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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.

    Dealing With a St Louis Sports Injury?

    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.)

     

    If these symptoms seem familiar, contact Neuropax Clinic today at www.neuropaxclinic.com or call 314-434-7784 for an appointment.  

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    Occipital Neuralgia Headaches - What Causes Them?

    We are seeing an epidemic of patients with the same complaint - headaches that have popped up out of nowhere.  The first question I ask is "how much time do you spend staring down at your phone per day?"  That's because "cell phone neck" is becoming the newest ailment that is affecting people.  Its real name is Occipital Neuralgia.  Occipital neuralgia, also known as C2 neuralgia, is a medical condition characterized by chronic pain in the upper neck, back of the head and behind the eyes. These areas correspond to the locations of the lesser and greater occipital nerves.

    Basically, the occipital nerves are being impinged, because people are holding their heads down at an angle that isn't natural.  Every inch that you crane your head downwards to look at your phone or tablet puts an additional 60 pounds of pressure on your vertebrae.  This additional stress can cause swelling in the tissues and pinch the nerves, causing your headaches.

    If you find that you're suffering from these headaches, and are just now realizing that this is how you read your phone, or if you're reading this article ON your phone and are just now realizing why you have a headache, giive us a call at 314-434-7784 to make an appointment to come in to see Dr. Robert Hagan about your headaches.  There are several methods to cure this condition before surgery, and you can explore them all before that option.  Learn more about occipital neuralgia here and visit www.neuropaxclinic.com to learn more about the practice.

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    Reduce Your St Louis Migraines With Nerve Surgery

    headache - mediumThere 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.

    Contact Neuropax Clinic today to set up a consultaion about your headaches.  Call 314-434-7784 or visit www.neuropaxclinic.com today!

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    Thoracic Outlet Surgery In St Louis and Its Treatment

    thoracic-outlet-syndromeWe get a lot of questions about Thoracic Outlet Syndrome, and how we can help with it. The first step would be to let you know what the syndrome actually is. Thoracic outlet syndrome (TOS) is a condition caused by compression of nerves or blood vessels in the thoracic outlet, the area between the base of the neck and the armpit, including the front of the shoulders and chest.

    There are three types of TOS:

    • Vascular. This can be a compression of the artery and vein.
    • Neurogenic. The nerves become compromised from an extra cervical rib, present at birth.
    • Disputed or painful form. There is no neurological deficit but patients experience neurological symptoms and pain. Typically these patients’ electrodiagnostic studies (EMG / NCV) are normal, but they complain of pain.

    But how do you know if this is the cause of your pain? There are several symptoms of the problem.

    • Neck, shoulder, and arm pain
    • Numbness in the arm, hand or fingers
    • Impaired circulation to the extremities (causing discoloration)
    • Weakness in the shoulders, arm and hands

    If you experience any of these, you may have Thoracic Outlet Syndrome. When you see these signs, call Neuropax Clinic and we will have you come in. We will then diagnose the issue, using:

    • A comprehensive clinical exam, including neurological exams
    • Complete medical history
    • Imaging studies such as X-rays and/or MRI (magnetic resonance imaging)
    • Electrodiagnostic studies (EMG)

    If we determine that Thoracic Outlet Syndrome is the culprit, we will then move on to treatment. There are a variety of ways to treat the issue BEFORE surgery, including:

    • Physical therapy with careful nerve stretching movements performed by a qualified and experienced physical therapist with experience treating TOS.
    • Injections with nerve blocking agents to suppress pain and reduce swelling and compression.
    • Acupuncture. Some patients with TOS have found relief using acupuncture.

    If surgery is required, Neuropax Clinic is prepared to perform surgery on the affected area and alleviate your Thoracic Outlet Syndrome pain. Call us today at 314-434-7784, email This email address is being protected from spambots. You need JavaScript enabled to view it. or fill out our new patient form at www.neuropaxclinic.com today. We are ready to help alleviate your Thoracic Outlet pain.

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    Thoracic Outlet Syndrome In St. Louis Symptoms

    Thoracic outlet syndrome (TOS) is a group of problems that occur when there is irritation, compression, or injury of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Thoracic outlet syndrome is named for the area (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.

    But how do you know if this is what you're suffering from? Here are the symptoms of Thoracic Outlet Syndrome.

    • neck, shoulder, and arm pain
    • numbness
    • impaired circulation to the affected areas

    The pain of TOS is often confused with angina, where chest pain is caused by a lack of oxygen to the heart muscle. The difference is that the pain of TOS doesn't increase when walking, while this agitates and increases pain from angina. TOS increases in pain when the arm in question is raised, while angina doesn't.

    What symptoms you have can also help determine where your TOS is located. Different locations have different pains associated with them. While TOS generally only affects the nerves, it can also attack the veins and arteries. In every type of TOS, though, the thoracic outlet is narrowed, with scar tissue forming around the area.

    If you experience any of these symptoms, please call Neuropax Clinic today in St. Louis to setup an appointment to talk to us. Call us at 314-434-7784 to take the first step to healing your Thoracic Outlet Syndrome.

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    St Louis Thoracic Outlet Syndrome Facts

    Thoracic Outlet Syndrome  (TOS)

    What is thoracic outlet syndrome?

    The thoracic outlet is a small space just behind and below your collarbone. The blood vessels and nerves that serve your arm and shoulder are located in this space. Thoracic outlet syndrome (TOS) is the presence of a mixture of hand, arm, shoulder and neck symptoms.  All of these symptoms are due to pressure (or compression) against the nerves (called the brachial plexus) or blood vessels within the scalene triangle at the thoracic outlet.

