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    Nerve Surgery St Louis

    Our vision at Neuropax Clinic is to be a leader in creating a health care delivery platform that works more effectively for patients suffering from chronic pain, peripheral diabetic neuropathy, carpal tunnel, tarsal tunnel, chronic migraines/headaches, cubital tunnel, radial tunnel and other serious complications related to peripheral nerve damage. We fulfill this vision by offering proven, advanced diagnostic and surgical techniques to help patients stop suffering and reclaim their quality of life.

    Neuropax Clinic is also dedicated to bringing relief to our patients through the education of patients and physicians. We advance science and public awareness about the benefits of our surgical procedures and the results of those procedures.

    How Did I Get Thoracic Outlet Syndrome?

    Last week we talked about some symptoms of Thoracic Outlet Syndrome, so this month we wanted to discuss a few causes.  These activities and conditions can all lead to Thoracic outlet syndrome, which occurs when the thoracic outlet becomes narrowed and compresses the nerves and blood vessels.

    An Extra Rib

    Some people are born with an extra rib above their first rib. This reduces the size of their thoracic outlet and compresses nerves and blood vessels.

    Poor Posture and Obesity

    People who don’t stand up straight or who have excess abdominal fat may have increased pressure on their joints. This can cause a narrowing of the thoracic outlet.

    Injury

    Car accidents and other traumatic injuries can compress the thoracic outlet as well as the vessels and nerves in this area.

    Overuse of the Shoulders and Arms

    Repetitive activities, such as working at a computer or lifting heavy objects above the head, can cause damage to the tissues in the thoracic outlet. Over time, the size of the thoracic outlet may shrink, placing pressure on the vessels and nerves.

    If you experience

    • pain in parts of the neck, shoulder, arm, or hand
    • numbness in the forearm and fingers
    • weakness of the hand

    please call us at 314-443-7784 to make an appointment or visit www.neuropaxclinic.com for more information.  Don't keep living in pain.

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    I Have Numbness and Tingling in My Hands, Is It Thoracic Outlet Syndrome

    Thoracic outlet syndrome refers to a group of conditions that develop when the blood vessels or nerves in the thoracic outlet become compressed. The thoracic outlet is the narrow space between your collarbone and first rib. Blood vessels, nerves, and muscles that extend from the back to the arms pass through this area. If the space in the thoracic outlet is too narrow, these structures can become compressed. The increased pressure on the blood vessels and nerves may cause pain in your shoulders, neck, and arms. It can also cause numbness or tingling in your hands.

    • pain in parts of the neck, shoulder, arm, or hand
    • numbness in the forearm and fingers
    • weakness of the hand

    Compressed blood vessels can cause:

    • swelling of the arm
    • redness of the arm
    • hands or arms that feel cold to the touch
    • hands or arms that become easily fatigued

    You may also find it difficult to lift objects above your head. You might also have a limited range of motion in your shoulders and arms.

    If you experience any of these symptoms, please contact Neuropax Clinic today.  We are available at 314-434-7784 and more information can be found at www.neuropaxclinic.com.  Don't live your life in pain.

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    What Is This Pain In My Thigh?

    Meralgia Paresthetica is a constellation of symptoms caused by a compression neuropathy (pinched nerve) of the Lateral Femoral Nerve (LFN). The LFN arises from the second and third lumbar spinal levels (L2,L3). As the LFN travels from the spine to the thigh region, the nerve can be pinched at the anterior pelvic tunnel. This tunnel is made by the bone of anterior superior iliac spine, the dense fibers of the inguinal ligament and overlaying musculature. Pressure on this nerve causes feelings of burning, pain and numbness along the front and lateral part of the thigh, extending all the way from anterior and lateral hip, groin and gluteal area to the knee. In some, there can even be very deep groin and testicular or labial pain.

    It is not uncommon for the severity of symptoms to be significantly debilitating, especially if the problem is not addressed. It is important to understand that this a very treatable problem. Its like having carpal tunnel of your hip. Early or old teachings that suggest there is nothing to do, still permeate the medical community regarding this problem.

    This compression neuropathy (pinched nerve condition) can be caused by several different mechanisms. Anatomical studies have shown that at least 5% of the population has an abnormal nerve tunnel. This anatomic variant is highly vulnerable for compression but any nerve can become compressed or damaged. History of pelvic fracture, Blunt trauma in or near the nerve and tunnel, can cause direct trauma to the nerve or trauma to the surrounding tissues that leads to compression of the nerve as well.

    Even just having surgery in the area of the hip, groin or abdomen can lead to changes in the tissue surrounding the nerve and lead to compression. Prior hip surgery, hernia surgery, bone graft harvest, cesarean sections are some of the most common.

    Some professional activities (i.e. police officers, firefighters and construction workers, etc.) require wearing heavy and loaded belts around the waist. This exposes the nerve to excess and repetitive pressure, especially if anatomical nerve path abnormalities already exist. Various sports like karate/kickboxing, football, soccer, rugby and others can all produce injuries that result in this problem. Body habitus such as abdominal obesity or pregnancies can also contribute to repetitive stress and stretching of the nerve.

    It is also important to recognize the affects of diabetes on this clinical problem. Diabetic patients, due to abnormal glucose metabolism, may develop swelling of the nerve, as well as narrowing of the tunnel itself. This alters the normally perfect relationship between the nerve and its tunnel, making it now too narrow for the more swollen nerve, resulting in lateral femoral cutaneous nerve neuropathy. Therefore, diabetic patients are at much higher risk for experiencing symptoms of Meralgia Paresthetica than the general population.

