Frequently Asked Questions

If you're living with peripheral nerve pain, you might be wondering why a plastic surgeon could be the right specialist to help you. This is a valid question to ask, given that the general public tends to associate plastic surgery with cosmetic surgery. However, plastic surgeons can be well-equipped to treat peripheral nerve pain that is negatively affecting your quality of life.

Dr. Eric H. Williams completed his plastic surgery residency at the University of Alabama in Birmingham in June 2006. He then turned his attention to peripheral nerve surgery, completing another full year in fellowship training with Dr. A. Lee Dellon, a world-renowned specialist in peripheral nerve surgery, in 2007. His practice currently focuses on the surgical care and rehabilitation of lower extremity and upper extremity complex peripheral nerve syndromes with an emphasis on nerve injury and entrapment. This includes treating conditions such as common peroneal nerve compression, meralgia paresthetica, tarsal tunnel syndrome, and migraines related to nerve compression.

How Plastic Surgery Has Evolved Over Time

Plastic surgeons are known for their creative expertise in soft tissue injuries, many of which involve damage to the surrounding nerves. While cosmetic surgery has become a significant part of their practice in recent years, their roots actually lie in reconstructive surgery. This medical specialty began by treating major war injuries like those seen in the Civil War, World War I, World War II, and Vietnam. The patient’s survival was the priority, not aesthetics.

Over time, plastic surgeons have perfected techniques first learned on the battlefield to improve the normal functions of the body. This can involve cosmetic procedures like eliminating wrinkles or reconstructing breasts after mastectomies, but it can also involve addressing pain caused by compression or injury to the peripheral nerves. 

Interestingly, approximately one-third of plastic surgeons practicing today are also trained hand surgeons. As a result, they receive comprehensive training in nerve injuries. The American Society for Peripheral Nerve (ASPN) has further fueled this interest, as it challenges plastic surgeons to become better at treating patients with peripheral nerve issues.

Why Plastic Surgeons Shine When It Comes to Treating Nerve Injuries

Plastic surgeons are not the only medical professionals who operate on peripheral nerves. However, since plastic surgeons operate all over the body, they have a broader perspective on soft tissue issues—including those involving peripheral nerves.

Other reasons plastic surgeons like Dr. Williams are well-equipped to treat peripheral nerve issues include:

• Specialized training. Despite being a subspecialty within plastic surgery, there is a growing community of plastic surgeons dedicated to peripheral nerve surgery. They receive specialized training and employ techniques that have proven to be effective in surgically stopping chronic pain related to nerve compression or other nerve injuries 
• Compassion and empathy. Plastic surgeons are often drawn to this field due to their desire to alleviate the suffering of their patients. Their compassion and empathy drive them to find solutions that genuinely work.
• A desire for continuous improvement. Plastic surgeons interested in peripheral nerve issues are continuously refining their techniques. Learning from past experiences and adapting as needed, they aim to provide better outcomes for their patients.

Plastic Surgeons Can Offer a Permanent Solution to Nerve-Related Dysfunction

Traditionally, pain management teams including physiatrists and anesthesiologists have treated nerve pain with medications, injections, or electrical stimulation. Medications can have their place, but opioids like OxyContin can cause more harm than good. Medications also focus on temporary symptom relief instead of fixing the underlying issue that is causing the death of the nerve. 

Imagine that your child is crying because they broke their arm, and you decide to stick a gag in their mouth. They’ll stop crying, but the gag isn’t doing anything to treat the broken arm. It’s only creating new problems by making it harder for your son or daughter to breathe. The sensible thing to do as a parent is to treat the injury itself.

When a nerve is being compressed or pinched, surgical nerve decompression relieves the excess pressure on the nerve. This reduces pain and restores mobility.  If a nerve is physically injured, then it makes better sense to try to fix or repair the nerve if it is possible. While this is not always possible, many patients are too easily overlooked for procedures that might treat the underlying problem.   

If the correct diagnosis is made, and a repair, decompression, or treatment of the injured or compressed nerve is performed, then in many cases, patients are no longer dependent on pain medication to make it through the day. To learn more about the results Dr. Williams has been able to achieve with his patients, refer to the testimonials section of our website. 

Fasciotomy is a surgical procedure to relieve pressure in a muscle compartment caused by a condition such as chronic exertional compartment syndrome. This procedure also increases blood flow to the nerves and muscles. Our doctor explains more about fasciotomy as a treatment option for exertional compartment syndrome. 

Treating Exertional Compartment Syndrome

Exertional compartment syndrome causes pain or cramps in the front muscle compartment of the lower leg. It can occur during exercise where there are repetitive movements such as swimming, biking, or running and lessen once the activity is stopped.

