If non-surgical treatments, such as wearing wrist braces and taking anti-inflammatory medication, have failed to help your symptoms of carpal tunnel, then it may be time to come in to see me. A very simple surgery can be performed that will alleviate pain and prevent further loss of sensation and strength.
These are the clear signs that you should consider surgery:
1.Â Â Â Â Â Â Progressing weakness and/or numbness in the hand.
2.Â Â Â Â Â Â If the achiness and pain is so severe that it is disrupting your lifestyle or affecting your work.
3.Â Â Â Â Â Â If there is loss of strength in the hand.
These are all signs that your median nerve is under considerable stress and needs to be relieved with a surgical procedure.
Carpal Tunnel Syndrome is a condition that can develop in your hand and wrist and is caused by the compression of the median nerve at the wrist. The median nerve supplies motor function and sensation to the hand. When the tendons in your wrist become inflamed, they can put excess pressure on the soft nerve, causing tingling, numbness, weakness, and loss of strength in the arm and hand. Â These symptoms usually gradually present themselves at night. According to a 2010 study by the Journal of Hand Surgery, approximately 5% of people in the United States have CTS.
There are some non-invasive options to help relieve some of the symptoms of CTS. The use of anti-inflammatory medications are the easiest way to help keep symptoms at bay. Also, wearing wrist splints at night can be extremely beneficial, as well as limiting intensive activities that require a strong grip or put pressure on the wrist and palm.
While many people live with CTS, it is important to see a doctor if the pain, numbness or weakness becomes disruptive to your daily life or continue to increase. Our clinic can set up an appointment for you to come in and see me, so we can talk about your best options. Most of my patients say that they would have had their CTS surgery much sooner, if only they had known how easy it was.
Being a neurosurgeon requires endless hours of continuous training, work and sacrifice. There is a reason they say â€œWell, it isnâ€™t brain surgeryâ€¦â€ but for me, it is- every day.
The included infographic details both my education and my practice by sheer numbers.Â Â The numbers are staggering and serve as a testament to the experience I have gained over the last 23 years in practice, as well as the success of my clinic. Below is some more personal information about me and my experience in practice:
I truly feel that God gave me special talents that I am to use for the behalf of His people. Â I always see my patients as my own mom, dad, brother and sister and always do my very best to help my patients get back to the highest level of function. Â I always pray for my patients before, during and after the surgery. Â If they wish to, I will pray with the whole family before surgery. Â I greatly value communication with the family and patient. Â I want everyone to be clear about what we are doing, why we are doing it, goals, risks, alternatives and probable benefits. Â I also work to dispel goals which are unrealistic. Â I love my job and I love to help other people along their journeys.
My favorite surgeries are:
- Neck surgeries for arm pain numbness or weakness
- Because patients do so well and are so happy after the surgery. Â A very high percentage of patients are thrilled and get most of their function back.
- Deep Brain surgery for Parkinsonâ€™s disease and orÂ Benign, Essential or Familial tremor
- Because these patients are devastated by their diseases and are on their way to a nursing home environment. Â In a few hours I can help them so much. Â They are thrilled, and the effect is long term. Â I like doing procedures that are highly innovative and cutting edge. Â No pun intended.
- I am the first spine doctor in Idaho to earn certification from the National Committee for Quality Assurance.
- I haveÂ neverÂ had a patient die after or during an elective operation (not a trauma).
- I haveÂ neverÂ had to give a patient a blood transfusion for blood loss as the result of an elective surgery.
- The most surgeries I have completed in one day isÂ 10.
- My longest operation lastedÂ 35Â hours; it was a brain tumor on a young woman with three children. I noticed that looked like my wife.Â She did wonderfully and was cured with no recurrence for 15 years.
- I have experienced, first hand, moreÂ miraclesÂ than I can count.
I am very proud of my quality data regarding patient length of stay, return to surgery rate, and success rate at helping arm/leg pain, preventing further numbness, and weakness in the arms/legs. My surgical complication rate -infection rate, death, neurologic injury, bleeding, cervical spinal fluid leak, nerve or spinal cord damage- is among the lowest both locally and nationally.
I know now, in retrospect, that I am a much better surgeon now than in the past. Â The years have helped me to grow in wisdom, to know when a surgery is necessary, and to know the smallest and most careful procedure to perform. Â Most importantly, I have learned when a surgery, even if recommended by another surgeon, is not in my patientsâ€™ best interest and should be avoided.
As a neurosurgeon, many people do not know the appropriate time to make an appointment to come and see me. There is a point that is too early for me to help, but also waiting too long can cause irreversible damage to your body. Here are some clear cut reasons to call soon:
If you have an infection, a known tumor, or cancer.
Your neck pain has become unbearable, despite use of anti-inflammatory medication.
If your neck pain is causing further suffering down the arm.
If you are experiencing arm or hand weakness of ANY degree, including numbness and/or tingling in the hand or arm.
If an x-ray has shown neck or back pain due to slippage of the bones.
Low back pain with suffering similar to anything listed above is also cause to come in and see me.
Please keep in mind that whatever feeling and strength you lose may never come back. This is why it is important to see a neurosurgeon as soon as possible if you have these symptoms.
