Migraine and other headache conditions are a common cause of pain. Migraine headaches are the leading cause of temporary disability in the work force. Fortunately, there are many medications that can be used to prevent and treat migraines.
The first therapeutic event which needs to happen is the correct diagnosis of migraine to be made. Patients can have multiple headache types. Headaches which are severe enough to limit activity and are associated with light and sound sensitivity with nausea and sometimes vomiting are most likely migraines. Migraines usually have a pulsating, heartbeat type pain – made worse by movement.
A common type of headache which can mimic migraine is occipital neuralgia. Occipital neuralgia starts at the base of the skull. There the occipital nerve exits the spine and runs up the back of the skull to the forehead. This nerve carries pain fibers. If it becomes irritated, due to trauma, “sleeping wrong” or just routine daily activities; occipital neuralgia headache occurs. The pain can be just as severe as a true migraine. The pain can be on one side, both sides or even isolated to the front of the head. Diagnosis of occipital neuralgia is made by gently pushing at the base of the skull, over the occipital nerve. If this reproduces the headache symptoms, the diagnosis of occipital neuralgia is made. The most effective treatment for occipital neuralgia is a simple injection in the upper neck in the region of the occipital nerve.
Botox was approved by the FDA in 2011 for treatment of intractable migraines. Botox migraine treatment is not for everyone. In order to have insurance or Medicare to pay for Botox, certain criteria must be met. These criteria include:
– 15 headache days a month
– Failed various migraine prevention medications
– Certain blood pressure medications
– muscle relaxants
– physical therapy
– migraines must be incapacitating causing missed work or school
All of these criteria must be met before insurance will authorize and pay for Botox therapy for migraines. Once approved, Botox for migraine is a simple, in-office procedure. For experienced migraine doctors, giving Botox for migraine takes about 20 minutes. Botox does not work immediately to relieve intractable migraines. Effects can be felt as soon as two weeks but maximum benefit is at 6 weeks after Botox treatment. Duration of pain relief can be from 6-8 weeks. With repeated Botox treatment for migraine headache, there is a cumulative benefit in many patients. The minimum time in between Botox treatments is 90 days.
For optimum migraine control, affected patients should be treated every 3-4 months. This results in the best migraine control. This in combination with oral medication migraine prevention therapy.
In conclusion, Botox is effective treatment for many headache patients with chronic, intractable migraines. Proper diagnosis and treatment must be given. For insurance to pay for Botox for migraine, specific criteria must be met. If you suffer from persistent, frequent headaches, call Sarasota Neurology today for an appointment. Start improving your quality of life today.
Posted in Botox, Migraines / Headache, Pain, Vertigo / Dizziness and tagged aspirin, Botox, brain, Cluster headaches, depression, Dr. Kassicieh, headache, headaches, memory, Memory loss, migraine, migraine treatment, neurologist, neurology, Pain by Dan Kassicieh, D.O.
In this episode of the Sarasota Neurology Podcast, Dr. Kassicieh, a recognized expert in clinical Botox, provides an overview of current techniques for treating dystonia, muscle spasm (which may be associated with pain), spasticity from stroke or brain injury with Botox.
Botox was first FDA approved for medical use in 1989. Since then, Botox has found many medical uses to treat clinical conditions that were previously difficult to treat. Conditions such as cervical dystonia, blepharospasm, hemifacial spasm and spasticity such as that seen in cerebral palsy, stroke or spinal cord injuries have all been successfully managed with Botox.
Other similar products such as Dysport and Xeomin all have uses for cervical dystonia. Most recently, Botox was approved for use for treatment of chronic migraine headaches. Listen for more information on the clinical use of Botox and other similar products.
If you would like to learn more about the benefits of Botox, please call (941) 955-5858 or click here to schedule your appointment today. If you’re outside the Sarasota area and unable to travel here, please locate a neurologist in your area.
Posted in Botox, Movement Disorders, Pain, Podcast, Stroke and tagged Botox, Botox injections, cerebral, clinical, dystonia, FDA, headaches, migraine, Pain, spasm, spinal cord, Stroke by Dan Kassicieh, D.O.