There are both nonsurgical and surgical options for treating exertional compartment syndrome. Nonsurgical options are only effective if you stop or reduce the specific activity triggering the condition. Surgery may be an option if conservative methods are ineffective in resolving pain. A fasciotomy is a surgical procedure often recommended for exertional compartment syndrome. It involves cutting the tight fascia, the bands of tissue surrounding the muscles, to relieve pressure in the muscle compartment.

What to Expect From Fasciotomy

Dr. Eric H. Williams will determine if your condition is exertional compartment syndrome or another condition causing the pain. Once a diagnosis is made, Dr. Williams will recommend treatment options such as a fasciotomy. At your consultation, he will thoroughly answer your questions and prepare you for what to expect before and after surgery.

Possible Risks and Complications

• Infection
• Permanent nerve damage
• Damage to muscle or blood vessels
• Weakness or numbness
• Shedding of skin
• Scar tissue formation

Fasciotomy may not completely resolve chronic exertional compartment syndrome in some cases.

Are You Looking for a Baltimore Peripheral Nerve Specialist?

If you have chronic exertional compartment syndrome and need help, contact Dr. Williams for an evaluation. Our goal is to help ease your symptoms and get you back to enjoying your favorite activities as soon as possible. To schedule an appointment in the Baltimore office, contact us at 410-709-3868, or fill out our contact form.

Related links: Baltimore Nerve Surgeon Exertional Compartment Syndrome Solutions for Exertional Compartment Syndrome in Runners Treatment of Exertional Compartment Syndrome

 

When we think about carpal tunnel syndrome, we generally think of a repetitive stress injury. We might, for example, associate the numbness, tingling, and pain of carpal tunnel syndrome with jobs that involve a significant amount of typing or other repetitive motions.

Carpal tunnel syndrome can also be caused by a traumatic injury such as a car accident. Any injury that entraps or impinges on the median nerve as it passes through the carpal tunnel in the wrist can lead to the development of symptoms.

How an Accident Can Lead to Traumatic Carpal Tunnel Syndrome

In an event like a car accident, the ligaments and tendons surrounding the median nerve may be damaged. As they heal, scar tissue may form. This scar tissue can impinge on the median nerve leading to the classic symptoms of carpal tunnel syndrome. Because the problem arises as ligaments and tendons heal rather than in the accident itself, the onset of traumatic carpal tunnel syndrome is often delayed—sometimes for quite some time.

Once traumatic carpal tunnel syndrome is diagnosed, however, the treatment plan resembles that of any case of carpal tunnel syndrome. 

Treating Traumatic Carpal Tunnel Syndrome

In most cases, your doctor will suggest a series of common, conservative treatment options to try to get you relief from your carpal tunnel symptoms. However, these are not always effective—especially since the cause of the problem is trauma rather than repetitive motion or genetic predisposition. 

It may well be the case that the best solution for addressing the symptoms of traumatic carpal tunnel syndrome is the minimally invasive surgical technique known as ultrasound-guided carpal tunnel release. This surgery releases the median nerve, alleviating the symptoms of carpal tunnel syndrome.

Dr. Williams Can Treat Trauma-Induced Injuries 

Dr. Eric H. Williams has the experience and expertise required to help you get the relief you need from traumatic carpal tunnel syndrome. Schedule an appointment today so that we can get you on the road to recovery sooner rather than later.

Related Links: How to Get Relief From Carpal Tunnel Syndrome With a Minimal Recovery Time Physical Therapy Isn’t Always the Right Treatment for Carpal Tunnel Syndrome Why Women Have an Increased Risk of Carpal Tunnel Syndrome

 

You have been experiencing the symptoms of carpal tunnel syndrome for quite some time. During that time, you have tried a range of different conservative approaches to treatment.

You’ve worn braces. You’ve consistently done some stretching exercises. You’ve tried over-the-counter pain relievers. But so far, nothing has really provided significant, consistent relief. And at this point, the pain, numbness, and tingling are starting to make it difficult for you to continue with your daily activities—a situation that can be particularly problematic if the pain is preventing you from performing your job duties. 

It’s time to consider surgery.

Don’t Wait Too Long to Take Care of Your Carpal Tunnel Pain

You may be reluctant to have surgery. That’s completely understandable. However, it is important to remember that surgery will stop the progression of the nerve damage you are experiencing. Stopping ongoing damage sooner rather than later is the best move you can make to ensure positive results from the surgical procedure.

In addition to simple reluctance to have surgery, you may also be worried that having the procedure done will result in a long recovery period that might keep you from working or enjoying your regular activities. 

Fortunately, we have good news on that front: The recovery time is minimal for ultrasound-guided carpal tunnel release surgery. That means you can get back to your daily life quickly—and in significantly less pain.

Let’s Take Care of Your Carpal Tunnel Syndrome Pain. Contact Our Nerve Pain Specialist Today.