    There are 3 types of TOS. (nerve, vein, or artery)

    Ninety-five percent (95%) of all cases of TOS are Neurogenic, which is compression of the nerves to the arm and shoulder. Venous TOS occurs only 3 to 4 percent of the time and is due to obstruction or clotting of the main vein to the arm, the subclavian vein. Arterial TOS, is the rarest type, occurring in only 1 percent of cases, and it is due to disease in the artery leading to the arm, the subclavian artery. Almost all cases of arterial TOS are associated with an extra rib (cervical rib) or an abnormal first rib.

    What are the symptoms?

    The common symptoms depend on which structure is being compressed.

    • Neurogenic TOS (nTOS), the symptoms are pain, numbness, tingling, and/or weakness in the arm and hand. Also common is a tired feeling in your arm, which is made worse by working with your arms raised over your head. Neck pain and headaches in the back of your head are also frequent symptoms. Another common occurrence is pain that starts in your shoulder and runs down your arm, as well as pain in your fingertips. One can even experience facial pain, jaw pain, ear pain and pain on the front of your chest. Unfortunately, the symptoms of neurogenic TOS can be vague and non-specific.
    • Venous TOS (vTOS) is distinguished by swelling in your entire arm, plus pain and dark discoloration.
    • Arterial TOS (aTOS) presents with pain, coldness, and a pale discoloration of the hand. Cramps occur when using the arm for activity.



    What causes thoracic outlet syndrome?

    Neurogenic TOS is most often the result of neck trauma such as a whiplash injury. Motor vehicle accidents, traction injuries to shoulder, slipping and falling on floors or ice, blunt injury to base of neck or top of shoulder, or repetitive stress from working on assembly lines are the common causes. 

    The symptoms are due to trauma and scar tissue formation in; neck muscles (called scalene muscles) and the nerves (brachial plexus). Congenital deformities of the first rib or having an anomalous cervical rib or band significantly increases the risk of acquiring this condition. Ultimately, the cause is compression and tethering of the brachial plexus nerves at the thoracic outlet.

    Venous TOS is commonly due to strenuous use of the arm and shoulder. Its underlying cause is congenital narrowing of the space through which the major arm vein (subclavian vein) passes from the shoulder area into the heart.

    Arterial TOS is caused by a narrowing in the main artery to the arm (subclavian artery), usually secondary to a congenital extra rib (cervical rib) or to an abnormal first rib. Once the artery has been narrowed, one of two things will occur. The artery may enlarge, forming an aneurysm just beyond the narrowing, and a clot will form in the wall of the aneurysm; or the artery may remain narrowed and a clot will form inside the artery just beyond the narrowing. The danger of the clot is that pieces of it will break off (called emboli) and travel down the arm to block the circulation to your hand. When this occurs, the hand becomes cold, numb, painful, and discolored and you are in danger of losing your hand. Treatment to restore circulation is essential.

    How is thoracic outlet diagnosed?

    Diagnosing TOS can be complex. It begins by your physician asking you a series of questions to find out your symptoms, the distribution of these symptoms and and how the symptoms began. Depending on your symptoms, the doctor will be able to tell if you might have a nerve, vein, or artery compression. An appropriate physical examination will be beneficial in determining your diagnosis as well.  It is not uncommon that patients have seen several physicians and have been evaluated for cervical neck problems and shoulder problems prior to the referral for evaluation of thoracic outlet syndrome. 

    For neurogenic TOS, your physician will have you perform a number of provocative maneuvers. These consist of putting your neck and arms in different positions of stress to try to reproduce your symptoms. Other physical findings include tenderness in certain places in your neck, chest, or arms. New technologies such as 3-Tesla MR neurography are helpful in establishing level of injuries and anomalous anatomy and may be requested in addition to traditional xrays.
    For venous TOS, physical examination consists primarily of noting swelling in your arm and prominent veins seen just under the skin at the spot where your shoulder joins your chest.

    In arterial TOS, physical exam often finds the pulse at your wrist is diminished or absent. Your hand may have a pale color compared to your pink, good hand.
    Venous and arterial TOS are best diagnosed with the aid of specific tests, venography for venous TOS and pulse volume or arteriography for arterial TOS.


    How is thoracic outlet syndrome treated?

    Your particular treatment will depend on the type of TOS you have. Determined by your symptoms, physical examination and test results.
    Neurogenic (nTOS) is initially treated with physical therapy. The basic therapy methods include stretching exercises of your neck, posture correction, learning to avoid specific movements that bring on or aggravate your symptoms, and modifying your work site when appropriate. While some therapists may suggest strengthening exercises, most patients with neurogenic TOS are made worse by strengthening exercises. Treatment with a therapist for a few weeks is usually followed by a home exercise program, which you continue on your own for at least several more weeks.

    The doctor may also prescribe medications such as muscle relaxants, non-steroidal anti-inflammatory drugs such as aspirin or ibuprofen, pain relievers, or steroids. In addition, some patients get relief by applying moist heat or massaging and stretching the affected area.

    When early conservative therapies are failing and there are significant painful symptoms, a diagnostic and/or therapeutic injection may be utilized.  This involves an ultrasound guided injection that has numbing agents and steroid.  Our technique can give significant temporary relief or can sometimes actually resolve the condition. Further, we have developed novel techniques that utilize our biologic therapeutics.  Candidates are determined by responses to initial diagnostic injections and the symptoms they are experiencing. 

    When treatment begins in the early stages of neurogenic TOS, a majority of patients improve with the measures listed above. However, if your nTOS symptoms do not improve with these measures, and if your symptoms are interfering with sleep, work, recreation, or activities of daily living, more aggressive treatment may be recommended.  The surgeon may recommend surgical decompression.