I remember it like it was yesterday. While playing racquetball in December 2011, I felt a sudden click in my right knee. I just knew that I had torn my right knee medial meniscus. The knee MRI proved it. The pain was excruciating, and it was compounded by the thought that this happened 9 weeks before my annual Rocky Mountain ski trip.
The misery did not last long though. I’ve been through this scenario before. I did the exact same thing to my left knee in 2010. (I have the MRI for that one, too!) So, I turned to the revolutionary treatment that got me back up on my feet and on the slopes last time this happened.
If I had gone the surgery route, my trip would have been cancelled, as surgery and rehab can take 3-6 months – with no guarantee of outcome. But I was on the slopes as planned! — Not just any slopes, but the “Expert” slopes! I skied for three gorgeous days in a row without pain or problems! No surgery. No downtime. No rehabilitation. Just a simple injection and then my body did the rest. I was completely healed, completely pain free by the time I left for my trip. All this only eight weeks after treating my right knee.
Sound too good to be true? Well it’s not…it’s PRP – platelet rich plasma. PRP is the cutting-edge therapy that even professional athletes have turned to when faced with career-limiting injuries.
PRP is short for platelet rich plasma. With PRP, a patient’s own blood is drawn and the platelets are extracted into a small amount of your own blood plasma. Platelets contain numerous beneficial, natural growth factors and chemical messengers that initiate and aid in healing and tissue regeneration. As the PRP is derived from the patient’s own blood, there is no risk for rejection or disease transmission. The PRP is then injected into the injury site. In my case, my knee. It’s that simple. Still not convinced? Let’s compare PRP therapy versus traditional arthroscopic knee surgery, which would be the usual prescribed course of treatment for an MRI proven torn meniscus.
Risks associated with Surgery may include:
- Possible complications due to anesthesia
- The surgical procedure itself – with no guarantee of pain relief
- Increased knee pain during recovery process
- 3-6 months rehabilitation after surgery
- 3 hours or more of lost work per week due to therapy plus drive time to appointment
- Use of narcotics to manage pain
- Possible risk of addiction to pain killers
Risks associated with PRP:
- Essentially zero
Pretty startling contrast between the two, don’t you think? Oftentimes, patients may complain PRP is not covered by traditional insurance and therefore too expensive to pay out-of-pocket. If you look at it a different way: Add up the co-payments associated with both the surgery and 3-6 months of rehabilitative therapy plus the missed time at work, you could have easily covered the cost of PRP therapy. That does not even include the downtime that you will have before and following surgery.
Remember, with PRP therapy there is no recovery time, no anesthesia, no narcotics, no downtime. You have one shot on Friday and are back to work on Monday.
PRP may not be right for every situation, but if you have an injury or condition that you’ve been told requires surgery, it’s definitely worth checking out! This is true not only for knee problems (not limited to a torn meniscus) but also for shoulder pain, rotator cuff injuries, hip pains, ankle injuries and plantar fasciitis (foot pain.) Remember: surgery is irreversible and narcotics are addictive. Surgery never comes with a guarantee and frequently patients have more pain after the surgical procedure. Avoid them if at all possible! For more information on the non-surgical treatment of joint pains and learn more about Sarasota PRP here.
I remember discussing my knee with my physical therapist friend who marveled at my rapid, complete recovery. He looked at me and said, “Why isn’t there a line out your door right now of patients waiting to get PRP instead of surgery?” I thought to myself, “He’s right. Too many patients are getting knee, shoulder and foot surgery who could do extremely well with PRP therapy.”
Ready to make your appointment today and start living pain free?
Posted in Pain, Platelet Rich Plasma and tagged avoid surgery, blood, growth factors, healing, injuries, knee pain, meniscus, MRI, natural, Pain, platelet, platelet rich, Platelet Rich Plasma, platelets, PRP, PRP therapy, rich plasma, Surgery, therapist by Dan Kassicieh, D.O.
Platelet rich plasma (PRP) has been used medically since the late 1990’s. Dentists were the first to use this natural healing mechanism to improve outcomes of dental procedures. PRP has been used since 2000 for intraoperative (in the course of surgery) therapy following orthopedic, thoracic and cardiac surgical procedures. PRP has found wide use in non-surgical orthopedic treatment of knee pain and other joint injuries.