    Once you have been identified to have symptoms consistent with Meralgia Paresthetica or compression of the Lateral Femoral Nerve (LFN) several diagnostic points should be addressed. In some cases, lower spine or lumbar spine pathology should be ruled out with an MRI. This study can also include a study of the pelvis to rule out any mass or tumor causing compression to the nerve along its course. Ultrasound guided, site specific, diagnostic injections are routinely utilized for confirming the diagnosis. In some cases, the addition of steroid to this injection can provide symptomatic relief for some variable length of time. If there is no spinal or pelvic pathology and the severity of symptoms are not too severe, conservative care is a very appropriate initial treatment. This may include: nerve modulator medicines (i.e. neurontin, amitriptyline, etc. ), topical compound cream, lifestyle changes, weight loss and physical therapy. If conservative therapies have been tried and fail after 3 months, surgical decompression should be considered. Accessory treatment modalities such as radio frequency ablation(RFA), sclerosing or spinal cord stimulators do not treat the problem and should not be utilized for this clinical problem.

    Surgical decompression of the nerve is successful in 80-85% of cases. In the residual population that fail decompression, 80% of these patients will respond to going back and resecting (neurectomy) the nerve.

    The success of the surgery depends on how long the nerve has been compressed, the severity of the compression, the extent of nerve damage due to injury and the possible presence of underlying medical or spine problems.

    The surgery performed in an outpatient setting. The surgical incision is generally very small, however body habitus can dictate a larger incision. The post-operative course is consistent but is affected by the amount of decompression required. In general, people can return to light duty work after 2 to 3 weeks and unlimited/unrestricted activity at 6 weeks.  For more information on Meralgia Paresthetica and ways it can be treated, visit www.neuropaxclinic.com and call 314-434-7784 for more information.

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    I Have Wrist Pain Is It Carpal Tunnel Syndrome?

    Carpal tunnel syndrome is numbness, tingling,weakness, and other problems in your hand because of pressure on the median nerve in your wrist.

    The median nerve and several tendons run from your forearm to your hand through a small space in your wrist called the carpal tunnel . The median nerve controls movement and feeling  in your thumb and first three fingers (not your little finger).

    Pressure on the median nerve causes carpal tunnel syndrome. This pressure can come from swelling or anything that makes the carpal tunnel smaller. Many things can cause this swelling, including:

    • Illnesses such as hypothyroidismrheumatoid arthritis, and diabetes.
    • Making the same hand movements over and over, especially if the wrist is bent down (your hands lower than your wrists), or making the same wrist movements over and over.
    • Pregnancy.

    Carpal tunnel syndrome can cause tingling, numbness, weakness, or pain in the fingers or hand. Some people may have pain in their arm between their hand and their elbow.

    Symptoms most often occur in the thumb, index finger, middle finger, and half of the ring finger. If you have problems with your other fingers but your little finger is fine, this may be a sign that you have carpal tunnel syndrome. A different nerve gives feeling to the little finger.

    You may first notice symptoms at night. You may be able to get relief by shaking your hand.

    Neuropax Clinic and Dr. Robert Hagan will help you.  Call us today at 314-434-7784 or visit www.neuropaxclinic.com for more information.

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    What is Foot Drop, and What is the Treatment in St Louis

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    What is peroneal nerve injury (foot drop)?

    A peroneal nerve injury (also called foot drop or drop foot), is a peripheral nerve injury that affects a patient’s ability to lift the foot at the ankle. While foot drop injury is a neuromuscular disorder, it can also be a symptom of a more serious injury, such as a nerve compression or herniated disc.

    Causes of peroneal nerve injury (foot drop)

    Foot drop injury can be caused by an injury to the spinal cord or from other underlying diseases, such as amyotrophic lateral sclerosis (ALS)multiple sclerosis (MS), or Parkinson's disease. Sometimes, drop foot is a complication from hip replacement surgery, or other injuries (e.g., knee or joint dislocation or fracture, herniated disc).

    Symptoms of peroneal nerve injury (foot drop)

    Symptoms of peroneal nerve injury (foot drop) may include:

    • Inability to point toes toward the body (dorsi flexion)
    • Pain
    • Weakness
    • Numbness (on the shin or top of the foot)
    • Loss of function of foot
    • High-stepping walk (called steppage gait or footdrop gait)

    Diagnosis of peroneal nerve injury (foot drop)

    Proper diagnosis of drop foot requires the expert attention of experienced neurologists and nerve specialists.

    Diagnosis will include:

    • A comprehensive clinical exam, including neurological exams
    • Complete medical history
    • Electrical testing
    • Imaging studies, such as X-rays or high-resolution 3-T MRI (magnetic resonance imaging)
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    Reduce Migraine Pain In St Louis

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    MIgraine headaches in St. Louis have become a real problem.  Thousands of people in the city suffer from this debilitating issue.  It costs people in many ways.  You can't work.  You don't want to spend time with your family and friends.  It can be a nightmare for people that have to deal with it daily.  It's not all a loss, though.  There is a solution that can work for people who have migraines that won't go away.

    Peripheral nerve surgery has been proven to reduce, and in some cases remove migraine pain from chronic migraine suffering.  This surgery reduces the stress on your nerves that cause migraines by relieving the stress on the nerve.  Tissue around the nerve is removed, giving the nerve a clear path and stopping the irritation. 

    Although the Greater occipital nerve is the most common nerve involved, other nerves can be involved as well. The lesser occipital nerve and dorsal (or least) occipital nerve which are located in the back of the head/scalp. Headaches may originate from the forehead or frontal region as well. The nerves involved in this area include the supra-orbital and zygomatico-temporal nerves.