Dr. Eric H. Williams is ready to help you find relief from the ongoing symptoms of carpal tunnel syndrome. Ultrasound-guided carpal tunnel release surgery can correct the problem and get you back to your activities quickly. 

If conservative approaches to dealing with the symptoms of carpal tunnel syndrome simply are not getting the job done, it is time to talk with Dr. Williams. You do not have to just live with the pain of carpal tunnel syndrome. Instead, contact us today to get started on the path toward putting carpal tunnel syndrome symptoms in your past. 

Related Links: Know the Symptoms That Might Indicate Carpal Tunnel Syndrome Diagnosing Carpal Tunnel Syndrome Why Women Have an Increased Risk of Carpal Tunnel Syndrome

 

It might seem quite unlikely that the pain you are experiencing in your neck could have anything to do with what is going on in your wrist. After all, there is quite a lot of real estate between your wrists and your neck, and they are engaged in quite different activities when it comes to moving various parts of your body.

But the fact is, carpal tunnel syndrome can, in some cases, lead to a literal pain in the neck.

Carpal Tunnel and It's Connection to Neck Pain

Carpal tunnel syndrome develops when the median nerve is pinched in the carpal tunnel at the base of the hand. The median nerve is quite long—running all the way from the tips of the fingers through the wrist, forearm, elbow, humerus, shoulder, and into the neck. With that in mind, it is easier to understand how an issue down near your hands can be causing pain up near your head.

It Is Important to Get the Diagnosis Right With Your Neck Pain

Of course, carpal tunnel syndrome is far from the only thing that could be causing pain in your neck. That is why it is essential that you see a doctor with expertise in nerve issues so that you receive the correct diagnosis.

An incorrect diagnosis might lead to the wrong treatments, which in the end could make the problems you are experiencing far worse rather than better.

What Can Be Done If My Neck Pain Is Carpal Tunnel Syndrome?

If your doctor determines that you are suffering from carpal tunnel syndrome, they may recommend ultrasound-guided carpal tunnel release. This procedure can repair the tunnel that is pinching your medial nerve, which can lead to significant relief from pain—no matter where along the median nerve you have been experiencing that pain.

Dr. Williams Can Help. Contact Our Nerve Pain Specialist Today.

If you are experiencing pain related to a nerve issue, Dr. Eric H. Williams can help you find relief. He offers a full range of effective treatment options, including ultrasound-guided carpal tunnel release. Don’t suffer any longer. Contact our clinic today to make an appointment.

Related Links: Can Carpal Tunnel Syndrome Cause Pain All the Way to My Shoulder? Cold Hands and Carpal Tunnel Syndrome Why Women Have an Increased Risk of Carpal Tunnel Syndrome

Numbness or a feeling of weakness in your hands when holding small objects such as a cellphone is a classic sign of carpal tunnel syndrome. This condition can make many everyday activities difficult to perform, but effective treatment options are available.

How Carpal Tunnel Syndrome Affects Fine Motor Skills

The carpal tunnel is a narrow region in your wrist located on the side of the palm. It protects the median nerve, but sometimes there can be too much pressure in this area. The compression of the median nerve leads to the condition known as carpal tunnel syndrome.

The median nerve controls your thumb, which is why it can be difficult to grasp small objects when you have carpal tunnel syndrome. You may notice trouble holding your phone first since this is something that you’re likely to do many times throughout the day. However, as your condition progresses, other simple tasks might become more difficult. Some examples of activities that might be hard to do with carpal tunnel syndrome include:

• Opening a bottle of juice or milk
• Chopping vegetables to make a salad
• Gripping the steering wheel of your car
• Holding a pen or pencil
• Buttoning up a dress shirt
• Brushing your teeth
• Applying makeup

As your condition progresses, you may find that you feel clumsy and struggle to tell where your hands are in relation to objects. This is called proprioception.

Getting Treatment for Carpal Tunnel. Contact Our Nerve Pain Specialist Today.

Not being able to complete simple tasks on your own is understandably frustrating. Carpal tunnel release can help you restore your independence.

You may be reluctant to consider carpal tunnel syndrome surgery because of the long recovery time associated with traditional open surgery or an endoscopic procedure. However, ultrasound-guided carpal tunnel release typically requires a recovery time of just three to six days. Since there’s normally no need for follow-up physical therapy, this is an effective way to help you get back to making the most of each day. Contact our Towson office to learn if this procedure might be the right choice for addressing your carpal tunnel syndrome symptoms.

Related Links: Cold Hands and Carpal Tunnel Syndrome Physical Therapy Isn’t Always the Right Treatment for Carpal Tunnel Syndrome Genetic Risk Factors for Carpal Tunnel Syndrome

It’s common knowledge that carpal tunnel syndrome can cause numbness, burning, or tingling in the hands, but many people are surprised to learn that cold hands can also be a symptom of the condition.

