Elbow Nerve Specialist
Are you experiencing pain, tingling, and a “falling asleep” or numb sensation in the little finger and ring finger? If so, you may have ulnar nerve entrapment, or a pinched nerve in your elbow. Also called cubital tunnel syndrome, ulnar nerve entrapment can occur in several places along the nerve path of the arm. Most symptoms are felt on the inside of the elbow and extend to the fingers of the hand. It is very important to visit a doctor at the onset of ulnar nerve compression symptoms to avoid muscle wasting. Ulnar nerve entrapment specialist, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who are experiencing the symptoms of a compressed or pinched elbow nerve. Contact Dr. Williams’ team today!
What is ulnar nerve entrapment?
The ulnar nerve is one of three main nerves of the arm. The ulnar nerve runs through the length of the arm and carries signals from the brain to the fourth and fifth fingers of the hand. This nerve courses from the base of the neck, along the inside of the arm, through the elbow and down to the fingers. Ulnar nerve entrapment is also known as cubital tunnel syndrome. An entrapped nerve is clinically the same as a pinched nerve. Entrapment of the ulnar nerve in the cubital tunnel of the elbow causes achiness, pain, tingling and numbness in the forearm and fingers. If left untreated, cubital tunnel syndrome can cause muscle loss in the hand and forearm. The site where the ulnar nerve
passes through the elbow (cubital tunnel) is narrow; the base of the tunnel is the bony portion of the medial epicondyle of the distal humerus. When the elbow is flexed, the ulnar nerve is stretched and compressed in the cubital tunnel, elbow extension reliefs this tension on the nerve. Though the cubital tunnel is the most common area of ulnar nerve entrapment in the arm, the nerve may be constricted in other areas of the arm as well.
What is cubital tunnel syndrome?
Cubital tunnel syndrome is ulnar nerve entrapment at the site of the medial epicondyle. The cubital tunnel is narrow and is comprised of a bony base and an inflexible ligamentous sleeve. The ulnar nerve travels behind the medial epicondyle in the cubital tunnel. Constriction of the ulnar nerve in the cubital tunnel typically is exacerbated by elbow flexion or bending. Cubital tunnel syndrome can result in pain, numbness and tingling in the forearm, hand and fingers; more severe cases can result in a loss of general motor function in the hand. Dr. Riley J. Williams, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas has extensive experience in cubital tunnel syndrome and ulnar nerve entrapment.
What are the symptoms of cubital tunnel syndrome?
Individuals in the New York area who suffer from ulnar nerve entrapment or cubital tunnel syndrome often report the following symptoms:
- Forearm, hand and finger numbness and tingling
- Loss of motor skills in the hand
- Loss of dexterity
- Pinky and ring finger tingling/numbness
- Hand clumsiness
- Inability to hold things, resulting in dropping objects
- Worsening symptoms at night, stemming from sleeping in a flexed elbow position
- Pain or a burning feeling in the elbow or funny bone (inner elbow)
How is ulnar nerve entrapment/cubital tunnel syndrome diagnosed?
Dr. Williams performs a physical exam to check for tenderness, motor strength, and sensory changes in the hand, forearm and elbow. Longstanding cases of ulnar nerve can present with muscle distal to the elbow. A diagnostic test, such as an electromyogram (EMG) will demonstrate the functionality of the ulnar nerve and determine where nerve compression may be located.
How is cubital tunnel syndrome treated?
Non-surgical treatment:
Conservative methods are typically the first line of treatment for the ulnar nerve compression. Rest, elbow splints, and NSAIDs, such as ibuprofen, can help reduce pain and inflammation. Physical therapy may be implemented to strengthen the arm muscles; occupational therapy can fine tune motor skills.
Surgical treatment:
If nonoperative methods fail or if cubital tunnel syndrome symptoms are longstanding, surgery is indicated. Dr. Williams performs ulnar nerve decompression and transposition on an outpatient basis. Light sedation and regional anesthetic are used during this surgery. An incision is made at the medial elbow, and the nerve is mobilized and cleared of all adhesions. The nerve can be left in the decompressed tunnel, or moved to a new location that is usually anterior to the cubital tunnel. It typically takes six weeks to recover from ulnar nerve compression surgery.
