contact Our Nerve Pain Specialist Today.
If you are experiencing pain related to a nerve issue, Dr. Eric H. Williams can help you find relief. He offers a full range of effective treatment options, including ultrasound-guided carpal tunnel release. Don’t suffer any longer. Contact our clinic today to make an appointment.
I’m experiencing numbness when I try to hold small objects like my phone. Is this a sign of carpal tunnel syndrome?
Numbness or a feeling of weakness in your hands when holding small objects such as a cellphone is a classic sign of carpal tunnel syndrome. This condition can make many everyday activities difficult to perform, but effective treatment options are available.
How Carpal Tunnel Syndrome Affects Fine Motor Skills
The carpal tunnel is a narrow region in your wrist located on the side of the palm. It protects the median nerve, but sometimes there can be too much pressure in this area. The compression of the median nerve leads to the condition known as carpal tunnel syndrome.
The median nerve controls your thumb, which is why it can be difficult to grasp small objects when you have carpal tunnel syndrome. You may notice trouble holding your phone first since this is something that you’re likely to do many times throughout the day. However, as your condition progresses, other simple tasks might become more difficult. Some examples of activities that might be hard to do with carpal tunnel syndrome include:
- Opening a bottle of juice or milk
- Chopping vegetables to make a salad
- Gripping the steering wheel of your car
- Holding a pen or pencil
- Buttoning up a dress shirt
- Brushing your teeth
- Applying makeup
As your condition progresses, you may find that you feel clumsy and struggle to tell where your hands are in relation to objects. This is called proprioception.
Getting Treatment for Carpal Tunnel. Contact Our Nerve Pain Specialist Today.
Not being able to complete simple tasks on your own is understandably frustrating. Carpal tunnel release can help you restore your independence.
You may be reluctant to consider carpal tunnel syndrome surgery because of the long recovery time associated with traditional open surgery or an endoscopic procedure. However, ultrasound-guided carpal tunnel release typically requires a recovery time of just three to six days. Since there’s normally no need for follow-up physical therapy, this is an effective way to help you get back to making the most of each day. Contact our Towson office to learn if this procedure might be the right choice for addressing your carpal tunnel syndrome symptoms.
Can cold hands be a sign of carpal tunnel syndrome?
It’s common knowledge that carpal tunnel syndrome can cause numbness, burning, or tingling in the hands, but many people are surprised to learn that cold hands can also be a symptom of the condition.
How Carpal Tunnel Syndrome Can Lead to Cold Hands
The carpal tunnel is a narrow region in the wrist that is located on the side of the palm and protects the median nerve. When there is too much pressure in this area, and the median nerve is compressed, a person develops carpal tunnel syndrome.
Coldness in the hands is due to pressure on the median nerve and a temporary loss of circulation. People with carpal tunnel syndrome may experience cold hands in any weather, but this symptom is generally most noticeable during the winter months.
If you’ve ever used an ice pack on a sprained ankle or another soft tissue injury, you might be wondering why cold hands increase the pain from carpal tunnel syndrome instead of making you feel better. Therapeutic icing is done for 15-20 minutes at a time and is usually alternated with heat therapy. Chronically cold hands occur because blood circulation is being limited through vasoconstriction, which is a normal response of the body to conserve heat. This exacerbates the restricted blood circulation that is already associated with carpal tunnel syndrome.
Getting Relief From Carpal Tunnel
If you have cold hands due to carpal tunnel syndrome, wearing fingerless gloves to keep your hands and wrists warm may help provide temporary symptom relief. However, if your carpal tunnel syndrome symptoms have progressed to the point where the pain is preventing you from doing the activities you enjoy, surgical treatment may be needed.
For many years, people would put off carpal tunnel syndrome surgery because they didn’t want to spend several weeks or even months recovering from a traditional endoscopic procedure or open surgery. Today, however, Dr. Eric H. Williams uses ultrasound-guided carpal tunnel release with the SX-One MicroKnife to relieve painful symptoms with a minimal recovery time and no need for follow-up physical therapy. Contact our Towson office to learn if this procedure might be the right choice for addressing your carpal tunnel syndrome symptoms.
Can carpal tunnel syndrome cause pain all the way to my shoulder?
Shoulder pain is an often overlooked symptom of carpal tunnel syndrome. It may seem counter-intuitive, but the pinching of the median nerve affects more than just your hand. You may experience pain or numbness in every muscle and joint between the tips of the fingers and the cortex of the brain.
How Carpal Tunnel Syndrome Can Lead to Shoulder Pain
The carpal tunnel is a narrow region in the wrist that is located on the side of the palm. It protects the tendons that are responsible for bending the fingers, as well as the median nerve. When there is too much pressure in this area, a person can experience weakness, numbness, or tingling in the fingers and hand.
Over time, the entire functionality of a person’s arm can be affected. Shoulder pain can be intense and constant, or it can occur with specific motions such as reaching overhead or behind the back. This can make it difficult to handle everyday tasks as simple as brushing your hair or putting away your groceries after a shopping trip.
Getting a Diagnosis for Carpal Tunnel
Do not attempt to diagnose your condition at home. Although it’s estimated that about 75% of cases of shoulder pain are related to carpal tunnel syndrome, there are a number of other medical problems that can also cause similar pain and limited range of motion. A doctor can perform a full examination to determine if carpal tunnel syndrome is the culprit.