    Surgery for nTOS involves removing certain muscles in your neck and cleaning scar tissue off the nerves of the brachial plexus.  The anterior and middle scalene muscles are the muscles making the scalene triangle in the neck at the thoracic outlet. These muscles are a source of the pathology and injury to them will cause compression to the brachial plexus nerves.  There are many redundant muscles in the neck, allowing for us to release or resect one or both of these muscles.  Additionally, the nerves at this level need to be released from scar tissue or fibrosis that have formed around them.  This encasing tissue is much like shrink-wrap and causes both compression and tethering of the nerve.  Releasing this tissue relieves compression and re-establishes the much needed gliding surfaces of these nerves.

    Resection of the first rib is unnecessary in nTOS except in the rare case (<1%) of a cervical rib or first rib anomaly.  Modern studies show there is no difference in outcomes, which advocates for not resecting a normal first rib.   Resection of the first rib is associated with a higher rate of complications and higher rates of post-operative chronic pain.  Further, without the rib resection the invasiveness of the surgery is less and the recovery is easier.   

    Surgery for thoracic outlet syndrome, however, is never without risks. There are vital structures in this part of the body that can be injured during TOS decompression surgery.  Rates of complications are very low but they are not zero.  These rare problems include; persistence of pain, hematoma, phrenic nerve injury, surgical infection, nerve injury resulting hand or arm dysfunction, surgical site infection, arterial injury or pneumothorax 

    In addition, surgery does not always relieve the symptoms of neurogenic TOS. Our success rate is currently 80 to 90%.  Larger studies evaluating outcomes from surgery for neurogenic TOS demonstrate that only up to 70 percent of patients have improvement in their symptoms, while 30 percent may feel no better or worse.  We feel that our success rate is higher based upon rigorous patient selection and because we rarely recommend the first rib resection. 

    Venous TOS is not treated with physical therapy. Rather, the clot in the vein is initially treated with clot dissolving medication (called thrombolysis), with blood thinners (anticoagulants), or sometimes treated by surgically opening the vein and removing the clot. Once the clot has been removed, your surgeon may recommend that the first rib be removed so that the narrow space through which the vein passed can be enlarged to prevent the vein from clotting again. If the vein is badly narrowed, the narrow spot can be widened by having a balloon stretch out the vein, a procedure called an angioplasty. In some instances, the vein will be repaired operatively, at the time of the rib removal, with a patch (made from another vein) or with replacement of the diseased segment of vein.

    Arterial TOS is treated in a very different way. If the subclavian artery in your thoracic outlet has become damaged by pressure, your vascular surgeon must repair the artery or replace it with an arterial graft. The replacement graft may be a vein from another part of your body or a plastic artery substitute. In addition to fixing the damaged artery, the abnormal rib must be removed to prevent the artery from being damaged again. Your vascular surgeon can perform all of this in one operation.

    What can I do to stay healthy?

    You can improve your recovery from TOS by practicing good posture, regularly stretching your chest muscles and the muscles in the front of your next, strengthening the muscles of your upper back and posterior shoulder, and losing weight if you are overweight. Also, if you are prone to TOS, it is wise to avoid repetitive lifting of heavy objects over your head.

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    How To Fix Proximal Median Nerve Damage In St. Louis

    Repetitive tasks involving: throwing, gripping, pronation (turning your hand to a palm down position), and sudden extension at the elbow can produce injury resulting in compression of the median nerve at the elbow and forearm level. Weight lifting may result in building muscle mass and can lead to nerve compression. Trauma to the upper forearm may also result in scarring and can induce compressive neuropathies at and around the elbow. Your own inherent anatomy may be a variant that makes you vulnerable to this condition.  Further, it is common to be predisposed to this nerve compression if you are diabetic.  Diagnosing this condition is very dependent upon the clinical evaluation and is often missed by electro-diagnostic studies ( nerve conduction, EMG). 
    The median nerve arises from the  cervical nerve roots C6 to T1 in the neck. After leaving the brachial plexus and crossing the shoulder it passes down the medial aspect of the arm, crosses the elbow and enters the forearm. 
    Median nerve compression in the elbow area can result in two conditions: pronator syndrome and anterior interosseus nerve syndrome.  It is not uncommon for both conditions to be present at the same time.


    Pronator Syndrome


    Pronator syndrome produces symptoms of aching of the proximal forearm, elbow and distal arm (just above elbow).  This aching may be aggravated by forceful use of the extremity, especially involving pronation. Sensory loss in the fingers and palmar components of the median nerve distribution and weakness or clumsiness in the hand are often noted, especially in the thumb and index finger.  
    Symptoms can be confusing with those seen in carpal tunnel syndrome. It is actually more common for proximal median nerve compression and carpal tunnel syndrome to both be present.  This is considered a double crush phenomenom which is when the same nerve is pinched at more than one level along its course.  
    In pronator syndrome, night pain is less common (but does occur) while carpal tunnel syndrome often wakes patients with complaints of aching and numbness in the hands.
    The physical examination may reveal tenderness and a Tinel sign over the pronator teres muscle. Weakness, if present, may involve the index finger, thumb flexion and pinch strength.  Atrophy in the thenar muscles (base of thumb in palm) may be noted in advanced cases. 
    Loss or decreased sensibility of the thumb and index/long fingers are consistent with both proximal median nerve compression and carpal tunnel syndrome.  Loss of sensation and/or pain in the palmar area on the thumb sites is suggestive of pronator syndrome. Provocative (exertional) tests on exam can be helpful in eliciting signs of pronator syndrome. 
    Plain x-rays are helpful to rule out a bony supracondylar process in the distal humerus or other post traumatic or degenerative pathology at the elbow as the cause for compression. Electrodiagnostic studies (EMG/NCS) are rarely conclusive but may be orderd to exclude or identify coexisting pathology.

