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PICSM employee examining elbow of patient


Many people suffer from neuropathic or nerve-related pain to the upper and lower extremities. Often it can be a deep burning, aching and at times knifelike pain that just won’t go away.  Most physicians prescribe pain medications for neuropathic pain with limited success. Few providers have knowledge of newer treatment strategies.  

What is important to understand is that nerve sheaths (the insulated wire coating) have their own innervation system to help signal pain from direct stimulation called the nervi nervorum. The nervi nervorum are sensitive to stretching and can lead to a release of inflammatory neuropeptides (proteins) that signal to the surrounding area that injury has occurred. This release of neuropeptides can cause vasospasm, ischemia (decreased blood flow), pain, breakdown of surrounding structures, insomnia, and mood disorders.

With repetitive injury to a nerve, a vicious cycle develops. When nerves are not healthy, they can lead to “sick” fascia and vice versa. Poor movement of nerves through fascia from adhesions, scar tissue, and/or nerve entrapments cause pain. At PICSM we specialize in the identification and treatment of nerve injury using high resolution ultrasound (HRUS) imaging. 

With our HRUS, we can improve  your neuropathic pain by releasing nerve compressions using a technique called nerve hydrodissection. Simply, nerve hydrodissection is performed by using an ultrasound-guided injection to the nerve entrapment area and using fluid to break up any tissue restrictions causing the entrapment and to stop the release of the inflammatory proteins.

Through our expertise in the use of HRUS imaging, our advanced training and our state-of-the-art equipment, we can accurately identify many nerve injuries, use hydrodissection procedures to release nerve entrapments, and use regenerative techniques to help resolve chronic neuropathy and nerve pain symptoms.

Carpal Tunnel Syndrome and other nerve entrapments

There are many different types of nerve entrapments in the body. Carpal tunnel is probably the most well known, but essentially any nerve can get entrapped by poorly moving or injured fascia or muscles, crossing over bony edges, going through tunnels, or being compressed or stretched beyond its tolerance level. When a nerve is entrapped, it also becomes inflamed, or “sick.” In some cases this leads to the nerve becoming larger and/or the release of chemicals, both of which can cause further pain and poor movement. The vicious cycle continues until we treat the area of entrapment and determine why the nerve became sick in the first place.

Cervical Plexus and Brachial Plexus

Dr. Steele is well known internationally for his work on nerve-related pain and disorders in the neck and shoulder blade area that many other providers are unaware even exist. He has not only treated hundreds of patients, but has also lectured and performed hands-on training at many conferences on his unique approach to these problems both diagnostically and therapeutically. He regularly teaches the other PICSM providers on these areas. PICSM works as a team, at times seeing some of these patients together to continue to advance these treatments so they can be offered to more patients.

Scar Release

Even well-healed scars can cause pain if the superficial nerve fibers have been damaged. Scars run deeper than the surface down to where the tissue was either cut or damaged. Consequently, scars can lead to the possibility of nerve entrapment or inflammation at many levels. Using our ultrasound-guided nerve hydrodissection technique, after a careful examination to determine if the scar is a source of pain, we can help treat pain related to scars.

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