How Carpal Tunnel Syndrome Can Lead to Cold Hands

The carpal tunnel is a narrow region in the wrist that is located on the side of the palm and protects the median nerve. When there is too much pressure in this area, and the median nerve is compressed, a person develops carpal tunnel syndrome.

Coldness in the hands is due to pressure on the median nerve and a temporary loss of circulation. People with carpal tunnel syndrome may experience cold hands in any weather, but this symptom is generally most noticeable during the winter months.

If you’ve ever used an ice pack on a sprained ankle or another soft tissue injury, you might be wondering why cold hands increase the pain from carpal tunnel syndrome instead of making you feel better. Therapeutic icing is done for 15-20 minutes at a time and is usually alternated with heat therapy. Chronically cold hands occur because blood circulation is being limited through vasoconstriction, which is a normal response of the body to conserve heat. This exacerbates the restricted blood circulation that is already associated with carpal tunnel syndrome.

Getting Relief From Carpal Tunnel

If you have cold hands due to carpal tunnel syndrome, wearing fingerless gloves to keep your hands and wrists warm may help provide temporary symptom relief. However, if your carpal tunnel syndrome symptoms have progressed to the point where the pain is preventing you from doing the activities you enjoy, surgical treatment may be needed. Contact our Towson office to make the right choice for addressing your carpal tunnel syndrome symptoms.

Related Links: Physical Therapy Isn’t Always the Right Treatment for Carpal Tunnel Syndrome Genetic Risk Factors for Carpal Tunnel Syndrome Shoulder Pain and Carpal Tunnel Syndrome

Please note that not every case is the same. There may be factors that change your expected recovery situation, and we will discuss these possibilities with you during your examination.

On average, however, you will be wide awake during the procedure, so no grogginess will be present afterwards.  However, should patients wish to have sedation arrangement for this can be provided in advance.  The total time you should spend with us is about 1 to 2 hours, with a fraction of that being the procedure itself.

Your incision may be closed with adhesive bandages or a single tiny suture if needed, but you will not have to immobilize your wrist. A Band-Aid or light dressing will be applied over the incision.  Standard over-the-counter medication should be all you need to manage discomfort after surgery; however, stronger medication will be prescribed if needed.

Recovery from the soreness of surgery typically takes 3-6 days, compared to weeks with other methods of carpal tunnel release. Resolution of the nerve symptoms of carpal tunnel vary for every patient depending on many factors – including length of time you have had the nerve compression, and the severity of the compression. 

The worse the disease, the longer it can take for the nerve to recover.  Moderate nerve symptoms are expected to resolve very quickly; frequently the symptoms of numbness, tingling, and pain that were present prior to surgery can resolve within hours, days, or weeks.   

There are many! To name several^1,2:

• A small incision (3-5 mm) above wrist crease on the forearm is all that is required compared to open scar on the palm of the hand or a potentially slightly larger incision with and endoscopic releases.
• The procedure itself takes only a matter of minutes.
• Carpal tunnel release with ultrasound guidance can be performed entirely within our office, with no need for a hospital or surgical center.
• Only local anesthesia is typically required.
• Sutures are rarely needed to close the small incision. Adhesive strips are often enough.
• There is no need for a brace or cast.
• The patient can return to most daily activities almost immediately (though we do emphasize caution – no reason to be fool hearty!
• Most patients will be able to return to work very quickly after surgery, typically within 3-6 days. 

<sub>1. Rojo-Manaute JM, Capa-Grasa A, Chana-Rodriguez F, et al. Ultra-minimally invasive sonographically guided carpal tunnel release: a randomized clinical trial. J Ultrasound Med. 2016 Jun;35(6):1149-1157.
2. Henning PT, Yang L, Awan T, et al. Minimally invasive ultrasound-guided carpal tunnel release: preliminary clinical results. J Ultrasound Med. 2018 Nov;37(11):2699-2706.</sub>

How badly the nerve is injured will affect how fast it can recover.  If a nerve is cut in half and sewn together, it can grow at the rate of an inch a month or a millimeter a day.  If the nerve is mildly pinched but still functional, then it can recover function in a few hours or a few days. 

As the nerve compression gets more severe or if it has been compressed a long time, it can take months for nerves to improve.  The nerve will regenerate better in younger patients than in older patients. However, we do see nerve regeneration and functional improvement even in the elderly.

Contact Our Office To Get Help With Nerve Damage Recovery

Dr. Williams can create a treatment plan to help ease your pain and get you back to living pain-free as soon as possible. To schedule an appointment in the Baltimore office, contact us at (410) 709-3868 or fill out our contact form online.