    Anterior Interosseus Nerve Syndrome (AIN Syndrome)


    The anterior interosseus nerve (AIN) syndrome as an isolated compression syndrome is more rare.  AIN is a branch of the median nerve that branches from the median nerve after it passes through the pronator muscle.  The AIN has no cutaneous (skin) sensory component therefore numbness is not associated with this syndrome, it is purely a motor problem.
    Anterior interosseus nerve syndrome includes complaints of absent or decreased flexion (bending) of the thumb and index finger. For instance, it is difficult to make an OK sign.  A weakened index finger-thumb pinch is generally noted as well. 
    EMG/NCS may be diagnostic in AIN syndrome. MRI is useful to identify any mass or lesion that may be causing this 


    Treatment


    The initial treatment for proximal median nerve compressions is conservative. However, if severity and duration of symptoms are significant at the time of initial presentation to the physician, you may require surgery at that point.    
    Anterior interosseus nerve syndrome again is more rare, but usually resolves with time, particularly if it is secondary to minor trauma or irritation to the nerve. However proximal median compression in the diabetic limb usually, ultimately requires surgery and is generally found coexisting with other compressions in the same extremity. 
    If no improvement with time and therapy are noted or if a space occupying lesion/mass is identified on the MRI, surgical release is then recommended. 
    Postoperatively the arm, forearm and elbow are wrapped in a bulky dressing for one week.  After this point, flexion and extension exercises are started and slowly progressed. Return to full function and full duty work are fairly consistent but vary based on several factors but particularly the amount of deconditioning at the time of surgery.
    The prognosis for full recovery is generally very good, however one must consider the amount of deconditioning that was present at the time of surgery.  Full recovery may take as long as 6 months even after surgical decompression.  If there is severe nerve damage, recovery may take longer and may be incomplete. Risks of the surgery are very rare but include: the persistent symptoms or pain, motor weakness, nerve injury, loss of function, and other generalized surgical risks such as hematoma, 

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    Talking About Carpal Tunnel In St. Louis

    Carpal tunnel syndrome (CTS) is the most expensive of all work-related injuries. Over his or her lifetime, a carpal tunnel patient loses about $30,000 in medical bills and time absent from work.

    CTS typically occurs in adults, with women 3 times more likely to develop it than men. The dominant hand is usually affected first, and the pain is typically severe. CTS is especially common in assembly-line workers in manufacturing, sewing, finishing, cleaning, meatpacking, and similar industries. Contrary to the conventional wisdom, according to recent research, people who perform data entry at a computer (up to 7 hours a day) are not at increased risk of developing CTS.

    What Is CTS?

    CTS is a problem of the median nerve, which runs from the forearm into the hand. CTS occurs when the median nerve gets compressed in the carpal tunnel—a narrow tunnel at the wrist—made up of bones and soft tissues, such as nerves, tendons, ligaments, and blood vessels. The compression may result in pain, weakness, and/or numbness in the hand and wrist, which radiates up into the forearm. CTS is the most common of the “entrapment neuropathies”—compression or trauma of the body’s nerves in the hands or feet.

    What Are the Symptoms?

    Burning, tingling, itching, and/or numbness in the palm of the hand and thumb, index, and middle fingers are most common. Some people with CTS say that their fingers feel useless and swollen, even though little or no swelling is apparent. Since many people sleep with flexed wrists, the symptoms often first appear while sleeping. As symptoms worsen, they may feel tingling during the day. In addition, weakened grip strength may make it difficult to form a fist or grasp small objects. Some people develop wasting of the muscles at the base of the thumb. Some are unable to distinguish hot from cold by touch.

    Why Does CTS Develop?

    Some people have smaller carpal tunnels than others, which makes the median nerve compression more likely. In others, CTS can develop because of an injury to the wrist that causes swelling, over-activity of the pituitary gland, hypothyroidism, diabetes, inflammatory arthritis, mechanical problems in the wrist joint, poor work ergonomics, repeated use of vibrating hand tools, and fluid retention during pregnancy or menopause.

    How Is It Diagnosed?

    CTS should be diagnosed and treated early. A standard physical examination of the hands, arms, shoulders, and neck can help determine if your symptoms are related to daily activities or to an underlying disorder.

    Your doctor of chiropractic can use other specific tests to try to produce the symptoms of carpal tunnel syndrome.  The most common are:

    • Pressure-provocative test. A cuff placed at the front of the carpal tunnel is inflated, followed by direct pressure on the median nerve.
    • Carpal compression test. Moderate pressure is applied with both thumbs directly on the carpal tunnel and underlying median nerve at the transverse carpal ligament. The test is relatively new.

     Laboratory tests and x-rays can reveal diabetes, arthritis, fractures, and other common causes of wrist and hand pain. Sometimes electrodiagnostic tests, such as nerveconduction velocity testing, are used to help confirm the diagnosis. With these tests, small electrodes, placed on your skin, measure the speed at which electrical impulses travel across your wrist. CTS will slow the speed of the impulses and will point your doctor of chiropractic to this diagnosis.

    What Is the CTS Treatment?

    Initial therapy includes:

    • Resting the affected hand and wrist
    • Avoiding activities that may worsen symptoms
    • Immobilizing the wrist in a splint to avoid further damage from twisting or bending
    • Applying cool packs to help reduce swelling from inflammations

    Some medications can help with pain control and inflammation. Studies have shown that vitamin B6 supplements may relieve CTS symptoms.

    Chiropractic joint manipulation and mobilization of the wrist and hand, stretching and strengthening exercises, soft-tissue mobilization techniques, and even yoga can be helpful. Scientists are also investigating other therapies, such as acupuncture, that may help prevent and treat this disorder.

    Occasionally, patients whose symptoms fail to respond to conservative care may require surgery. The surgeon releases the ligament covering the carpal tunnel. The majority of patients recover completely after treatment, and the recurrence rate is low. Proper posture and movement as instructed by your doctor of chiropractic can help prevent CTS recurrences.

    How Can CTS Be Prevented?