For more information on ulnar nerve entrapment, cubital tunnel syndrome and the treatment options available, please contact the office of Riley J. Williams, MD, orthopedic elbow specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Snapping Scapula Specialist
Are you experiencing a snapping sensation in the shoulder blade? Do you have pain along the shoulder blade when moving? If so, you may have a shoulder condition called snapping scapula syndrome. This can be caused by overuse, reaching overhead or by sports that involve overhead movements. Snapping scapula syndrome specialist, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who are experiencing snapping scapula syndrome. Contact Dr. Williams’ team today!
What is snapping scapula syndrome?
Snapping scapula syndrome is also known as scapulothoracic bursitis; this malady is characterized by snapping, popping, and pain in the upper back area, usually deep to the shoulder blade. The scapula is the shoulder blade; the scapula is a triangular shaped bone that sits at the superior area of the right and left upper back. A bursa (fluid filled sac) is located between the scapula and the thorax (rib cage). The bursa provide cushioning and protection against friction during movement of the shoulder blade relative to the rib cage. This fluid sac is known as the scapulothoracic bursa. Inflammation of the scapulothoracic bursa can occur is association with weightlifting, throwing, swimming, tennis and a number of other upper extremity based activities. Inflammation of this bursa is also known as scapulothoracic bursitis. Dr. Riley J. Williams, orthopedic shoulder specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas has extensive experience in treating snapping scapula syndrome and other shoulder related injuries.
What are the symptoms of scapulothoracic bursitis?
The scapula is connected to the rib cage by soft tissue attachments only. There is no bony joint between the thorax and the scapula. These soft tissue attachments allow for the smooth movement of the upper extremity relative to the thorax. Typically, the scapula moves synchronously with the rib cage; inflammation of the deep bursa of the scapula can alter this dynamic. The symptoms of the snapping scapula include:
- Snapping sensation and noises in the shoulder blade
- Swelling
- Stiffness
- Shoulder weakness/instability
- Shoulder blade pain upon movement
- Pain/tenderness
- Noticeable posture difference
- Inability to perform overhead arm movements
How is snapping scapula diagnosed?
Dr. Williams will discuss your medical history and source of pain. He will also perform a physical examination while looking for deformities of the scapula and posture. A physical pop can be detected deeply at the shoulder blade in more severe cases. Shoulder range of motion and strength are assessed. Imaging tests, such as an x-ray, MRI or CT scan can help further diagnose the injury. CT scans are very helpful in detecting deep bony projection of the scapula that may be responsible for this malady.
How is snapping scapula treated?
Non-surgical treatment:
Non-surgical approaches are commonly applied with patients suffering scapulothoracic bursitis. Resting, activity modification and icing the affected area helps to decrease pain and inflammation. Over-the-counter non-steroidal anti-inflammatory medications, such as ibuprofen or naproxen can also help decrease swelling and pain. Range of motion exercises and physical therapy restore normal shoulder motion and motor strength. A strong shoulder girdle helps to improve shoulder kinematics. Dr. Williams may also suggest a corticosteroid injection. These injections provide immediate relief but should be considered carefully prior to adminstration.
Surgical treatment:
If pain, mechanical symptoms and shoulder dysfunction persist after the application of nonoperative treatment strategies, Dr. Williams may recommend surgery. The surgical approach involves removing the scapulothoracic bursa and/or partial scapular resection. A bursectomy is a procedure that removes inflamed bursa and surrounding scar tissue. In addition, irregular bony projections or spurs are typically removed during this procedure. A partial scapular resection focuses on the upper medial portion of the scapula which may be causing improper friction against the thorax (rib cage). Patients are typically immobilized for a few days following this procedure; a sling is used for approximately one week. Physical therapy is started after the first week and typically continues for 2-3 months.