Platelet rich plasma also can heal injured tendons, ligaments, muscle, cartilage and bone. Major league sports has discovered the incredible natural healing effects of PRP. Many national and international sports leagues have adopted PRP therapy as one of the first line treatments of their injured athletes. Professional sports has recognized the economic value of PRP in that one PRP treatment costs $1500-2000 as compared to the typical orthopedic surgery which can range from $20,000 – 40,000. Additionally PRP has virtually no down time and does not require months of physical rehabilitation. Platelet rich plasma has become an early treatment option in the treatment of professional athletes that have suffered muscle, joint, tendon and ligament injures.
NFL Players Who Have Received PRP
Hines Ward, the Pittsburgh Steelers wide receiver, has use platelet rich plasma therapy on at least two occasions for a torn medial collateral ligament — a knee injury. The use of PRP allowed him to go on and win two Super Bowls. Mr. Ward has attributed his ability to play to receiving PRP.
Other NFL players have successfully been treated with PRP for various injuries. Troy Polamalu, a Steeler’s defensive safety, has had his share of traumatic injuries. As one of the top defensive players, Polamalu has had repeated trauma to his knees. He had one significant MCL injury for which he had PRP therapy.
Donald Jones of the Buffalo Bills and Andre Dixon of the Hartford Colonials have also had PRP therapy for their injuries -all with excellent success. Houston Texans wide receiver Andre Johnson suffered a high ankle sprain. To expedite the recovery process, Johnson underwent platelet rich plasma therapy.
These professional athletes were able to get back to playing football in only a few short weeks, instead of the normal 2-4 months of healing and rehabilitation time it take for more conventional therapies. Surgical treatment would sideline these highly trained athletes for a whole season. NFL physicians have discovered that PRP is the answer to getting these players healed quickly, with needing to resort to surgery. Platelet rich plasma regenerates new, stronger tissue in these injured players.
Major League Baseball and PRP
Alex Rodriguez, one of Major League Baseball’s most famous players used five PRP treatments to accelerate healing and recovery following hip surgery that left him in pain. His trainers were amazed to see how much faster A-Rod was able to get back into playing baseball.
Takashi Saito suffered an elbow injury in his pitching arm while playing as a Pitcher for the LA. At 38, surgery was not a good option, as recovery could have taken as much as 9 months. He had PRP therapy and was able to resume pitching in only a few weeks. Saito credited his unlikely recovery from a partially torn ulnar collateral ligament to PRP therapy.
In one year, Major League Baseball’s 30 teams had 519 players who spent 28,602 days on the disabled list for injuries sustained while playing baseball. This represented $455 million in total salary sitting idle, as these athletes were sidelined. PRP therapy can and does have a major effect in reducing recovery and down time.
National Basketball Association and PGA
One of the most famous basketball players, Kobe Bryant, has had several arthroscopic knee surgeries for right knee pain. He went to Germany to receive platelet rich plasma therapy. Being in his 30’s, he did not see more surgery as a good alternative. The promise of non-surgical, more rapid improvement with PRP therapy for his knee pain convinced this basketball legend to undergo therapy. Similarly professional golf star, Tiger Woods has undergone platelet rich plasma therapy more than once following ACL reconstructive surgery. His knee pain continued after surgery and he went with PRP with beneficial results.
National Tennis and World Soccer
Other major national and international sports have recognized PRP therapy as an outstanding alternative to “standard” conservative therapy and certainly its benefits over surgical intervention. World tennis star, Rafael Nadal underwent PRP therapy after injuring his knee. His physician, Dr. Mikel Sanchez, described platelet rich plasma as a miraculous regenerative treatment. Indeed, that is what PRP does, regenerates new tissue. Major League Soccer players have also discovered the potential for better, rapid healing with PRP therapy.
