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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.

    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?

    headache - medium

    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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    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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