    When no other underlying diseases or conditions are found, you may be a candidate for a nerve decompression surgery that can reduce or end your migraine headaches.  This is an outpatient surgery with short recovery times. Results are often immediately evident but may take several weeks. Neuropax surgeons can assess if nerve decompression surgery would help to alleviate or significantly reduce your debilitating symptoms.

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    Get Migraine Surgery in St Louis at Neuropax Clinic

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    Migraine headaches, real, chronic migraines, can ruin your life.  That’s not hyperbole, it’s the truth.  When you get migraines regularly, you know that they can cause you to miss work, school, or social events.  You can end up curled up in bed for the day, in excruciating pain.  Migraine headaches are a scourge on those that suffer from them.  But what if there was a way to relieve these nightmares?

    Nerve compression surgery can help.  It is estimated that up to 13 % (likely even higher) of all chronic headaches are related to occipital nerve neuralgia. Neuralgia is a general term for pain or irritation along the course of a nerve. We are addressing the irritation caused by nerve compression in this situation.  Surgery by Dr. Robert Hagan of the Neuropax Clinic can help relieve the symptoms and causes of severe headaches, allowing the recipient to suffer far reduced migraines, or possibly end the headaches altogether.

    Although the Greater occipital nerve is the most common nerve involved, other nerves can be involved as well. The lesser occipital nerve and dorsal (or least) occipital nerve which are located in the back of the head/scalp. Headaches may originate from the forehead or frontal region as well. The nerves involved in this area include the supra-orbital and zygomatico-temporal nerves.

    When no other underlying diseases or conditions are found, you may be a candidate for a nerve decompression surgery that can reduce or end your migraine headaches.  This is an outpatient surgery with short recovery times. Results are often immediately evident but may take several weeks. Neuropax surgeons can assess if nerve decompression surgery would help to alleviate or significantly reduce your debilitating symptoms.

    If you have persistent signs and symptoms suggestive of migraine pain, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, they'll only get worse.  For more information or to make an appointment with Neuropax Clinic, call us at 314-434-7784 or visit www.neuropaxclinic.com today to learn more.  Don't live with Migraine Pain any longer than you have to.

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    Migraine Relief in St. Louis

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    We are asked quite a bit whether we will see St. Louis patients for migraine surgery, or if we’ll see out-of-town patients as well. Of course we do!  Anyone may be able to achieve significant and lasting relief no matter where they call home!  We are excited to help people from all over the globe as migraine surgery is an area to which I have dedicated a large portion of my practice and is something about which I remain very passionate. We wish to extend an invitation to everyone anywhere to look us up and decide for themselves whether we might be able to help to reduce or eliminate their chronic headaches with peripheral nerve surgery.

    People that have been living with their headaches for decades and have resigned themselves to a life of chronic pain despite medication deserve a chance to live without pain. Happily, we proved that was not the case. Furthermore, because we see so many foreign and out of town patients, we have developed a system to help make your overall experience as seamless as possible. Finally, because post-operative follow-up is an extremely important part of the surgical experience and critical to achieving optimal outcomes, we use these same modalities to keep tabs on our patients after they have gone home and remain available to discuss issues with your local treating physicians if needed. This important time can be hard for patients as well as doctors that can't see their patients directly, but our practice has refined this process to ask the right questions and determine if any further action is needed.

    If you have persistent signs and symptoms suggestive of migraine pain, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, they'll only get worse.  For more information or to make an appointment with Neuropax Clinic, call us at 314-434-7784 or visit www.neuropaxclinic.com today to learn more.  Don't live with Migraine Pain any longer than you have to.

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    Signs That You Have Carpal Tunnel in St Louis

    Carpal Tunnel Pain

     

    Carpal tunnel syndrome usually starts gradually with numbness or tingling in your thumb, index and middle fingers that comes and goes. This may be associated with discomfort in your wrist and hand. Common carpal tunnel syndrome symptoms include:

    • Tingling or numbness. You may experience tingling and numbness in your fingers or hand, especially your thumb and index, middle or ring fingers, but not your little finger. This sensation often occurs while holding a steering wheel, phone or newspaper or, commonly, waking you from sleeping. The sensation may extend from your wrist up your arm.

      Many people "shake out" their hands to try to relieve their symptoms. As the disorder progresses, the numb feeling may become constant.

    • Weakness. You may experience weakness in your hand and a tendency to drop objects. This may be due to the numbness in your hand or weakness of the thumb's pinching muscles, which are controlled by the median nerve.

    When to see a doctor

    If you have persistent signs and symptoms suggestive of carpal tunnel syndrome, especially if they interfere with your normal activities and sleep patterns, see your doctor. If you leave the condition untreated, permanent nerve and muscle damage can occur.  For more information or to make an appointment with Neuropax Clinic, call us at 314-434-7784 or visit www.neuropaxclinic.com today to learn more.  Don't live with Chronic Joint Pain any longer than you have to.

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    Chronic Joint Pain Can Be Solved

    Chronic joint pain can be solved if you feel that it is becoming unlivable.  It has become increasingly common.  People are living longer, but the joints will break down at the same time that they would have normally, leaving millions of Americans with chronic joint pain in their advancing years.  However, they don't have to deal with this forever.

    Joint denervation surgery could possibly provide lasting pain relief for you. Your joint pain may have been caused by direct trauma to the joint or surrounding nerves. Alternatively, it may be post surgical pain or chronic arthritis with no other treatment options.