For more information on snapping scapula syndrome and the treatment options available, please contact the office of Riley J. Williams, MD, orthopedic shoulder specialist serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Ulnar Nerve Transposition Surgeon
Are you experiencing tingling or numbness in the elbow, wrist, or fingers and specifically in the ring and pinky fingers. If so, you may have cubital tunnel syndrome, or a nerve that is pinched in your elbow. This elbow condition can be treated by a procedure called ulnar nerve transposition. Ulnar nerve transposition surgeon, Doctor Riley J. Williams provides diagnosis as well as surgical and nonsurgical treatment options for patients in Manhattan, Brooklyn, New York City and surrounding areas who are experiencing a pinched nerve in their elbow or cubital tunnel syndrome. Contact Dr. Williams’ team today!
What is ulnar nerve transposition?
Ulnar nerve transposition is an outpatient surgical procedure that treats ulnar nerve entrapment or cubital tunnel syndrome. The procedure involves moving the ulnar nerve (“the funny bone”), which runs at from top of the inner upper arm near the shoulder, across the inside of the elbow, and down to the fingers. The ulnar nerve is repositioned from its placement behind the medial epicondyle to an area above the condyle where it will not be compressed or stretched during normal elbow bending. Dr. Riley J. Williams, orthopedic elbow surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in successfully performing ulnar nerve transposition procedures.
What is ulnar nerve entrapment?
Ulnar nerve entrapment or compression may also be referred to as cubital tunnel syndrome. Ulnar nerve entrapment is responsible for tingling or numbness in the elbow, wrist, or fingers, specifically the ring and pinky fingers. This long nerve pass through a narrow soft tissue sleeve at the bottom of the medial elbow and is called the cubital tunnel. The nerve run behind the elbow and is stretched when the elbow is flexed or bent. Abnormal constriction or tension of the nerve in the cubital tunnel can lead to pain, numbness and tingling in the forearm and hand. Surgery may be necessary if the numbness and tingling substantially affect hand and finger motor skills.
How is ulnar nerve transposition performed?
Dr. Williams makes an incision by the medial epicondyle; he then carefully locates and exposes the ulnar nerve. A release of the nerve and neurolysis is performed. He then reposition the nerve to a different (more anterior) location on the inside of the elbow. The new placement will be superficial (subfascial), or within the muscle (submuscular). This relocation prevents the nerve from getting stretched or compressed in the cubital tunnel. Following the transposition, the nerve slackens with elbow flexion. Once surgery is completed, the elbow is placed in a bulky dressing and sling for about one week.
What are the risks of ulnar nerve transposition?
Risks from surgery may include:
- Infection
- Continued tingling due to incomplete decompression of the nerve
- Pain at the incision site
- Nausea, vomiting and/or constipation from prescribed pain medication
- Swelling
How long does it take to recover from cubital tunnel surgery?
A bulky dressing is used for about one week after surgery. Physical therapy begins 5-7 days after surgery and patients are encouraged to move their elbow right away. Prescribed pain medication (narcotics) may be advised for a finite period of time after the surgery to stay on top of pain before transitioning to an over-the-counter non-steroidal anti-inflammatory medication PT is recommended to restore mobility, strength and range of motion in the elbow, hand and fingers. Patients can increase their activity to tolerance once the wound is healed and range of motion is restored. A full recovery is expected over 2-4 months.
For additional resources on ulnar nerve transposition or to have your elbow pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic elbow surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Osteochondral Allograft Transplantation Specialist
Dr. Riley J. Williams performed the first fresh osteochondral allograft transplant in New York State in 1998 and since then, has performed over 3,000 OCA transplant surgeries. OCA or osteochondral allograft transplantation treats patients who have large areas of damaged articular cartilage in the knee. If you experience pain, inflammation or catching of the knee that affects your athletic performance or everyday tasks, and if you are under the age of 50, you may benefit from this type of treatment. Patients in Manhattan, Brooklyn, New York City and surrounding areas who would like more information on an OCA transplant should contact Dr. Williams’ team today!
What is osteochondral allograft transplantation (OCA)?