    The American Chiropractic Association recommends the following tips:

    • Perform on-the-job conditioning, such as stretching and light exercises.
    • Take frequent rest breaks.
    • Wear splints to help keep the wrists straight.
    • Use fingerless gloves to help keep the hands warm and flexible.
    • Use correct posture and wrist position.
    • To minimize workplace injuries, jobs can be rotated among workers. Employers can also develop programs in ergonomics—the process of adapting workplace conditions and job demands to workers’ physical capabilities.
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    St Louis Diabetic Neuropathy Treatment

    Diabetic Neuropathy Treatment

    Peripheral Diabetic Neuropathy (PDN) is a major, long-term complication of Type 1 and Type 2 Diabetes. Diabetic neuropathy often presents as tingling, loss of sensation, pain and numbness in the legs, feet, arms and hands. This loss of sensation can preclude sensation of injury, leading to development of wounds or ulcerations. When not adequately treated, the risks of infection and ultimately amputation are high.

    Diabetic neuropathy has been considered an irreversible disorder with traditional treatments focused on preventing the progression of the condition; or reducing the pain symptoms with drugs or specialized footwear.  However, treatment with nerve decompression surgery to address the symptoms of diabetic peripheral neuropathy now have an established clinical track record.  Many clinical studies have been published reporting the value of nerve decompression surgery in the treatment of peripheral diabetic neuropathy.

    Goals of the surgery are to restore sensation to the hands or feet, reduce or eliminate pain and to regain strength. If sensation is restored to the feet, the risk of having an ulceration or infection leading to an amputation is nearly eliminated.  Many patients are able to discontinue their medications relating to neuropathy after this procedure. 

    If you suffer from diabetic neuropathy, physicians from Neuropax Clinic can determine whether surgery might be appropriate for you. A comprehensive evaluation will be performed to determine whether you have compressed nerves that may respond to surgery. We have already helped many patients regain sensation and get relief from pain with this surgical approach.

    For more information on treatments for all nerve problems, visit www.neuropaxclinic.com and call 314-434-7784 to setup an appointment.

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    Proximal Median Nerve Compression In St Louis

    Many patients have come to me asking about problems with the Proximal Nerve, and how it can be affected and fixed.  Here are my thoughts on the nerve and what we can do for you!

    PROXIMAL MEDIAN NERVE COMPRESSION


    Repetitive tasks involving: throwing, gripping, pronation (turning your hand to a palm down position), and sudden extension at the elbow can produce injury resulting in compression of the median nerve at the elbow and forearm level. Weight lifting may result in building muscle mass and can lead to nerve compression. Trauma to the upper forearm may also result in scarring and can induce compressive neuropathies at and around the elbow. Your own inherent anatomy may be a variant that makes you vulnerable to this condition.  Further, it is common to be predisposed to this nerve compression if you are diabetic.  Diagnosing this condition is very dependent upon the clinical evaluation and is often missed by electro-diagnostic studies ( nerve conduction, EMG). 
    The median nerve arises from the  cervical nerve roots C6 to T1 in the neck. After leaving the brachial plexus and crossing the shoulder it passes down the medial aspect of the arm, crosses the elbow and enters the forearm. 
    Median nerve compression in the elbow area can result in two conditions: pronator syndrome and anterior interosseus nerve syndrome.  It is not uncommon for both conditions to be present at the same time.


    Pronator Syndrome


    Pronator syndrome produces symptoms of aching of the proximal forearm, elbow and distal arm (just above elbow).  This aching may be aggravated by forceful use of the extremity, especially involving pronation. Sensory loss in the fingers and palmar components of the median nerve distribution and weakness or clumsiness in the hand are often noted, especially in the thumb and index finger.  
    Symptoms can be confusing with those seen in carpal tunnel syndrome. It is actually more common for proximal median nerve compression and carpal tunnel syndrome to both be present.  This is considered a double crush phenomenom which is when the same nerve is pinched at more than one level along its course.  
    In pronator syndrome, night pain is less common (but does occur) while carpal tunnel syndrome often wakes patients with complaints of aching and numbness in the hands.
    The physical examination may reveal tenderness and a Tinel sign over the pronator teres muscle. Weakness, if present, may involve the index finger, thumb flexion and pinch strength.  Atrophy in the thenar muscles (base of thumb in palm) may be noted in advanced cases. 
    Loss or decreased sensibility of the thumb and index/long fingers are consistent with both proximal median nerve compression and carpal tunnel syndrome.  Loss of sensation and/or pain in the palmar area on the thumb sites is suggestive of pronator syndrome. Provocative (exertional) tests on exam can be helpful in eliciting signs of pronator syndrome. 
    Plain x-rays are helpful to rule out a bony supracondylar process in the distal humerus or other post traumatic or degenerative pathology at the elbow as the cause for compression. Electrodiagnostic studies (EMG/NCS) are rarely conclusive but may be orderd to exclude or identify coexisting pathology.

    Anterior Interosseus Nerve Syndrome (AIN Syndrome)


    The anterior interosseus nerve (AIN) syndrome as an isolated compression syndrome is more rare.  AIN is a branch of the median nerve that branches from the median nerve after it passes through the pronator muscle.  The AIN has no cutaneous (skin) sensory component therefore numbness is not associated with this syndrome, it is purely a motor problem.
    Anterior interosseus nerve syndrome includes complaints of absent or decreased flexion (bending) of the thumb and index finger. For instance, it is difficult to make an OK sign.  A weakened index finger-thumb pinch is generally noted as well. 
    EMG/NCS may be diagnostic in AIN syndrome. MRI is useful to identify any mass or lesion that may be causing this 


