WRIST PAIN


There are many conditions affecting the wrist that may cause a range of symptoms ranging from mild discomfort to severe pain.  These can adversely affect the quality of your life including the ability to work, sleep and enjoy recreational activities.


At the Center for Integrated Pain Management a customized treatment plan is designed to give you optimal health and relief.  Below is a list of elbow, hand and wrist conditions that the Center treats:


  • De Quervain’s Tenosynovitis
  • Carpal Tunnel Syndrome
  • Muscle Spasms
  • Wrist Osteoarthritis
  • Wrist Sprains, Strains and tears
  • Nerve Entrapment/Radiculopathy


A diagnosis will be made once Dr. Kulick reviews your family history, completes a thorough physical examination and conducts an in-office ultrasound. If necessary, Dr. Kulick may request that you obtain an MRI, a CT Scan or additional X-rays in order for him to precisely determine the diagnosis and treatment plan.

To learn more about the treatment and relief of wrist conditions please contact our office at 212-867-1777.


De Quervain’s Tenosynovitis


What is De Quervain’s Tenosynovitis?

De Quervain’s Tenosynovitis is an inflammation of the tendons, the tissue that attaches muscles to bones, at the base of the thumb near the wrist.  Overuse and repetitive hand or wrist movements may cause this painful ailment. Scar tissue from a previous injury may also increase the risk of developing this condition.


Seek treatment for the following symptoms:

  • Pain or swelling at the base of the thumb
  • Difficulty making a fist or grasping an object
  • Trouble turning the wrist
  • A “snapping” sensation when moving the thumb


Next Steps

Consult the Center for a diagnosis and for treatment options. These may include rest, physical therapy, a wrist or thumb splint, ultrasound-guided corticosteroid injections, a tenotomy to destroy damaged tissue followed by ultrasound-guided prolotherapy injections or platelet rich plasma therapy (PRP) injections to accelerate the growth of healthy replacement tissue.

To learn more about the treatment and relief of De Quervain’s Tenosynovitis please call our office at 212-867-1777.


Carpal Tunnel Syndrome


What is Carpal Tunnel Syndrome?

Carpal Tunnel Syndrome occurs when swelling in the carpal tunnel, a narrow channel located at the wrist, causes pressure on the median nerve. This nerve controls sensation in the thumb, index and middle fingers. Inflammation of the tunnel may be caused by arthritis or a trauma to the wrist such as a fracture.  Women are more likely to develop this condition. Numbness, tingling and pain in the hand, fingers and forearm may be experienced.


Seek Treatment for these Symptoms:

Symptoms may begin gradually.  If left untreated they can become permanent.

  • Numbness or tingling in the hands or fingers
  • Pain in the hand or forearm
  • Difficulty gripping items


Next Steps

Consult the Center for a diagnosis and for treatment options. These may include rest, a steroid-free hydrodissection in which the median nerve is freed from compression, an ultrasound-guided nerve block injection and a wrist splint.


To learn more about the treatment and relief of Carpal Tunnel Syndrome please call our office at 212-867-1777.


Muscle Spasms

 

What Are Muscle Spasms?

Muscle spasms are very common and can happen without warning. Perhaps you pick up a heavy box, reach for an item or even sleep in an awkward position. This suddenly triggers a muscle spasm in your wrist and you cannot straighten or move it without pain. Muscle spasms are the involuntary contraction or tensing of one or more muscles. They may in the wrist, forearm, hand, neck, upper or lower back, and legs.  Muscle spasms may be caused by heavy lifting, muscle overuse, weak muscles, nerve compression, spinal conditions such as degenerative disc disease or a herniated disc, and many sports injuries. Some sports including golf, football, weightlifting and basketball that require the constant twisting of the spine may lead to back spasms. Spasms may seem to appear out of nowhere, however, typically small tears in the muscle may have developed over time. These tears may lead to swelling that compresses the nerves surrounding the muscle. This in turn triggers a muscle spasm that can cause pain, cramping or twitching.


Seek Treatment for these Symptoms:

  • Muscle pain that does not dissipate on its own
  • Constant muscle cramps
  • Difficulty walking or moving
  • Muscle appears hard or distorted


Next Steps

If the muscle spasm does not resolve by itself after a few days of rest, icing the area for short periods of 10 to 20 minutes every two hours or using a heated pad, and taking non-steroidal anti-inflammatory medication, then seek treatment. Consult the Center for a diagnosis and for options.  The spasm may be the result of an underlying condition that can be treated. Once identified, treatment options may include ultrasound-guided corticosteroid injections, trigger point therapy, ultrasound guided prolotherapy injections or anti-inflammatory or muscle relaxant medication. Ultrasound guided injections of platelet rich plasma (PRP), or stem cell therapy may be advised. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve or ultrasound-guided nerve block injections will be recommended.

To learn more about the treatment and relief of Muscle Spasms please call our office at 212-867-1777.