Dr. Williams performed the first fresh osteochondral allograft transplant in New York State in 1998. Osteochondral allograft transplantation is a surgical procedure that uses healthy tissue from a cadaver donor to repair a cartilage injury or defect. Most osteochondral allograft procedures are performed in the knee. Damaged knee articular cartilage results in exposed bone in the knee joint. Loading of this exposed bone causes knee joint pain, friction and inflammation. During an osteochondral allograft transplantation procedure, a donor cartilage graft is shaped to fit the area of cartilage deficit. The allograft is then transplanted into the cartilage defect and replaces the damaged section. The transplanted graft immediately fills in the missing cartilage and help provide the patient with pain relief and improved knee function. Dr. Riley J. Williams, orthopedic knee surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in performing osteochondral allograft transplantation.
What does an OCA transplant treat?
Osteochondral allograft transplantation is used to treat large areas of damaged articular cartilage in the knee. If an individual experiences pain, inflammation or catching of the knee that affects athletic performance or everyday tasks, and the individual is under the age of 50, he or she may benefit from this type of treatment. Those who suffer from osteochondritis dissecans (damaged cartilage associated with a bone disorder), avascular necrosis (bone tissue death) or localized, full-thickness cartilage, may benefit from osteochondral allograft transplantation. Osteochondral allograft procedures can be used to treat all surfaces of the knee joint: femur, patella and trochlea. Dr. Williams will discuss the severity of the injury and the required treatment with the patient.
How is an osteochondral allograft (OCA) transplant performed?
Osteochondral allograft transplant is a relatively simple procedure that is done on an outpatient basis. Light sedation and regional anesthesia is used for this surgery. Because Dr. Williams is replacing large areas of cartilage, osteochondral allograft transplantation requires the use of a small incision just adjacent to the patella tendon. Most implanted allografts are cylindrical and are called dowel grafts; the top of the graft is cartilage and the bottom in bone. After Dr. Williams makes the incision, he measures the defect. He prepares the damaged cartilage area in preparation for allograft implantation. The sterile allograft is sized to fit perfectly over the damaged section that was prepared. Most graft are placed as a “press fit”; screws or pins are not typically needed to stabilize these grafts. Graft stability is ensured by bony ingrowth into the base of the implanted graft. Long term graft survival is maintained by the live cells that reside within the cartilage of the donated graft.
Patients use crutches for one week, and then are allowed to full-weight bear. A small brace is used early during the rehabilitation process; bracing discontinued after approximately 3 weeks. Physical therapy starts one week after surgery and continues for about 3 months following the procedure.
What are the risks of OCA surgery?
Rare side effects include infection, bleeding, continued pain, stiffness and allograft rejection. Infection is rare due to strict standards for screening and sterilizing donor tissue; prophylactic antibiotics are always used before surgery to mitigate the infection risk. Larger allografts can fragment or collapse if not properly implanted. Graft rejection is exceedingly rare. Dr. Williams has performed over 3000 OCA procedures and seen this occur in one patient over 20+ years.
How long does it take to recover from an osteochondral allograft transplant?
Most OCA transplant patients are fully recovered around six months. Normal activities of daily living are manageable in most patients by 4 weeks after surgery. Full clearance for sports is predicated on the return of normal knee strength, range of motion and coordination. MRI scans are used at 6 months to confirm graft incorporation and competency prior to clearance for sports.
For additional resources on osteochondral allograft transplantation or to have your knee pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic knee surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.
Lysis of Adhesions (LOA) Doctor
Do you have a stiff knee, or have you been diagnosed with stiff knee syndrome or arthrofibrosis? Arthrofibrosis can occur after knee surgery or after a traumatic injury. Arthroscopic knee surgeon, Doctor Riley J. Williams can treat stiff knee syndrome for patients in Manhattan, Brooklyn, New York City and surrounding areas, using a treatment called lysis of adhesions. This very specialized surgery should be done by an expert. For an evaluation of your knee stiffness and to see if you can be helped by this procedure, contact Dr. Williams’ team today!
What is knee arthroscopy lysis of adhesions (LOA)?