Jonathan Bornstein, one of the top new young stars in soccer, twisted his knee resulting in a torn ligament. Facing the prospect of being out of playing soccer for 10 weeks, Bornstein elected to have PRP for his knee injury. He was back to running in 3 weeks and was ready to resume playing soccer only 2 weeks later. The list of professional athletes in a broad range of Major League sports, who have undergone platelet rich plasma therapy is growing every week. This list is beyond the scope of this article. The conclusion though is that PRP therapy is here to stay in the treatment of these injured, highly trained athletes.
PRP therapy is considered to be acceptable medical therapy by the International Olympic Committee, World Anti-Doping Agency and most professional sports association. Platelet rich plasma therapy is distinctly not blood doping and has been ruled on by the IOC and WADA as well as professional athletic associations.
Platelet rich plasma is a novel, non-surgical therapy to heal injured tissue. The platelets contain growth factors, cytokines and other agents that trigger the healing cascade. The difference is, is that with PRP therapy, a massively concentrated amount of platelets and supporting proteins are injected directly into the damage tissue. The body uses the same natural healing process for injuries but not in this high concentration. With this high concentration of healing platelets and growth factors, injured tissues can be regenerated and healed in only a few weeks. Many patients can have pain relief in 3 weeks. Many other painful conditions can be treated with PRP. If you suffer from joint, muscle, tendon or back pain – contact Sarasota Neurology for PRP therapy in Sarasota.
Posted in Back Pain, Pain, Platelet Rich Plasma and tagged Hines Ward, injuries, joint pain, knee pain, Major League Baseball, NFL, olympic, orthopedic, Pain, Pittsburgh Steelers, platelet, Platelet Rich Plasma, PRP, PRP therapy, prp therapy sarasota, rafael nadal, Tiger Woods by Dan Kassicieh, D.O.
What do you think of when you think of neck or back massage therapy? Most people think of the type of massage you would receive if you went to the spa for the day. That type of massage therapy is known as a Swedish Massage. Swedish Massage is only one of over 40 types of massage that a person can receive. When you say you went to see your doctor today, what do you think of? If I went to see my family doctor, my image would be different than if I said I went to see my Cardiovascular surgeon. They are both doctors, but the exams and procedures that they perform are vastly different.
The field of massage is similar in its sub-specialization within the scope of massage therapy. Swedish Massage is great for relaxation and stress reduction, but if your back just went into spasm and is locked up, you would be much better served going to a Massage Therapist that specializes in Rehabilitation and back pain relief. Neuromuscular Therapy, Myofascial Release, Positional Release and Muscle Energy are just a few of the specialized massage techniques that were developed to treat muscle pain and skeletal dysfunction. These techniques are focused on looking at the role of the soft tissues in causing pain. Soft tissues include muscle, tendon, ligament and fascia. Fascia is the covering over muscles and internal organs that provide stability and strength. Neuromuscular therapy treats fascia and muscle pain. Myofascial Release treats connective tissue disorders, particularly tight fascia which is a painful syndrome that frequently accompanies muscle pain and spasm. Positional Release treats muscle spasms, muscle energy treats joint restrictions.
These techniques are taught to Massage Therapists as advanced, highly specialized postgraduate courses. Just as a doctor can practice medicine after four years in medical school, he/she must first participate in a postgraduate internship and residency program to specialize in his/her specific field of medicine. A Massage Therapist who is treating patient for acute and chronic muscle and joint pain should have more than just basic, Swedish Massage training. What patient’s want most is pain relief.
In summary, specialized massage therapy for medical conditions, requires advanced training on the part of the massage therapist. Many hours of postgraduate massage therapy education and training is necessary for successful outcomes in the treatment of patients suffering from pain in the neck, back, head or extremities. For more information visit Soar Point Massage or contact Jack Ryan, LMT a 941–993-3339 for an appointment.
Posted in Back Pain, General Medicine, Pain and tagged Back Pain, joint pain, massage, Pain, pain relief, therapist, therapy by Dan Kassicieh, D.O.