In cases of lower levels of pain or discomfort, I may not be able to help with a surgery. These include:
If you are experiencing neck or back pain that is isolated only in those areasÂ without arm or leg pain, numbness and/or weakness.
However, if these symptoms are associated with a fever, trauma, or cancer, you should make an appointment to see me.
As a general rule, persistent back or neck pain for over 6 months- despite the use of medications and therapy- probably should be evaluated by a physician. Significant arm or leg pain associated with any numbness and or weakness warrants evaluationÂ by me. Â Neck or low back pain alone rarely needs evaluation by a neurosurgeon unless associated with fever, trauma or cancer.
However, not everyone will be automatically admitted to surgery. Only these “red flags” require surgery by a neurosurgeon. Otherwise, your symptoms can be treated with proper conservative care.
Cervical Arthroplasty, or disc replacement surgery, is an incredibly effective alternative to traditional Cervical Fusion surgeries.
Rather than fusing the affected vertebrae together, forcing the surrounding discs to work harder and reducing your range of motion, Cervical Arthroplasty uses anÂ artificial disc. This disc preserves all range of motion, providing a more natural feeling in the neck or back. Furthermore, disc replacement prevents degeneration- or the general wearing down- of discs surrounding the affected area, reducing the risk of a revision surgical procedure. This is a great improvement from earlier technologies, as research shows that 25% of patients who have a Cervical Fusion will require another operation within 10 years, as surrounding discs begin to wear out.
This procedure not only allows full range of motion in the neck, but it also drastically reduces recovery time. Where a Cervical Fusion surgery requires time for the bones grow in, taking 3-4 months for recovery time, Cervical Arthroplasty allows the patient to be back to all normal activities in a matter of weeks. This procedure is also less invasive and requires no bone grafting, resulting in less pain, blood loss and overall surgical risks.
I have done more cervical arthroplasty than anyone in the Treasure Valley and because I, myself, have had a neck fusion, I can say that I would rather have had a disc replacement and saved my full range of motion. Â However, this option is not for everyone. Â Poor selection between the two techniques by the surgeon can cause long term neck pain. Â I have extensive experience determining the best option for each individual patient.
See my video on Disc Replacement as well as two patient testimonials here http://timjohansmd.com/disc-replacement/
While 80% of neck pain will resolve on its own, there are some red flag indicators that it is time to see a doctor.
When anti-inflammatory medications are not working to resolve your on-going neck pain, you should consider making an appointment to see a doctor. Â Especially if you are experiencing pain extending down your arm, it is time to see a doctor. Â If you are experiencing numbness or weakness in your arm, it is important to see a doctor as soon as possible.Â
Before you make your appointment, use ice, heat and anti-inflammatory medications. Pay attention to what activities causes pain and be wary of them. Â If your neck pain does not resolve itself after these measures are taken, or you have any of the “red flag” symptoms listed above, it is time to see a physician.
Significant arm or leg pain associated with any numbness and or weakness warrants evaluation. Â Neck or low back pain alone rarely needs evaluation by a neurosurgeon unless associated with fever, trauma or cancer.
The most common causes of neck pain include infection, joint inflammation, and trauma – such as an accident, cancer, or most commonly, bone spurs and disc herniation. When you come in to see me, one of my first tasks will be to assess what is causing the pain in your neck. From there, we can move forward.
Neck pain on its own does not necessitate an MRI. Â MRIâ€™s will be ordered if your neck pain persists beyond any normal solutions or if you are experiencing pain, numbness or loss of feeling down your arms. Another reason to order an MRI is if you have experienced a recent trauma that has led to new pains, or if you have cancer or are taking certain drugs that may compromise your immune system.
Many people ask if surgery is the solution to their neck pain. Unfortunately, there is not a clear answer to this question. Surgery can help neck pain, but that is not the goal of an invasive operation. I will not operate on a patient for neck pain alone; there must be other symptoms, such as pain, weakness, or numbness radiating down the arms. In these cases, the goal of surgery is to prevent any further loss of sensation or strength in the arms. Surgery does not guarantee that lost sensations or strength will return, but further nerve damage will be avoided.
Other reasons for neck surgery include cancer, tumors and instability in the neck when you move your head backwards and forwards, as well as inflammatory arthritis or natural degeneration.
I, myself, have been in the patientâ€™s seat: about ten years ago, I was experiencing intense neck pain. I took every measure to avoid surgical intervention, including anti-inflammatory medication, as well as limiting my activities. It was not until the problem extended down my arm that surgery became an option. Since my surgery, my neck pain has been greatly reduced, and my arm pain was diminished and eventually went away. Still, I have to take anti-inflammatory medicine and take caution in certain activities.
Surgery is a reasonable solution for some kinds of neck pain, which can be discussed with your neurosurgeon. When you come in to see me, I will first assess the causes of your neck pain before considering surgery or ordering an MRI.
For more information on neck pain please click here.
PHONE AND FAX
Tel: (208) 918 1914
Fax: (208) 367 2968
6140 W. Curtisian Avenue
Boise, Idaho 83704
3875 E. Overland Road
Meridian, Idaho 83642