    Treatment


    The initial treatment for proximal median nerve compressions is conservative. However, if severity and duration of symptoms are significant at the time of initial presentation to the physician, you may require surgery at that point.    
    Anterior interosseus nerve syndrome again is more rare, but usually resolves with time, particularly if it is secondary to minor trauma or irritation to the nerve. However proximal median compression in the diabetic limb usually, ultimately requires surgery and is generally found coexisting with other compressions in the same extremity. 
    If no improvement with time and therapy are noted or if a space occupying lesion/mass is identified on the MRI, surgical release is then recommended. 
    Postoperatively the arm, forearm and elbow are wrapped in a bulky dressing for one week.  After this point, flexion and extension exercises are started and slowly progressed. Return to full function and full duty work are fairly consistent but vary based on several factors but particularly the amount of deconditioning at the time of surgery.
    The prognosis for full recovery is generally very good, however one must consider the amount of deconditioning that was present at the time of surgery.  Full recovery may take as long as 6 months even after surgical decompression.  If there is severe nerve damage, recovery may take longer and may be incomplete. Risks of the surgery are very rare but include: the persistent symptoms or pain, motor weakness, nerve injury, loss of function, and other generalized surgical risks such as hematoma, seroma or neuroma.

    For more information on how to treat Poximal Median Nerve Compression, visit www.neuropaxclinic.com and call us at 314-434-7784 to set up an appointment!

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    When Surgery Is Needed For Carpal Tunnel In St Louis

    Carpal Tunnel Syndrome is an issue in the wrist where the median nerve is "pinched" at the wrist. It causes numbness, tingling, and pain in the arm, hand, and fingers. The wrist has an area called the carpal tunnel that houses the median nerve and 9 tendons, and allows them to pass into the hand. When the swelling gets too great, it causes pressure on this median nerve and causes the symptoms associated with carpal tunnel syndrome.

    There are a variety of treatments available to help with carpal tunnel, and surgery is the last option. There are medications and steroid injections to reduce inflammation, braces to align the wrist properly, and changes to lifestyle and work habits that can eliminate the problem entirely. However, that's not what we're talking about today. We're going to explain how the surgery works to correct it.

    During surgery, the ligament that forms the roof of the tunnel on the palm of the hand is cut back, which relieves the pressure on the nerve. The exact placement of the incision can vary by where the impingement lies, but the goal always is to relieve pressure on the nerve itself.

    The surgery relieves the numbness and tingling, but the time for recovery varies. Severe cases may not see the entire issue disappear, but nearly all surgeries result in relief.

    If you have any of these symptoms, please call Neuropax Clinic in St. Louis at 314-434-7784 to make an appointment and read more about us at www.neuropaxclinic.com to learn how we can help you.

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    St Louis Has A Diabetic Neuropathy Problem

    photo operationsWith Type 1 and Type 2 Diabetes rates climbing, the sufferers of diabetic neuropathy increase as well. These patients suffer from debilitating pain that radiates from the hands, feet, legs and arms. It has been referred to for years as an irreversible disease, and treated as such by physicians. They look to prevent the disease's progression, and minimize pain with medication, or specialized footwear.

    However, new breakthroughs in the field of nerve decompression have opened up pathways to new treatments for the pain of diabetic neuropathy. Nerve decompression works to ease the pain that inflamed tissue puts on the nerves in the extremities and has shown to be VERY effective in the fight against diabetic neuropathy. Clinical trials and studies back nerve decompression as a breakthrough treatment.

    The goals are simple for this surgery: restore sensation and eliminate the pain. When the sensation is restored, it severely reduces the risk for ulceration and infection that leads to amputation. Many patients find that their need for the medications is lessened after the surgery is complete.

    If you suffer from diabetic neuropathy, physicians from Neuropax Clinic can determine whether surgery might be appropriate for you. A comprehensive evaluation will be performed to determine whether you have compressed nerves that may respond to surgery. We have already helped many patients regain sensation and get relief from pain with this surgical approach.

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    Peripheral Nerve Decompression In St Louis

    While many people know about the benefits of peripheral nerve decompression surgery for Carpal Tunnel, Cubital Tunnel, Tarsal Tunnel, Radial Tunnel, Foot Drop/Common Peroneal Nerve, Meralgia Paresthetica/Lateral Femoral Nerve, Winged Scapula/ Long Thoracic Nerve, and Proximal Median Nerve Compression, some don't know the causes of the conditions that warrant them. Learning this can help pinpoint where decompression can help.

    Axon -mediumNerve Compression can come from a variety of places. There are many ailments, including diabetes, trauma to the area, abnormal anatomy (the nerves/joints are in an unusual configuration). Knowing that these ailments can cause compression in nerves can help your physician determine what is causing your issues, and lead to steps to remedy them.

    For example, we know that diabetes causes significant changes to the nerve architecture including swelling and stiffness. A good analogy might be a situation much like placing a balloon in a napkin ring and blowing up the balloon. The napkin ring does not expand but crimps or "compresses" the balloon (the nerve). In cases of trauma, the tissue in the area of the nerve as it passes through the tunnel can be damaged. The result is swelling and inflammation that eventually goes away but leaves behind tightened fibrotic tissue that essentially contracts the tunnel and its surrounding tissue.

    There are common, vulnerable anatomic points that are evaluated to see if there are focal nerve compressions at these sites. The most common type or most well known nerve compression syndrome is carpal tunnel syndrome. Amazingly, there are approximately 44 sites (22 on each side) of nerve compression throughout the body.

    When performing nerve decompression, the surgeon is releasing the surrounding tissue from the nerve without damaging the nerve. Scar tissue and/or perinueral fibrosis are removed and the nerve is completely mobilized resulting in relief of pressure on the nerve, thus relieving pain. Also, reestablishment of blood flow occurs to that segment of the nerve and a smooth gliding surface for the nerve is provided.

    To learn more about how your nerve compression can be treated, visit www.neuropaxclinic.com and call 314-434-7784 for an appointment with Dr. Robert Hagan.