Do you have knee pain? Tear a knee meniscus, sprain a ligament or have symptomatic knee arthritis or bursitis? Knee injuries, cartilage tears or tendon sprains are common causes of knee pain. Many patients can get relief with rest, wearing a knee brace and taking an aspirin, ibuprofen or other pain relieving agent. Sometimes a cortisone injection will relieve the knee pain without further treatment. When knee pain persists, patients seek out orthopedic surgical opinions. All too often, patients are told that surgery is their only option. Unfortunately surgery does not always work and patients are left with persistent knee pain. They then resort to narcotic pain killers to relieve pain.
Platelet rich plasma therapy has been FDA approved for medical use for over 20 years. Platelet rich plasma is derived from your own blood, eliminating risk of disease transmission. Two ounces of blood is drawn and the natural healing component of the blood is concentrated by 500%. This is the platelet rich plasma, (PRP). PRP is the concentrated healing component of blood. This can be injected directly into the knee joint (a relatively painless procedure.) Platelet rich plasma will heal damaged knee tissue naturally, using the body’s own healing mechanism to repair the damaged meniscus, ligament or tendon. In patients whom suffer from bone-on-bone arthritis as a cause of their knee pain, platelet rich plasma can stimulate the natural regrowth of cartilage, which relieves the pain. PRP can also help patients who have had arthroscopic surgeries who still have knee pain. Avoid surgery, stay off narcotics.
Using PRP has many advantages: 1) it is an outpatient procedure with no recovery time, 2) it requires no general anesthesia, 3) there is no rehabilitation required, 4) healing occurs by a completely natural process, 5) complications are almost unheard of and 6) cost is much less than surgery. If you have knee pain or other joint pain, you should look into getting platelet rich plasma therapy a proven, non-surgical treatment for joint pain. For more information go to our Sarasota PRP for knee pain page or call Dr. Kassicieh at 941-955-5858 for an appointment.
Posted in Pain, Platelet Rich Plasma and tagged arthritis, knee pain, meniscus, orthopedic, Pain, plasma therapy, Platelet Rich Plasma, PRP Sarasota, Sarasota PRP, sprain, sprains by Dan Kassicieh, D.O.
Patients are being treated currently at Sarasota Neurology with PRP (platelet rich plasma) for a wide variety of joint pain and other pain issues. Among the more common uses for PRP are knee pain, shoulder pain and other painful conditions such as plantar fasciitis, tennis elbow, some types of low back pain. PRP can also be used in patients that have residual joint pain from having had orthopedic arthroscopic knee or shoulder surgery.
PRP works to heal painful joints by using the patients’ own natural biological healing mechanism. The injured or damaged tissue in the joints, ligament and tendons or muscle send out chemical signals that there is injury or incomplete healing. PRP has receptors on the active platelets that seek out these damaged tissues. The PRP graft then biologically and molecularly attach to the damage tissue and trigger the natural healing process of making new collagen. This process takes six weeks to have a full effect although actual healing can continue for up to three months.
PRP may be used in some patients as an alternative to having surgery on their knees, rotator cuffs or in cases of plantar fasciitis (foot pain). Beginning in early 2011, Sarasota Neurology will be offering a new and innovative uses for PRP. This highly effective treatment is ideal for patients who would prefer to avoid the cost, pain and time involved in having surgery for the same problem. Check back with us in February to get more details of this exciting treatment with PRP in Sarasota.
Posted in Back Pain, Pain, Platelet Rich Plasma and tagged collagen, foot pain, healing, joint pain, knee pain, ligament, low back pain, natural, neurology, orthopedic, Pain, plantar fasciitis, platelet, Platelet Rich Plasma, platelets, PRP, PRP in Sarasota, rotator cuff, Sarasota, Sarasota Neurology, Sarasota PRP, shoulder pain, Surgery, tennis elbow by Dan Kassicieh, D.O.
A recent report in the Journal of the AMA (De Vos, et al JAMA 2009) reported that platelet rich plasma therapy was no more effective for chronic Achilles tendinopathy than standard, conservative therapy. This study was inherently flawed in its design resulting in incorrect conclusions. Platelet rich plasma is the healing component of blood. It is derived and concentrated from a patient’s own blood and then injected into the affected area. Not all PRP is the same. Blood processing is the key, levels of growth factors are of utmost importance and successful outcomes will vary with the technique, protocol and level of expertise the clinician possesses. Different PRP extraction equipment and how the blood product is handled during this process is also critical.