    First, it is important that you have addressed the structural or mechanical problems regarding your joint pain with your orthopedist, extremity surgeon, or podiatrist, as joint denervation surgery in general is not a primary treatment. Most patients have pain relief with traditional musculoskeletal therapies but varying percentages will have persistent or chronic pain. Some patients will have benefited from a course of pain management therapy with a specialist. This sometimes breaks the cycle of pain or bridges the gap while natural healing courses take place. However, if the pain has not subsided, or if you are unable to wean off undesirable pain medications, then you should consider being evaluated for joint denervation surgery.

    Joint denervation surgery is not a novel idea. This procedure has been around since the 1950's. However, like nerve decompression surgery, the application of this proven surgical technique has been under-utilized until recently. Now, the technique is being applied to multiple types of refractory chronic joint pain. 

    All joints have sensory nerves that provide pain fibers to its surrounding capsule. These nerves can be injured or may provide the pathway or conduit for the pain to travel through. Remember, pain is a feedback stimulus and is transmitted from periphery to the central nervous system (CNS, brain and spine). If you have pain, it is traveling through some nerve or multiple, smaller branches that lead to a common pathway. Joint denervation surgery removes a segment of the damaged nerve in order to disrupt or remove the chronic signal. 

    The result of joint denervation is a significant or complete relief of pain. When the pain is relieved, often range of motion will improve because pain is no longer preventing the motion. Muscles begin to work within a more natural range and become strong again. In the lower extremity, joint denervation can re-establish more normal walking patterns. The ultimate goal is better function allowing more normal work or life activities.

    Joints  
    Shoulder Denervation
    Elbow Denervation
    Wrist Denervation
    Knee Denervation
    Ankle Denervation

    *Please note: Joint Denervation Surgery is not a treatment for acute or incidental pain regardless of intensity.*

    For more information or to make an appointment with Neuropax Clinic, call us at 314-434-7784 or visit www.neuropaxclinic.com today to learn more.  Don't live with Chronic Joint Pain any longer than you have to.

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    What Causes Carpal Tunnel Pain?

    Figure 3 Carpal Tunnel

    Carpal tunnel syndrome (CTS) is a condition brought on by increased pressure on the median nerve at the wrist. In effect, it is a pinched nerve at the wrist. Symptoms may include numbness, tingling, and pain in the arm, hand, and fingers. There is a space in the wrist called the carpal tunnel where the median nerve and nine tendons pass from the forearm into the hand (see Figure 1). Carpal tunnel syndrome happens when pressure builds up from swelling in this tunnel and puts pressure on the nerve. When the pressure from the swelling becomes great enough to disturb the way the nerve works, numbness, tingling, and pain may be felt in the hand and fingers.

    Things that put you at risk for carpal tunnel syndrome include:

    • Health problems or illnesses that can cause arm pain or swelling in the joints and soft tissues in the arm, or reduce the blood flow to the hands. These include obesity, rheumatoid arthritis, diabetes, lupus,hypothyroidism, and multiple sclerosis.
    • Being female. Women between the ages of 40 and 60 have the highest risk. Pregnant women near the end of their pregnancies often have short-term symptoms. Women taking birth control pills, going through menopause, or taking estrogen are also thought to be at risk.
    • Hand and wrist movements and activities that require repeated motions, especially in awkward positions.
    • Smoking. It may contribute to carpal tunnel syndrome by affecting the blood flow to the median nerve.
    • Broken wrist bones, dislocated bones, new bone growth from healing bones, or bone spurs. These can take up space in the carpal tunnel and put more pressure on the median nerve.
    • Tumors and other growths (such as ganglions). These uncommon causes of carpal tunnel syndrome are usually benign.
    • Normal wear and tear of the tissues in the hand and wrist caused by aging.

    If you find yourself at risk for Carpal Tunnel Syndrome or in extreme wrist pain, call Neuropax Clinic today at 314-434-7784 or visit www.neuropaxclinic.com for more information.  Don't live with the pain.  Fix your Carpal Tunnel Syndrome today.

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    What Can I Do About My Chronic Migraine Pain?

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    What Can I Do About My Chronic Migraine Pain?  Everyone gets a headache from time to time. Hangovers, lack of sleep, stress, and other factors can all lead to a common headache. But what if you don't have a "common headache"? Many people suffer from what are referred to as Chronic Migraine Headaches. That's when the headaches appear on a dialy or cintinual basis, and can ruin your life if left untreated. These migraine headaches present themselves as intense, repeated pain, with increased sensitivity.

    There are 180 different types of defined headaches. 30 million people in the US suffer from chronic migraines in some form. Many patients have centralized headaches that respond well to medicines. However, many people have headaches that are debilitating and don't respond well to current available pharmaceuticals.

    It is estimated that up to 13 % (likely even higher) of all chronic headaches are related to occipital nerve neuralgia. Neuralgia is a general term for pain or irritation along the course of a nerve. We are addressing the irritation caused by nerve compression in this situation.

    Although the Greater occipital nerve is the most common nerve involved, other nerves can be involved as well. The lesser occipital nerve and dorsal (or least) occipital nerve which are located in the back of the head/scalp. Headaches may originate from the forehead or frontal region as well. The nerves involved in this area include the supra-orbital and zygomatico-temporal nerves.

    When no other underlying diseases or conditions are found, you may be a candidate for a nerve decompression surgery that can reduce or end your migraine headaches. This is an outpatient surgery with short recovery times. Results are often immediately evident but may take several weeks. Neuropax surgeons can assess if nerve decompression surgery would help to alleviate or significantly reduce your debilitating symptoms.

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    Do You Have Sports Injury Pain?