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    Diabetic Neuropathy Treatment in St Louis

    Diabetic Neuropathy St Louis

    Peripheral Diabetic Neuropathy (PDN) is a major, long-term complication of Type 1 and Type 2 Diabetes. Diabetic neuropathy often presents as tingling, loss of sensation, pain and numbness in the legs, feet, arms and hands. This loss of sensation can preclude sensation of injury, leading to development of wounds or ulcerations. When not adequately treated, the risks of infection and ultimately amputation are high.

    Diabetic neuropathy has been considered an irreversible disorder with traditional treatments focused on preventing the progression of the condition; or reducing the pain symptoms with drugs or specialized footwear. However, treatment with nerve decompression surgery to address the symptoms of diabetic peripheral neuropathy now have an established clinical track record. Many clinical studies have been published reporting the value of nerve decompression surgery in the treatment of peripheral diabetic neuropathy.

    Goals of the surgery are to restore sensation to the hands or feet, reduce or eliminate pain and to regain strength. If sensation is restored to the feet, the risk of having an ulceration or infection leading to an amputation is nearly eliminated. Many patients are able to discontinue their medications relating to neuropathy after this procedure.

    If you suffer from diabetic neuropathy, physicians from Neuropax Clinic can determine whether surgery might be appropriate for you. A comprehensive evaluation will be performed to determine whether you have compressed nerves that may respond to surgery. We have already helped many patients regain sensation and get relief from pain with this surgical approach. To schedule an appointment, visit www.neuropaxclinic.com and call 314-434-7784 for more information.

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    The Process Towards Carpal Tunnel Surgery in St Louis

    Carpal Tunnel St LouisWhen we have patients in for carpal tunnel surgery, we like to explain the various treatments that we go through before we start surgery.  Just because you are diagnosed with carpal tunnel, it doesn't mean that you necessarily need surgery immediately.  We have a full course of procedures that we like to employ to start the patient down the road to recovery.

    Step 1 - Recognizing and correction of mechanical issues.

    The wrist is a very versatile and dexterous part of the human anatomy, offering a full range of motion that enables it to perform the various tasks that are required of it.  However, this can lead to stress on the joint that, with repetitive motions and cramped positions from a job.  This can cause stress on the joint, leading to inflammation and pain.  The first course of action is a splint that will help keep the joint in the proper position.  This can be worn at work and during sleeping hours.  The brace makes sure that the wrist stays straight, and can start the healing process.

    Step 2 - Steroid Injection

    This is a step beyond the brace.  The steroid injection is designed to reduce swelling in the joint to hopefully reduce the pain and give range of motion back to the wrist.  The injection is given straight to the carpal tunnel.

    Step 3 - Surgery

    If these treatments fail, the next step is surgery.  Pressure on the nerve is decreased by cutting the ligament that forms the roof (top) of the tunnel on the palm side of the hand (see Figure 3). Incisions for this surgery may vary, but the goal is the same: to enlarge the tunnel and decrease pressure on the nerve. 

    Following surgery, soreness around the incision may last for several weeks or months. The numbness and tingling may disappear quickly or slowly. It may take several months for strength in the hand and wrist to return to normal. Carpal tunnel symptoms may not completely go away after surgery, especially in severe cases.

    For more information and to schedule an appointment for Carpal Tunnel consultation and surgery in St. Louis with Dr. Robert Hagan, call 314-434-7784, email us at This email address is being protected from spambots. You need JavaScript enabled to view it. and visit www.neuropaxclinic.com to learn more.

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    What Happens When You Have Carpal Tunnel Syndrome In St Louis

    The symptoms of carpal tunnel syndrome usually develop gradually. Symptoms often improve if you stop or change an activity that is helping to cause the condition.

     

    Most mild cases of carpal tunnel syndrome get better with treatment. Usually there is no permanent damage to the median nerve. Your symptoms may improve by themselves when:

     

    Fluid buildup decreases, such as after pregnancy.

    You change or stop the activity that has caused your carpal tunnel syndrome.

    Other health problems that cause or contribute to your carpal tunnel symptoms improve.

    Long-term carpal tunnel syndrome can cause:

     

    A loss of feeling and coordination in the fingers and hand. The thumb muscles can become weak and waste away (atrophy).This can make it hard to grip or hold objects.

    Permanent damage to the median nerve. You may have trouble using the hand.

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    Nerve Compression in St Louis

    Nerves extend from your brain and spinal cord, sending important messages throughout your body. If you have a pinched nerve (nerve compression) your body may send you warning signals such as pain. Don't ignore these warning signals.

     

    Damage from a pinched nerve may be minor or severe. It may cause temporary or long-lasting problems. The earlier you get a diagnosis and treatment for nerve compression, the more quickly you'll find relief.

     

    In some cases, you can't reverse the damage from a pinched nerve. But treatment usually relieves pain and other symptoms.

     

    Causes of Pinched Nerves

    A pinched nerve occurs when there is "compression" (pressure) on a nerve.

     

     

    The pressure may be the result of repetitive motions. Or it may happen from holding your body in one position for long periods, such as keeping elbows bent while sleeping.

     

    Nerves are most vulnerable at places in your body where they travel through narrow spaces but have little soft tissue to protect them. Nerve compression often occurs when the nerve is pressed between tissues such as:

     

    Ligament

    Tendon

    Bone

    For example, inflammation or pressure on a nerve root exiting the spine may cause neck or low back pain. It may also cause pain to radiate from the neck into the shoulder and arm (cervical radiculopathy). Or pain may radiate into the leg and foot (lumbar radiculopathy or sciatic nerve pain).

     

    These symptoms may result from changes that develop in the spine's discs and bones. For example, if a disc weakens or tears -- known as a herniated disc -- pressure can get put on a spinal nerve.