De Vos et al commented “A limitation of the study was that the amount of platelets and quantity of activated growth factors that were present in the PRP injections were unknown.” This introduces several variables that would invalidate the data and the study’s conclusion:
1. What PRP processing system was used?
2. Were the levels of Growth Factors therapeutic? Therapeutic level ranges are usually 4-5 times the baseline.
3. No levels or PRP concentrations were taken or reported.
All of these are significant study design flaws that will result in invalid study conclusions. Additionally the study stated “Platelets are slow to activate by exposure to tendon collagen, but it might be that therapeutic pressure within the tendon, a large amount of PRP diffused rapidly out of the tendon thereby reducing its effect.” Additionally thrombin – a critical component in PRP therapy – was not used to activate the platelets. PRP and growth factors will not activate or be as effective if thrombin is not used in this procedure.
Perhaps most significant study design error was that only one PRP injection was given. The study patients, by design criteria, were required to have chronic Achilles tendinopathy that had responded poorly to prior therapies. Chronic tendon injuries, particularly those in the Achilles tendon, heal poorly due to inherently poor blood circulation. The standard PRP technique in this type of injury would be a series of three injections over a period of 3-4 months. A study that specifies treating a patient with a chronic tendinopathy with a single PRP injection is setting up the patient unnecessarily for failure. Lastly, the study had a low number of subjects in it to make any clinically significant conclusions. Only 27 subjects were treated, each with a single PRP injection and there were 27 control subjects.
Regenerative medicine – Platelet rich plasma – has been FDA approved for medical use for 20 years. It has been used widely in dental, cardiac, orthopedic medicine to assist in and improve medical outcomes. The professional horse racing associations widely use PRP therapy to heal leg injuries in their million dollar race horses. Major league sports such as the NFL and MLB consider platelet rich plasma therapy an important treatment option to get their elite athletes “back into the game” in as short of time as possible. PRP healing typically takes six weeks, particularly when combined with rehabilitation. In conclusion, PRP is a highly effective medical treatment for ligament, tendon, muscle and other knee/shoulder injuries as well as lower back pain. Even patients with post-operative knee pain or shoulder pain can benefit from PRP therapy. Outcomes are entirely dependent on the preparation and handling of the blood, equipment used and experience as well as skill of the treating physician. Additional information on PRP can be found at PRP Stops Pain. Excellent clinical study references can be found by clicking here.
Posted in Back Pain, General Medicine, Pain, Platelet Rich Plasma and tagged Achilles, Achilles tendinopathy, Back Pain, blood, FDA approved, growth factors, JAMA, joint pain, knee pain, ligament, lower back pain, MLB, NFL, Pain, platelet, Platelet Rich Plasma, platelets, PRP, PRP stops pain, shoulder pain, tendon, thrombin by Dan Kassicieh, D.O.
As a neurologist who sees many patients with neck, back and various joint pains, I practice an area of medicine known as neuro-orthopedics. As such, I treat patients for their pain without surgical intervention. Many patients with neck, back and joint pain (knee pain, shoulder pain, elbow pain, etc.) can be successfully treated without invasive surgery and the many risk that go along with this. With surgery there is also a prolonged recovery time and need for extensive rehabilitation. The area of medicine that applies to successfully treating patients without surgery or use of narcotic medications is known as regenerative medicine. In this field, platelet rich plasma is injected into the affected joint, tendon, ligament or soft tissue area that has pain and is failing to heal completely. Tendons attach muscle to bone and ligaments attach bones to bones. Platelet rich plasma (PRP) is the concentrated healing components of the blood. Only one percent of the blood contains the bioactive proteins and platelets that are involved in healing. Through a specialized process, we can take the patient’s own blood and concentrate the platelets and bioactive proteins up to 500%. This small amount of concentrated PRP is then injected into the joint or other body area, that needs regeneration, after local anesthetic is administered. The PRP graft is then activated with thrombin and the healing process begins. Using the patient’s own blood eliminates the risk of transmitting disease and prevents graft rejection. PRP also has the benefit of being antimicrobial, killing off bacteria thereby limiting the risk of infection. David Crane, MD published an excellent overview of platelet rich plasma.
