What We Do

Diagnostic Studies

What is a nerve study?

Electromyography (EMG), and nerve conduction studies (NCS) are performed to assess the integrity of your nerves and muscles. It is usually ordered to ascertain if a patient’s symptoms are due to a problem with a nerve or nerves. It is less commonly ordered to evaluate for the possibility of muscle disease.

How is the test performed?

Electromyography (EMG), and nerve conduction studies (NCS) are performed to assess the integrity of your nerves and muscles. It is usually ordered to ascertain if a patient’s symptoms are due to a problem with a nerve or nerves. It is less commonly ordered to evaluate for the possibility of muscle disease.

 Will the test hurt?

The test is not pain free, but only uncomfortable. A calm patient will experience less discomfort than a tense, anxious one.

Are there any side effects from the test?

There are no side effects from the NCS exam. Some bruising may occur on occasion with the EMG exam, but this is temporary. The intramuscular electrode used for the EMG exam is a very fine wire with teflon coating, much smaller in diameter than the hollow needle used for the drawing of blood or injections. The EMG electrode is used only once, then discarded.

How long will the test take?

Usually the test will take 30 to 60 minutes. More complicated cases may take longer.

How should I prepare for the test?

You may shower or bathe normally, using deodorant. Please do not use cream or lotion on your skin. If your arms are to be tested, a short sleeve shirt may be advisable. You may be asked to change into a gown.

 What are nerves?

Nerves are made of soft tissue cables that exit the spinal cord as nerve roots, and travel to the extremity or trunk. They convey information to and from the brain. Sensory nerves carry information regarding sensation to the spinal cord and brain. Motor nerves carry electric impulses from the brain through the spinal cord, terminating in a muscle. Muscles contract as the result of chemical and electrical impulses generated through a peripheral nerve.

 What are symptoms of nerve problems?

Depending on the nerve, symptoms of numbness, tingling, motor weakness, or clumsiness are suspicious of a nerve-related problem.

How do nerves become damaged?

The usual mechanism of damage is for the nerve to be constricted or compressed by various anatomic structures. Nerves can be cut during trauma. Various medical conditions such as Diabetes can cause nerve problems. Toxic effects from various medications, exposure to certain organic compounds, or excessive of intake of alcoholic beverages can affect the nerves. Lack of important nutritional elements can cause nerve disease.

What is Carpal Tunnel Syndrome?

Carpal tunnel syndrome (CTS) implies the compression of the median nerve in the palm. Symptoms include numbness and tingling of the thumb, index and middle fingers. Motor weakness affecting the thumb may occur in more advanced cases. Symptoms are provoked by activities performed with a flexed wrist such as driving.

What is Cubital Tunnel Syndrome?

This condition implies a compression of the ulnar nerve at the inner elbow. This is the area called the “funny bone”. Symptoms include numbness and tingling of the little and ½ of the ring finger. Motor weakness of hand and forearm muscles will occur in more advanced cases. Symptoms are usually provoked by periods of positioning with a bent elbow, or when the inner aspect of the elbow is resting on a support.

What is Guyon’s Canal?

The ulnar nerve may become entrapped at the wrist. The symptoms may include numbness and tingling of the little and ½ of the ring finger, and weakness of the hand muscles. This condition can be brought about after a fall and fracture to the wrist, or by compression of the area of the palm used when biking, performing push-ups, or pushing heavy weights at the gym.

What is Peripheral polyneuropathy?

This condition implies damage of multiple nerves, usually affecting the lower extremities first, then the upper extremities. Symptoms will include numbness and tingling, usually first in the feet and legs, then hands and arms, in a so called “stocking-glove distribution”. Advanced cases will demonstrate motor weakness of the feet and hands, then in the more distal, possibly more proximal muscles of the arms and legs. Causes of peripheral polyneuropathy include a relation to medical conditions such as Diabetes, after suffering from certain infectious diseases such as Guillen Barre syndrome, exposure to toxins such as lead, excessive alcohol intake, as a side effect from certain medications, or simply hereditary in nature. Many times the underlying cause of a patient’s peripheral polyneuropathy is unable to be determined.