Ultrasound-Guided Carpal Tunnel Release Can Help
Dr. Eric H. Williams understands that you don’t want to spend several weeks or even months recovering from a traditional endoscopic procedure or open surgery. Ultrasound-guided carpal tunnel release with the SX-One MicroKnife is an innovative alternative that relieves symptoms with a minimal recovery time and no need for follow-up physical therapy.
You deserve to be able to work, care for your family, and enjoy your favorite hobbies without pain. Contact our Towson office to learn more about how ultrasound-guided carpal tunnel release can get you back to making the most of each day.
Will regular computer use increase my risk of developing carpal tunnel syndrome?
It’s a common misconception that office workers who spend their days typing at a computer are placing themselves at risk of carpal tunnel syndrome. A 2001 study in Neurology conducted by researchers from the Mayo Clinic in Rochester, Minnesota, offers insight into the prevalence of carpal tunnel syndrome among office workers. This study looked at office workers who used their computer keyboards for six to seven hours per day and did not find an increased risk of carpal tunnel syndrome compared to other workers. Only 3.5% of the 250 workers in the study met the diagnostic criteria for carpal tunnel syndrome—a rate that was similar to the general population.
Computer Use Makes Symptoms More Noticeable
While typing doesn’t cause a person to develop carpal tunnel syndrome, it can make the symptoms of the condition more noticeable. Office workers who experience numbness, tingling, and burning in the fingers or pain that travels up the forearm towards the shoulder while typing should consult their healthcare provider for a diagnosis. A doctor can rule out conditions with overlapping symptoms, such as tendonitis.
Office Workers May Have Other Risk Factors
The mistaken belief that typing causes carpal tunnel syndrome may be related to the fact that office workers often have other risk factors for the condition. Women, especially those who are experiencing hormonal changes due to pregnancy or menopause, have an increased risk of carpal tunnel syndrome. Obesity and a sedentary lifestyle are also known risk factors.
Get Carpal Tunnel Treatment at Our Towson Office
If carpal tunnel symptoms are interfering with your workday despite using wrist splints and over-the-counter pain relievers, you may be a good candidate for ultrasound-guided carpal tunnel release. CTR with the SX-One MicroKnife and ultrasound guidance relieves symptoms with a minimal recovery time. Most patients can return to their daily activities in three to six days without any post-operative physical therapy.
Dr. Eric H. Williams, a nerve expert who specializes in reconstructive surgery and pain relief, knows that the demands of your work may not allow for you to spend several weeks or even months recovering from a traditional endoscopic procedure or open surgery. Learn more about your options for quickly and effectively addressing your carpal tunnel pain by contacting our Towson office.
What should I expect during recovery from ultrasound-guided carpal tunnel release surgery?
Please note that not every case is the same. There may be factors that change your expected recovery situation, and we will discuss these possibilities with you during your examination.
On average, however, you will be wide awake during the procedure, so no grogginess will be present afterwards. However, should patients wish to have sedation arrangement for this can be provided in advance. The total time you should spend with us is about 1 to 2 hours, with a fraction of that being the procedure itself.
Your incision may be closed with adhesive bandages or a single tiny suture if needed, but you will not have to immobilize your wrist. A Band-Aid or light dressing will be applied over the incision. Standard over-the-counter medication should be all you need to manage discomfort after surgery; however, stronger medication will be prescribed if needed.
Recovery from the soreness of surgery typically takes 3-6 days, compared to weeks with other methods of carpal tunnel release. Resolution of the nerve symptoms of carpal tunnel vary for every patient depending on many factors – including length of time you have had the nerve compression, and the severity of the compression.
The worse the disease, the longer it can take for the nerve to recover. Moderate nerve symptoms are expected to resolve very quickly; frequently the symptoms of numbness, tingling, and pain that were present prior to surgery can resolve within hours, days, or weeks.
What are the benefits of carpal tunnel release with ultrasound guidance?
There are many! To name several1,2:
- A small incision (3-5 mm) above wrist crease on the forearm is all that is required compared to open scar on the palm of the hand or a potentially slightly larger incision with and endoscopic releases.
- The procedure itself takes only a matter of minutes.
- Carpal tunnel release with ultrasound guidance can be performed entirely within our office, with no need for a hospital or surgical center.
- Only local anesthesia is typically required.
- Sutures are rarely needed to close the small incision. Adhesive strips are often enough.
- There is no need for a brace or cast.
- The patient can return to most daily activities almost immediately (though we do emphasize caution – no reason to be fool hearty!
- Most patients will be able to return to work very quickly after surgery, typically within 3-6 days.
1. Rojo-Manaute JM, Capa-Grasa A, Chana-Rodriguez F, et al. Ultra-minimally invasive sonographically guided carpal tunnel release: a randomized clinical trial. J Ultrasound Med. 2016 Jun;35(6):1149-1157.
2. Henning PT, Yang L, Awan T, et al. Minimally invasive ultrasound-guided carpal tunnel release: preliminary clinical results. J Ultrasound Med. 2018 Nov;37(11):2699-2706.
How does carpal tunnel release using ultrasound guidance differ from other carpal tunnel release techniques?
More traditional forms of carpal tunnel release either involve an open incision or the use of an endoscope inserted through an incision in order to see where to operate.
Carpal tunnel release performed under the guidance of ultrasound uses an external means of determining where to operate, and a new instrument called the SX-One MicroKnife® is placed through a small incision to perform the release.
SX-One MicroKnife is a registered trademark of Sonex Health, Inc.