    If you ever played a sport competitively, you probably have some degree of sports-injury related pain.  There+'s no embarassment to it, it's just the way of life.  If you spend your youth running into people, you will feel it as you age.  Sports related injuries do not discriminate based on age or ability. Athletes, from professionals to weekend warriors are vulnerable to chronic pain as the result of injuries. Persistent pain can stall progress with rehab/physical therapy and keep individuals from returning to their activity, in some cases disabling them from other daily activities.

    If you continue to experience persistent chronic pain after a sports injury, peripheral nerve surgery may relieve pain and help you return to your sport and other normal activities that may have been affected.

    At Neuropax Clinics, we treat athletes for a variety of chronic pain conditions related to peripheral nerve damage.  While we are not focused on the primary treatment of sports related injuries, we can offer you hope for relief of pain that has not responded to traditional treatments. 

    Common Nerve Related Conditions

    • Blunt or repetitive injury to the neck shoulder interface (brachial plexus) 
    • (i.e. shoulder stinger, throwing athletes, cycling accidents)
    • Chronic shoulder pain after repair or reconstruction
    • Persistent elbow pain from tennis elbow (Lateral epicondylitis), golfers elbow (medial epicondylitis), elbow fractures or reconstruction (e.g., Tommy Johns surgery) 
    • Chronic wrist pain from sprains or fractures
    • Chronic groin pain from blunt injury, groin pull, sports hernia (i.e. groin pull from repetitive soccer style kicking, stinger to the hip, etc.)
    • Chronic knee pain after reconstructive surgery, multiple arthroscopies, or trauma that has no true mechanical injury only pain (i.e. MCL reconstruction. Medial meniscus repair, knee dislocation, etc.)
    • Chronic ankle or foot pain(i.e. ankle sprains, fractures, tendonitis, etc.)
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    Causes of Carpal Tunnel Syndrome

    Causes

     
    Anatomy of the carpal tunnel showing the median nerve passing through the tight space it shares with the finger tendons.

    Most cases of CTS are of unknown cause. Carpal tunnel syndrome can be associated with any condition that causes pressure on the median nerve at the wrist. Some common conditions that can lead to CTS include obesity, oral contraceptives, hypothyroidism, arthritis, diabetes, prediabetes (impaired glucose tolerance), and trauma. Carpal tunnel is also a feature of a form of Charcot-Marie-Tooth syndrome type 1 called hereditary neuropathy with liability to pressure palsies.

    Other causes of this condition include intrinsic factors that exert pressure within the tunnel, and extrinsic factors (pressure exerted from outside the tunnel), which include benign tumors such as lipomas, ganglion, and vascular malformation. Carpal tunnel syndrome often is a symptom of transthyretin amyloidosis-associated polyneuropathy and prior carpal tunnel syndrome surgery is very common in individuals who later present with transthyretin amyloid-associated cardiomyopathy, suggesting that transthyretin amyloid deposition may cause carpal tunnel syndrome.

    The median nerve can usually move up to 9.6 mm to allow the wrist to flex, and to a lesser extent during extension. Long-term compression of the median nerve can inhibit nerve gliding, which may lead to injury and scarring. When scarring occurs, the nerve will adhere to the tissue around it and become locked into a fixed position, so that less movement is apparent.

    Normal pressure of the carpal tunnel has been defined as a range of 2–10 mm, and wrist flexion increases this pressure 8-fold, while extension increases it 10-fold. Repetitive flexion and extension in the wrist significantly increase the fluid pressure in the tunnel through thickening of the synovial tissue that lines the tendons within the carpal tunnel.

    Work related

    The international debate regarding the relationship between CTS and repetitive motion in work is ongoing. The Occupational Safety and Health Administration (OSHA) has adopted rules and regulations regarding cumulative trauma disorders. Occupational risk factors of repetitive tasks, force, posture, and vibration have been cited. The relationship between work and CTS is controversial; in many locations, workers diagnosed with carpal tunnel syndrome are entitled to time off and compensation.

    Some speculate that carpal tunnel syndrome is provoked by repetitive movement and manipulating activities and that the exposure can be cumulative. It has also been stated that symptoms are commonly exacerbated by forceful and repetitive use of the hand and wrists in industrial occupations, but it is unclear as to whether this refers to pain (which may not be due to carpal tunnel syndrome) or the more typical numbness symptoms.

    A review of available scientific data by the National Institute for Occupational Safety and Health (NIOSH) indicated that job tasks that involve highly repetitive manual acts or specific wrist postures were associated with incidents of CTS, but causation was not established, and the distinction from work-related arm pains that are not carpal tunnel syndrome was not clear. It has been proposed that repetitive use of the arm can affect the biomechanics of the upper limb or cause damage to tissues. It has also been proposed that postural and spinal assessment along with ergonomic assessments should be included in the overall determination of the condition. Addressing these factors has been found to improve comfort in some studies. A 2010 survey by NIOSH showed that 2/3 of the 5 million carpal tunnel cases in the US that year were related to work. Women have more work-related carpal tunnel syndrome than men.

    Speculation that CTS is work-related is based on claims such as CTS being found mostly in the working adult population, though evidence is lacking for this. For instance, in one recent representative series of a consecutive experience, most patients were older and not working. Based on the claimed increased incidence in the workplace, arm use is implicated, but the weight of evidence suggests that this is an inherent, genetic, slowly but inevitably progressive idiopathic peripheral mononeuropathy.