     

    Nerve compression in your neck or arm may also cause symptoms in areas such as your:

     

    Elbow

    Hand

    Wrist

    Fingers

    This can lead to conditions such as:

     

    Peripheral neuropathy

    Carpal tunnel syndrome

    Tennis elbow

    If nerve compression lasts a long time, a protective barrier around the nerve may break down. Fluid may build up, which may cause:

     

    Swelling

    Extra pressure

    Scarring

    The scarring may interfere with the nerve's function.

     

    Symptoms of Pinched Nerves

    With nerve compression, sometimes pain may be your only symptom. Or you may have other symptoms without pain.

     

    These are some of the more common symptoms of compressed nerves:

     

    Pain in the area of compression, such as the neck or low back

    Radiating pain, such as sciatica or radicular pain

    Numbness or tingling

    "Pins and needles" or a burning sensation

    Weakness, especially with certain activities

    Sometimes symptoms worsen when you try certain movements, such as turning your head or straining your neck.

     

    Treatment for Pinched Nerves

    How long it takes for symptoms to end can vary from person to person. Treatment varies, depending on the severity and cause of the nerve compression.

     

    You may find that you benefit greatly from simply resting the injured area and by avoiding any activities that tend to worsen your symptoms. In many cases, that's all you need to do.

     

    If symptoms persist or pain is severe, see your doctor. You may need one or more types of treatment to shrink swollen tissue around the nerve.

     

    In more severe cases, it may be necessary to remove material that's pressing on a nerve, such as:

     

    Scar tissue

    Disc material

    Pieces of bone

    Treatment may include:

     

    NSAIDs. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin, ibuprofen, or naproxen may reduce swelling.

     

    Oral corticosteroids. These are used to reduce swelling and pain.

     

    Narcotics. These are used for brief periods to reduce severe pain.

     

    Steroid injections. These injections may reduce swelling and allow inflamed nerves to recover.

     

    Physical therapy. This will help stretch and strengthen muscles.

     

    Splint. A splint or soft collar limits motion and allows muscles to rest for brief periods.

     

    Surgery. Surgery may be needed for more severe problems that don't respond to other types of treatment.

     

    Contact Neuropax Clinic for more information, and to set up an appointment.

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    How Is Diabetic Neuropathy Diagnosed in St. Louis

    Diabetic neuropathies are a family of nerve disorders caused by diabetes. People with diabetes can, over time, develop nerve damage throughout the body. Some people with nerve damage have no symptoms. Others may have symptoms such as pain, tingling, or numbness—loss of feeling—in the hands, arms, feet, and legs. Nerve problems can occur in every organ system, including the digestive tract, heart, and sex organs.

    About 60 to 70 percent of people with diabetes have some form of neuropathy. People with diabetes can develop nerve problems at any time, but risk rises with age and longer duration of diabetes. The highest rates of neuropathy are among people who have had diabetes for at least 25 years. Diabetic neuropathies also appear to be more common in people who have problems controlling their blood glucose, also called blood sugar, as well as those with high levels of blood fat and blood pressure and those who are overweight.

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    How Do I Know If I Have Carpal Tunnel In St Louis?

    Carpal tunnel syndrome is usually diagnosed using:

     

    Medical history. The doctor will ask about any medical problems or illnesses, prior injuries, current symptoms, or daily activities that may be causing your symptoms.

    Hand diagram. You may be asked to help fill in a diagram of your hand to show where you have numbness, tingling, or pain.

    Physical exam, including comparing the strength of both hands.

    More testing

    If your symptoms are severe, if nonsurgical treatment has not improved symptoms, or if your symptoms aren't clearly caused by carpal tunnel syndrome, your doctor may recommend:

     

    Nerve testing, which checks the median nerve.

    X-rays. These can check for bone problems caused by past injury, arthritis, recently broken or dislocated bones, or tumors. X-rays aren't used to diagnose carpal tunnel syndrome. But they can be helpful for finding signs of arthritis or an old or new wrist or neck injury that may be adding to your symptoms.

    Ultrasound, to look at the size of the median nerve. It is inexpensive, comfortable, and quick. But its use for carpal tunnel syndrome diagnosis is still unproven and fairly uncommon.

    MRI. This imaging test can find swelling of the median nerve, narrowing of the carpal tunnel, or problems with circulation of blood through the carpal tunnel.

    Blood tests. These are sometimes done to check for a thyroid problem, rheumatoid arthritis, or another medical problem.

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    Proximal Median Issues in St Louis

    Compression neuropathies of the median nerve in the proximal forearm are unusual lesions. Many patients have vague symptoms for many months or even years prior to confirming the diagnosis of either pronator syndrome or anterior interosseous syndrome of the forearm. Serial examinations clinically and electrodiagnostically may be necessary at intervals of 6 to 8 weeks as required for the evaluation of the patient's symptoms.

    As with other compression neuropathies, the diagnosis is solely dependent on the diagnosis of neuropathy of the median nerve using whatever parameter satisfies the surgeon's diagnostic criteria and then having made that diagnosis, localizing the site of that neuropathy by physical examination or electrodiagnosis with the support of radiographic techniques as appropriate. Surgical exploration of proximal median nerve compression is normally followed by prompt and predictable recovery from the median neuropathy and clinical symptoms between 8 and 12 weeks after surgical exploration.

    Prolonged symptom complexes after surgical exploration of the proximal median nerve are, in my experience, due to either (1) extremely severe median nerve injury secondary to pronator syndrome with prolonged recovery and distal nerve axomnetic recovery into the hand, or (2) sensory nerve dysesthesis of the small sensory nerves on the proximal volar surface of the forearm. The symptoms of either of these postoperative findings normally improve with time.  For more information, visit www.neuropaxclinic.com today.

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