Wrist Osteoarthritis


What is Wrist Osteoarthritis?

Arthritis, the inflammation of a joint, is a prevalent source of chronic pain for millions of people including older adults and children.  The joint is the point at which bones are connected to other bones. Osteoarthritis, a progressive and chronic disease, causes the cartilage to wear away where the bones meet in the wrist. Most often the joints at the base of the thumb, middle of the finger and near the fingernails are affected. The edges of bones are covered with a cushion of connective tissue called cartilage to ensure the friction-free movement of the joint. When cartilage deteriorates, bones rub against one another, triggering inflammation, stiffness and pain.  Boney knots in the fingers often form and can intensify the pain. Aging and daily wear and tear increase the degeneration of the joints.


Seek Treatment for these Symptoms:

  • Pain in the wrist or fingers
  • Stiffness in the wrist or fingers
  • Redness or swelling of the wrist or finger joints
  • Difficulty moving the fingers or wrist


Next Steps

Consult the Center for a diagnosis and for treatment options. Hand and wrist osteoarthritis treatments include anti-inflammatory medication, ultrasound-guided corticosteroid injections, ultrasound-guided injections of a hyaluronic injection acid such as Synvisc or Supartz to help cushion the joint as well as physical therapy.


To learn more about the treatment and relief of Wrist and Hand Osteoarthritis please call our office at 212-867-1777.


Wrist Sprains and Strains and Tears


What are Wrist Sprains and Strains?

Wrist sprains and strains are very common injuries. A sprain is an injury to a ligament, the connective tissue that attaches bones to bones in this case in the wrist. A wrist train is the stretching or tearing of the muscles or tendons in the wrist. Tendons attach muscle to bone. Repetitive motions, lifting heavy objects incorrectly or even working out improperly, may cause a strain in the hand or wrist. A blow to the wrist or when you try to break a fall with an outstretched hand can cause a sprain. The wrist twists in an unnatural position resulting in damage to the ligaments that may range from a mild stretching of the ligament to a partial or complete tear. Since there is little blood flow to the ligaments a sprain takes longer to heal than a strain.


Seek treatment for the following symptoms:


  • Wrist pain
  • Bruising of the wrist
  • Muscle spasms
  • Swelling of the wrist


Next Steps


Consult the Center for a diagnosis and for treatment options. These include rest, ice, ultrasound-guided corticosteroid injections and physical therapy. Additional highly specialized and cutting edge options for strains include ultrasound-guided tenotomy injections that destroy damaged tissue, followed by ultrasound-guided prolotherapy injections or ultrasound guided injections of platelet rich plasma therapy (PRP) to accelerate the growth of healthy replacement tissue.


To learn more about the treatment and relief of Wrist Sprains, Strains and Tears, please contact our office at 212-867-1777.



Nerve Entrapment/Radculopathy


What Is Radiculopathy?

Radiculopathy is a group of conditions affecting one or more nerves in the spine. These nerves may become pinched or compressed, causing pain, numbness or tingling in the arms or legs. The sciatic nerve, the large nerve that runs down the lower back, hip, buttocks, and back of leg to the foot may be compressed in the lower back as a result of a herniated disc or other spinal damage.

Radiculopathy commonly occurs in the cervical spine (neck), the thoracic spine (mid back)or the lumbar spine (lower back).

Cervical, thoracic, and lumbar radiculopathy are often caused by herniated discs in the vertebrae (bones of the spine) and spinal stenosis, a narrowing of the hole in the vertebrae through which spinal nerves exit.  This places pressure on the nerves as they branch out from the spine. The compression may also be caused by an injury, overuse of muscles and tendons, poor posture, bone spurs, and arthritis.

Seek Treatment for these Symptoms:

  • Pain that radiates outward from the injured nerve
  • Numbness, tingling, burning sensation
  • Muscle weakness
  • Cervical radiculopathy affects the neck, upper back, shoulder, chest, arm,or hand.
  • Thoracic radiculopathy affects the chest, ribs, shoulders, mid back or stomach area
  • Lumbar radiculopathy causes sciatica which is an irritation of the large sciatic nerve located in the lower back.  This causes pain to radiate down the back of the leg to the calf or foot called sciatica
  • Pain may be aggravated by activities such as walking, climbing stairs or sitting

Next Steps

Consult the Center for a diagnosis and for treatment choices.  Depending on the diagnosis, treatment options may include ultrasound-guided corticosteroid injections, ultrasound -guided injections of platelet rich plasma (PRP), ultrasound-guided prolotherapy injections, physical therapy and anti-inflammatory medication. If nerve entrapment is indicated then a steroid-free hydrodissection to release the nerve and ultrasound-guided nerve block injections will be recommended.


To learn more about cervical radiculopathy and its treatment please call our office at 212-867-1777.




Location
Alexander Kulick, MD
112 East 61st Street
Upper East Side

New York, NY 10065
Phone: 917-810-4139
Fax: (646) 585-0042
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917-810-4139