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    Get Rid of St Louis Repetitive Strain Pain

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    Repetitive Strain Injuries are annoying and costly.  Everything from Carpal Tunnel to Foot Drop can be caused by just repeating the same motions repeatedly, causing stress on the joint in a way that it's not meant to be used.  While companies can adjust workstations and reassign tasks to reduce employee injuries, treating an injury once it occurs is not nearly as easy. For instance, computer-related repetitive strain injury, caught early enough, can be remedied or controlled with physical therapy, education about posture and body mechanics, and sometimes, time away from the keyboard. But if an employee keeps working without making such changes, he or she can wind up so disabled that performing even simple tasks like cooking, gardening, picking up a baby, or carrying groceries becomes difficult. Even if the problem never reaches that point, some employees are never able to return to their full capacity.

    Most often, doctors tell patients to get adequate rest, take frequent breaks, do stretching exercises, vary their tasks if possible, and change the way they sit or move -- for instance, periodically hold or reach for something with a different hand. Some physicians recommend anti-inflammatory medication and using ice or heat on the injured area until the pain subsides. Many also refer patients for a range of alternative treatments, including chiropractic or osteopathic manipulation,acupuncture, or a method called myofascial release, which focuses on the soft tissue. Depending on the injury, surgery can help -- for instance, carpal tunnel release surgery in the wrist takes pressure off the medial nerve in order to preserve nerve function.

    Since repetitive strain injuries are essentially the result of doing more than the body can handle, many doctors say the best chance for recovery lies in eventually strengthening the body's tissues.  How long does it take? That's the rub.  Strengthening the joint or surrounding areas can help with repetitive injuries, but sometimes, surgery is required.  

    If strengthening the area hasn't helped, Dr. Robert Hagan of Neuropax Clinic can help.  To learn more about Repetitive Strain Pain, or any nerve related surgery, visit www.neuropaxclinic.com or call 314-434-7784 to make an appointment.  Don't live with repetitive strain pain any longer.

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    Migraines - How Nerve Surgery Can Help You

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    Migraines can ruin your life.  They take away full days from your life, debilitating and stopping you from living your life how you want to.  What if there was a way to minimize or even eliminate your Chronic Migraine Pain?  Nerve surgery for your migraines couls be your answer.

    There are 180 different types of defined headaches.  Many people have headaches from time to time, but if you experience them on a daily or continual basis, your headaches may fall into the category of Chronic Migraine Headache. 30 million people in the US suffer from chronic migraines in some form. Many patients have centralized headaches that respond well to medicines. However, many people have headaches that are debilitating and don't respond well to current available pharmaceuticals.

    It is estimated that up to 13 % (likely even higher) of all chronic headaches are related to occipital nerve neuralgia. Neuralgia is a general term for pain or irritation along the course of a nerve. We are addressing the irritation caused by nerve compression in this situation.

    Although the Greater occipital nerve is the most common nerve involved, other nerves can be involved as well. The lesser occipital nerve and dorsal (or least) occipital nerve which are located in the back of the head/scalp. Headaches may originate from the forehead or frontal region as well. The nerves involved in this area include the supra-orbital and zygomatico-temporal nerves.

    When no other underlying diseases or conditions are found, you may be a candidate for a nerve decompression surgery that can reduce or end your migraine headaches.  This is an outpatient surgery with short recovery times. Results are often immediately evident but may take several weeks. Neuropax surgeons can assess if nerve decompression surgery would help to alleviate or significantly reduce your debilitating symptoms.

    For more information, visit www.neuropaxclinic.com or call our office at 314-434-7784 today to make an appointment.  

    Dr. Robert R. Hagan received his MD from Saint Louis University School of Medicine. He received his general surgery training at The Lahey Clinic in Boston, Massachusetts and his plastic surgery training at The Lahey Clinic and Harvard Medical School hospitals. He continued his education as a fellow at Harvard Medical School in Boston, Massachusetts specializing in hand and microsurgery. Upon returning to the Midwest he completed a craniofacial fellowship at Washington University in St. Louis, MO.

    Currently, Dr. Hagan maintains a private practice at Neuropax Clinic in St. Louis, MO. He has special interests in peripheral nerve surgery and hand/extremity surgery. His diverse training in plastics, hand, peripheral nerve, craniofacial, reconstructive and microsurgery has served him well to understand the many challenges of today's pain and peripheral nerve disorders.

    Peripheral nerve itself includes diabetic neuropathy, compression neuropathies (carpal tunnel, cubital tunnel, tarsal tunnel, etc.), nerve trauma, chronic joint pain, chronic groin pain, chronic migraines, and RSD/causalgia.
     
    Dr. Hagan is committed to the research and further development of peripheral nerve surgery. Neuropax Clinic provides a multi-center platform for clinical research and advancement of surgical techniques. Dr. Hagan has many ongoing studies focused on improving the diagnosis of and treatment of peripheral nerve and pain disorders.

    Dr. Hagan and Neuropax Clinic together provide fellowship training in peripheral nerve surgery to teach other surgeons their advanced diagnostic and surgical techniques. He is also a clinical instructor for the Saint Louis University, Department of Surgery, Division of Plastic Surgery.
     
    Dr. Robert Hagan's professional hospital appointments include Missouri Baptist Hospital and Barnes Jewish-West Country Hospital; all located in St. Louis, Missouri.  He is a member of the American Society of Plastic Surgeons(ASPS), the American Association for Hand Surgery(AAHS), American Society For Peripheral Nerve(ASPN), the American Society for Reconstructive Microsurgery(ASRM), the Association of Extremity Nerve Surgeons(AENS), the American Headache Society(AHS), and the American Diabetes Society(ADS).

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    Wrist Pain: Will I Need Carpal Tunnel Surgery

    So, you're experiencing wrist pain, and you've been diagnosed with Carpal Tunnel Syndrome.  You'd like to know "Will I Need Carpal Tunnel Surgery"? and "What Does Carpal Tunnel Surgery Entail?" We'll go through a few of the key points to give you an idea what to expect.