Platelet rich plasma works by first being injected into the affected area and activated. The activated platelets attach themselves to the damaged tissue, whether that be tendons, ligaments, muscle or bone. The platelets release alpha granules and dense particles. The small packets contain powerful bioactive proteins that begin the healing process. The alpha granules contain clotting factors, growth factors, cytokines and adhesion molecules. These substances allow the PRP graft to attach to the damaged tissue and start recruiting other healing cells to migrate into the area. The dense particles contain proteins that allow the platelets to clump together, forming the structural matrix of the PRP graft.
Posted in Back Pain, General Medicine, Nerve Pain, Pain, Platelet Rich Plasma and tagged arthritis, Back Pain, blood, bones, bursitis, collagen, elbow pain, FDA, FDA approved, foot pain, healing, Hines Ward, joint pain, joint pains, knee pain, leg pain, ligament, lower back pain, matrix, nerve, neurologist, Pain, plantar fasciitis, platelet, platelet rich, Platelet Rich Plasma, PRP, PRP stops pain, Quality of Life, regenerative medicine, rich plasma, sacroiliitis, Sarasota Neurology, sciatica, shoulder pain, stem cell, stem cells, Surgery, tendon, tennis elbow, Tiger Woods by Dan Kassicieh, D.O.
Carpal tunnel syndrome is the most common “pinched nerve” condition that neurologists see. It is a form of compression neuropathy The typical patient comes in with complaints of hand or arm pain associated with one or more numb fingers. There is usually sparing of the little finger. This painful numbness will frequently wake affected patients from their sleep. They will complain of a swollen feeling in their hand (or both hands) associated with painful numbness affecting all but the little finger.
Carpal tunnel syndrome is caused by compression of the median nerve (the “carpal tunnel nerve”) as it pass under the carpal tunnel ligament. The carpal tunnel is located at the wrist. There is a small band of tissue across this to hold down the median nerve and vein. When the carpal tunnel becomes too narrowed, the median nerve becomes “pinched” and the vein is compressed. This combination of events results in the hand becoming numb and swollen. Carpal tunnel symptoms frequently occur only at night, during sleep. This is because we all have a tendency to sleep with our wrists slightly flexed. This position further narrows the carpal tunnel, causing symptoms. As the carpal tunnel narrows further, with time, patients will develop daytime hand numbness. Holding a newspaper, magazine or steering wheel can bring on symptoms. In more severe cases hand grip weakness can occur. Patients find that they have difficulty removing jar lids or may drop objects. Carpal tunnel syndrome occurs in both hand about 50% of the time.
CTS is diagnosed, most commonly by a neurologist, on the basis of the patient’s symptoms and detailed neurological exam. Electrical diagnostic testing, nerve conduction studies (NCV), are necessary to confirm carpal tunnel syndrome – particularly if surgery is being considered. Many patients can have carpal tunnel symptoms and have normal NCV studies. These patients are not candidates for surgery. The standard of care medical treatment for CTS is wearing a cock-up wrist brace. These braces prevent wrist flexion, thereby reducing the pressure on the median nerve. Frequently patients can “cure” their CTS with wearing a brace. For more severe symptoms with abnormal NCV studies, surgical decompression may be indicated. This is a procedure done under local anesthesia. A small incision is made at the wrist and the carpal ligament is cut. This relieves the pressure on the median nerve. Success rate for this surgery is approximately 90%.
If you feel that you have carpal tunnel syndrome, you should see a neurologist and have diagnostic studies performed. Most patients will do well with conservative, non-surgical treatment. For more detailed information click here.
Posted in Nerve Diseases, Nerve Pain, Neuropathy and tagged braces, Carpal Tunnel, Carpal Tunnel Syndrome, compression neuropathy, hand, hands, nerve, neurologist, neurology, Neuropathy, numb, Pain, pinched nerve, Sarasota, Sarasota Neurology, sleep, Surgery by Dan Kassicieh, D.O.