Knee arthroscopy lysis of adhesions is a minimally invasive surgery that uses small incisions and surgical tools to remove scar tissue and tightness in the knee. Lysis of adhesions involves cutting bands of abnormal tissue called adhesions. Scar tissue can form in the knee joint after an injury or prior surgery. Severe cases of scar tissue formation can lead to the development of arthrofibrosis (global knee scarring). Soft tissue adhesion and scar tissue can restrict movement in the joint, cause pain, and limit range of motion. The goal of lysis of adhesions is to restore near normal knee function and kinematics by removed all abnormal soft tissue connections and scar tissue. A deep understanding of knee anatomy and mechanics is necessary to treat knee dysfunction associated with adhesions, scar tissue and arthrofibrosis. Dr. Riley J. Williams, orthopedic knee surgeon, serving Manhattan, Brooklyn, New York City, NY and surrounding areas, has extensive experience in performing knee arthroscopy lysis of adhesions procedures.
Why is knee arthroscopy LOA performed?
Knee arthroscopy lysis of adhesions is performed on individuals who have exhausted conservative treatment methods for knee stiffness or arthrofibrosis (stiff knee syndrome). Knee arthrofibrosis can occur after a traumatic injury or surgery (i.e. ACL reconstruction or knee replacement). Stiff knee syndrome limits mobility because scar tissue entraps the knee joint structures. In this condition, the synovium (joint lining) becomes globally inflamed and thickens as a natural response to trauma. Arthrofibrosis causes muscle and connective tissue in the knee to shorten and stiffen. If physical therapy is unsuccessful in treating knee stiffness, lysis of adhesions (LOA) may be the next step in treatment.
How is knee arthroscopy LOA performed?
Sedation with regional anesthesia is most often used for this procedure. Knee arthroscopy lysis of adhesions uses surgical tools and a small camera called an arthroscope. The knee is inflated with fluid to provide greater space and access within the joint for the procedure. Small incisions are made in the knee which allows for the arthroscope to project images of the injury onto a monitor. Adhesions are identified and then debrided with a surgical device called an arthroscopic shaver. Any areas of abnormal constraint or connection are released. Often an arthroscopic radiofrequency device is used for soft tissue release and vessel cautery during LOA. A lateral retinaculum release may be done as part of an LOA. This means the ligaments on the outer side of the knee are loosened for patients who experience limited patellar (kneecap) mobility. Improved patella mobility and excursion is a major goal of lysis of adhesions. Upon completion of the needed soft tissue releases, the knee is manipulated to confirm increased range of motion and normal stability.
As a note, more severe cases of arthrofibrosis may require a small incision to fully excise all of the scar tissue present. This is a judgment call that is determined by findings at the time of surgery. Fortunately, the need for open surgery does not change the postoperative management of affected patients.
What are the risks of lysis of adhesion surgery?
Knee arthroscopy lysis of adhesions is a simple procedure but the aftercare is important to maximize clinical results. The outcome of the surgery can be highly dependent on how quickly the surgery was performed after the onset of the arthrofibrotic condition. In the most severe cases, full knee range of motion may not be achievable even after surgery. Compliance with physical therapy is crucial to a successful outcome. The patient should expect swelling and soreness temporarily afterward the procedure. Other issues such as infection, bleeding, blood clots and continued stiffness are possible but rare.
How long does it take to recover from lysis of adhesions surgery?
Patients treated with lysis of adhesions go home the day of surgery. Range of motion exercises should be started the day following the procedure; physical therapy starts 3-5 days after surgery and continues 2-3 times per week for approximately eight weeks. After six weeks, improved range of motion and patella excursion should be observed. Pain medications, such as narcotics as well as NSAIDs (non-steroidal anti-inflammatory) medications will be necessary immediately following surgery. Crutches are recommended for the first three days after the procedure for swelling reduction and stability.
For additional resources on knee arthroscopy lysis of adhesions or to have your knee pain evaluated, please contact the office of Dr. Riley J. Williams, MD, orthopedic knee surgeon serving Manhattan, Brooklyn, New York City, NY and surrounding areas.