    During open carpal tunnel release surgery the transverse carpal ligament is cut, which releases pressure on the median nerve and relieves the symptoms of carpal tunnel syndrome.

    An incision is made at the base of the palm of the hand. This allows the doctor to see the transverse carpal ligament. After the ligament is cut, the skin is closed with stitches. The gap where the ligament was cut is left alone and eventually fills up with scar tissue.

    If you have open carpal tunnel release surgery, you typically do not need to stay in the hospital. It is usually done under local anesthetic, and you can go home on the same day.

    What To Expect After Surgery

    After surgery, the hand is wrapped. The stitches are removed 10 to 14 days after surgery. The pain and numbness may go away right after surgery or may take several months to subside. Try to avoid heavy use of your hand for up to 3 months.

    When you return to work depends on whether the dominant hand (the hand you use most) was involved, what your work activities are, and how much effort you put into rehabilitative physical therapy.

     
    • If you have surgery on your nondominant hand and do not do repetitive, high-risk activities at work, you may return to work within 1 to 2 days, although 7 to 14 days is most common.
    • If you have surgery on your dominant hand and do repetitive activities at work, you may require 6 to 12 weeks for a full recovery before you can return to previous work duties. Physical therapy may speed your recovery.

    Why It Is Done

    Open carpal tunnel surgery is considered when:

    • Symptoms are still present after a long period of nonsurgical treatment. In general, surgery is not considered until after several weeks to months of nonsurgical treatment. But this assumes that you are having ongoing symptoms but no sign of nerve damage. Nerve damage would make surgery more urgent.
    • Severe symptoms (such as persistent loss of feeling or coordination in the fingers or hand, or no strength in the thumb) restrict normal daily activities.
    • There is damage to the median nerve (shown by nerve test results and loss of hand or finger function), or a risk of nerve damage.
    • Tumors or other growths need to be removed.

    How Well It Works

    Most people who have surgery for carpal tunnel syndrome have fewer or no symptoms of pain and numbness in their hand after surgery.

    In rare cases, the symptoms of pain and numbness may return (the most common complication), or there may be temporary loss of strength when pinching or gripping an object, due to the cutting of the transverse carpal ligament.

    If the thumb muscles have been severely weakened or wasted away, hand strength and function may be limited even after surgery.

    Risks

    The risk and complication rates of open surgery are very low. Major problems such as nerve damage happen in fewer than 1 out of 100 surgeries (less than 1%).2 There is a small risk that the median nerve or other tissues may be damaged during surgery. After open surgery, recovery may be slower than after endoscopic surgery. And there may be some pain in the wrist and hand. You may also have some tenderness around the scar. There are also the risks of any type of surgery, including possible infection and risks of general anesthesia. But most open carpal tunnel surgery is done with local anesthesia or regional block rather than with general anesthesia.

    The main takeaway is that Carpal Tunnel Surgery can eliminate the pain and numbness that is felt in the wrist and help you regain all of the mobility that you previously enjoyed.  For more information about Carpal Tunnel Syndrome visit www.neuropaxclinic.com and call 314-434-7784 for an appointment.  Don't live with the pain any longer than you have to.

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    Symptoms of a St Louis Migraine That May Need Surgery

    Migraines are a scourge that can ruin your quality of life if not treated properly.  Luckily, there are treatments available if these symptoms of a St Louis Mmgraine that may need surgery sound familiar to you.

    Prodrome

    One or two days before a migraine, you may notice subtle changes that signify an oncoming migraine, including:

    • Constipation
    • Depression
    • Food cravings
    • Hyperactivity
    • Irritability
    • Neck stiffness
    • Uncontrollable yawning

    Aura

    Aura may occur before or during migraine headaches. Auras are nervous system symptoms that are usually visual disturbances, such as flashes of light. Sometimes auras can also be touching sensations (sensory), movement (motor) or speech (verbal) disturbances. Most people experience migraine headaches without aura. Each of these symptoms usually begins gradually, builds up over several minutes, and then commonly lasts for 20 to 60 minutes. Examples of aura include:

    • Visual phenomena, such as seeing various shapes, bright spots or flashes of light
    • Vision loss
    • Pins and needles sensations in an arm or leg
    • Speech or language problems (aphasia)

    Less commonly, an aura may be associated with limb weakness (hemiplegic migraine).

    Attack

    When untreated, a migraine usually lasts from four to 72 hours, but the frequency with which headaches occur varies from person to person. You may have migraines several times a month or much less often. During a migraine, you may experience the following symptoms:

    • Pain on one side or both sides of your head
    • Pain that has a pulsating, throbbing quality
    • Sensitivity to light, sounds and sometimes smells
    • Nausea and vomiting
    • Blurred vision
    • Lightheadedness, sometimes followed by fainting

    Postdrome

    The final phase, known as postdrome, occurs after a migraine attack. During this time you may feel drained and washed out, though some people report feeling mildly euphoric.

    When to see a doctor

    Migraine headaches are often undiagnosed and untreated. If you regularly experience signs and symptoms of migraine attacks, keep a record of your attacks and how you treated them. Then make an appointment with your doctor to discuss your headaches.

    Even if you have a history of headaches, see your doctor if the pattern changes or your headaches suddenly feel different.