Hand Therapy

When your doctor refers you to our Hand Therapy department, you will be evaluated and treated by an occupational therapist with advanced certification in the field of hand and upper extremity therapy. Depending on your needs, the purpose of therapy is to restore strength, range of motion, functional use and to decrease pain levels. Your treatment may include modalities such as whirlpool, fluidotherapy, paraffin wax, hot/cold packs, electrical stimulation, ultrasound or iontophoresis. Various types of exercise equipment may be used for range of motion or strengthening. Our therapists are skilled in the fabrication of customized splints (orthotics) using low temperature thermoplastic materials. All efforts are made to see the patient immediately following the physician referral. However, at times that is not possible and scheduling at another time is required. The ultimate goal is returning the patient to work, sports, and daily activities with the highest possible level of function. You can reach for the Hand Therapy Department at extension 175.

Hand Therapy

What types of patients are helped by hand therapy?

Fractures, Arthritis, Replants, Replants of Limbs, Trigger Finger, Tendon Injuries, Amputations, Industrial or Traumatic Injuries, Activities of Daily Living Problems, Burn Injuries, Crush Injuries, Tennis Elbow or Golfer’s Elbow, Cumulative Trauma, RSD or Complex Regional Pain, Nerve Injuries, Congenital Abnormalities, Joint Replacements, Carpal Tunnel Syndrome, Dislocations, Strains or Sprains, Soft Tissue Wounds or Injuries, Repetitive Motion Injuries, Dupuytren’s Disease, Tendinitis, Lacerations, Dexterity Problems, Sports Injuries, Shoulder Injuries

Who will treat me?

Our therapists have advanced skills in the treatment of hand and upper extremity conditions. Our occupational therapists/certified hand therapists have close relationships with the Center's surgeons for optimal coordination of your treatment.

 How is care coordinated?

Upon the doctor's referral to our hand therapy department, our therapy secretary will make an appointment for you to be seen in our therapy department. Many walk-in patients are seen on the same day as their visit with the hand surgeon. Clarification of the doctor's orders can easily occur verbally with your physician present in the facility. Your care will also be coordinated with your insurance carrier, worker's compensation rehabilitation coordinator, primary care physician or referring physician. Updates of your current progress will be reported to your doctor on an ongoing basis to ensure appropriate continuity of care.

How long does therapy last?

Depending on the nature of the upper extremity problem and the type of intervention, average therapy sessions last 30 minutes to 1 hour and encompass a single session or continue for months.

Does the type of insurance affect my treatment?

Your insurance may dictate how many visits you are allowed for treatment. Please contact your insurance company to clarify your policy so that the therapist can customize your treatment to your available visits. While we do see patients covered by most insurance companies, it is best to understand your coverage before treatment begins. Some insurance carriers will pay for therapy services, but may restrict you in where you may be seen or what type of equipment may be used.

Who can make a referral for therapy?

Depending on the type of services required, referrals may come from a variety of sources. While the Hand & Shoulder Center's physicians refer most of our patients, other physicians may refer. Employers, insurance companies, attorneys, patients and families may recommend our rehabilitation services, however physician orders are necessary for evaluation and treatment of patients.

Occupational Health

Matching injured workers with appropriate work is the ultimate goal of the Hand & Shoulder Center's Occupational Health Services division. Utilizing the Functional Capacity Evaluation (FCE) as the core service, determinations made regarding appropriate job matching are coordinated between the worker, the employer, the surgeon, and the insurer. Matching the workers' known capabilities through the FCE with known components of the individual's work helps prevent further injury or re-injury and ensures productive return to appropriate work activities. Additional services such as workstation modification consultations and ergonomic risk analysis services provide solutions that enable the earliest optimal return to work.

Workers’ Compensation

The Hand & Shoulder Center provides workers' compensation services to assist in coordinating the care of injured workers treated at our facility. Partnering with the injured worker, the surgeon, the employer, insurance companies and nurse case managers, we seek to provide a cost-effective ingoing treatment plan that best meets the care needs of each injured worker while returning the worker quickly yet safely to the workplace. Coordinating the flow of information covering the injured worker's medical condition, treatment work status and ability to perform work activities is a central function of this service.

Independent Medical Examinations

We provide comprehensive Independent Medical Evaluations for workers’ compensation and liability injuries. Our board certified and trained physicians have expertise in a wide range of hand and upper extremity injury cases. Please call our offices to receive more information regarding our IME services at extension 168.

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