    See your doctor immediately or go to the emergency room if you have any of the following signs and symptoms, which may indicate other, more serious medical problems:

    • An abrupt, severe headache like a thunderclap
    • Headache with fever, stiff neck, mental confusion, seizures, double vision, weakness, numbness or trouble speaking
    • Headache after a head injury, especially if the headache gets worse
    • A chronic headache that is worse after coughing, exertion, straining or a sudden movement
    • New headache pain if you're older than 50

    If you see these symptoms or are dealing with this pain, call Neuropax Clinic in St. Louis at 314-434-7784 to schedule an appointment, and visit www.neuropaxclinic.com for more information.

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    Symptoms of Cubital Tunnel Surgery in St. Louis

    How is carpal tunnel syndrome treated?

    Cubital tunnel syndrome -- also known as ulnar neuropathy -- is caused by increased pressure on the ulnar nerve, which passes close to the skin's surface in the area of the elbow commonly known as the "funny bone." You're more likely to develop cubital tunnel syndrome if you:


    Repeatedly lean on your elbow, especially on a hard surface
    Bend your elbow for sustained periods, such as while talking on a cell phone or sleeping with your hand crooked under your pillow
    Sometimes, cubital tunnel syndrome results from abnormal bone growth in the elbow or from intense physical activity that increases pressure on the ulnar nerve. Baseball pitchers, for example, have an increased risk of cubital tunnel syndrome, because the twisting motion required to throw a slider can damage delicate ligaments in the elbow.

    Early symptoms of cubital tunnel syndrome include:

    Pain and numbness in the elbow
    Tingling, especially in the ring and little fingers
    More severe symptoms of cubital tunnel syndrome include:

    Weakness affecting the ring and little fingers
    Decreased ability to pinch the thumb and little finger
    Decreased overall hand grip
    Muscle wasting in the hand
    Claw-like deformity of the hand
    If you have any of these symptoms, your doctor may be able to diagnose cubital tunnel syndrome by physical examination alone. He or she also may order a verve conduction study and a test called electromyography. Electromyography is a procedure in which electrodes placed into muscles and on the skin measure the health of muscles and the nerve cells that control them, to confirm the diagnosis, identify the area of nerve damage, and determine the severity of the condition.

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    How is Carpal Tunnel Syndrome Treated in St. Louis?

    Figure 2 Carpal TunnelTreatments for carpal tunnel syndrome should begin as early as possible, under a doctor's direction. Underlying causes such as diabetes or arthritis should be treated first. Initial treatment generally involves resting the affected hand and wrist for at least 2 weeks, avoiding activities that may worsen symptoms, and immobilizing the wrist in a splint to avoid further damage from twisting or bending. If there is inflammation, applying cool packs can help reduce swelling.

    Non-surgical treatments

    Drugs - In special circumstances, various drugs can ease the pain and swelling associated with carpal tunnel syndrome. Nonsteroidal anti-inflammatory drugs, such as aspirin, ibuprofen, and other nonprescription pain relievers, may ease symptoms that have been present for a short time or have been caused by strenuous activity. Orally administered diuretics ("water pills") can decrease swelling. Corticosteroids (such as prednisone) or the drug lidocaine can be injected directly into the wrist or taken by mouth (in the case of prednisone) to relieve pressure on the median nerve and provide immediate, temporary relief to persons with mild or intermittent symptoms. (Caution: persons with diabetes and those who may be predisposed to diabetes should note that prolonged use of corticosteroids can make it difficult to regulate insulin levels. Corticosteroids should not be taken without a doctor's prescription.) Additionally, some studies show that vitamin B6 (pyridoxine) supplements may ease the symptoms of carpal tunnel syndrome.

    Exercise - Stretching and strengthening exercises can be helpful in people whose symptoms have abated. These exercises may be supervised by a physical therapist, who is trained to use exercises to treat physical impairments, or an occupational therapist, who is trained in evaluating people with physical impairments and helping them build skills to improve their health and well-being.

    Alternative therapies - Acupuncture and chiropractic care have benefited some patients but their effectiveness remains unproved. An exception is yoga, which has been shown to reduce pain and improve grip strength among patients with carpal tunnel syndrome.

    Surgery

    Carpal tunnel release is one of the most common surgical procedures in the United States. Generally recommended if symptoms last for 6 months, surgery involves severing the band of tissue around the wrist to reduce pressure on the median nerve. Surgery is done under local anesthesia and does not require an overnight hospital stay. Many patients require surgery on both hands. The following are types of carpal tunnel release surgery:

    Open release surgery, the traditional procedure used to correct carpal tunnel syndrome, consists of making an incision up to 2 inches in the wrist and then cutting the carpal ligament to enlarge the carpal tunnel. The procedure is generally done under local anesthesia on an outpatient basis, unless there are unusual medical considerations.

    Endoscopic surgery may allow faster functional recovery and less postoperative discomfort than traditional open release surgery. The surgeon makes two incisions (about ½ inch each) in the wrist and palm, inserts a camera attached to a tube, observes the tissue on a screen, and cuts the carpal ligament (the tissue that holds joints together). This two-portal endoscopic surgery, generally performed under local anesthesia, is effective and minimizes scarring and scar tenderness, if any. Single portal endoscopic surgery for carpal tunnel syndrome is also available and can result in less post-operative pain and a minimal scar. It generally allows individuals to resume some normal activities in a short period of time.

    Although symptoms may be relieved immediately after surgery, full recovery from carpal tunnel surgery can take months. Some patients may have infection, nerve damage, stiffness, and pain at the scar. Occasionally the wrist loses strength because the carpal ligament is cut. Patients should undergo physical therapy after surgery to restore wrist strength. Some patients may need to adjust job duties or even change jobs after recovery from surgery.

    Recurrence of carpal tunnel syndrome following treatment is rare. The majority of patients recover completely.

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