Pinched Nerve Treatment

About Pinched Nerve Pain

Nerves form a complex network of long structures that transmit messages between your brain and the rest of your body. Nerve roots descend from your brain via your spinal canal, and exit between their respective vertebrae. From there, they branch off to innervate tissues, organs and systems throughout your body, and to relay messages back to the brain from peripheral tissues.

Sometimes nerves can become compressed or entrapped (pinched) by other structures, preventing them from gliding freely among bones, organs, muscles and connective tissues, and causing pain and dysfunction. Nerve compression is a symptom of a more complex musculoskeletal disorder, and treating pain symptoms alone is not enough to permanently resolve the problem.

Understanding Pinched Nerve Pain

The term “pinched nerve” is a non-clinical misnomer, contributing to a general misunderstanding of nerve-generated pain. Pain can arise from nerves being stretched, compressed, entrapped, irritated or pinched in more than one place – a condition called double crush syndrome.

Nerve compression can occur at multiple
sites throughout the body:

  • In osteofibrous tunnels, such as the carpal and tarsal tunnels
  • In the vertebrae, between the disc and the facet joint
  • During certain movements where the nerve is temporarily compressed between other structures
  • In spaces where nerves interact with fascia, muscles and bony structures
  • In spaces where a nerve’s path is obstructed by osteophytes, joint cysts or lesions

Nerve compression is often downstream of physiological changes that disrupt optimal biomechanics. Alterations in joint alignment due to weak and/or inelastic muscles, poor posture, densified fascia and traumatic injury can all interfere with nerve gliding, causing tension, friction, compression and entrapment.

Nerves can become obstructed anywhere in the body, and the possibility of nerve compression should be considered whenever a patient presents with pain, weakness, numbness, tingling, and other nerve-related symptoms..

It is important to note that nerves can be compressed without producing pain symptoms. In such cases, your brain may compensate by altering your alignment or diverting muscle recruitment patterns to allow the nerve to decompress. Asymptomatic pinched nerves do not generate pain at the site of entrapment, but the patient may experience pain anywhere proximal to the area of compression due to compensatory alterations.

Subgluteal nerve entrapment

In the lumbar region, pain can arise from spinal entrapment of nerve roots, or from nerve compression or entrapment in the subgluteal space – a condition called subgluteal space syndrome.

Subgluteal entrapment can occur at multiple locations,
the most common being:

  • The space where the nerve passes near or through an enlarged or inflamed piriformis muscle
  • At the junction of the sacroiliac joint and superior gluteal nerve
  • At the gemellus-obturator internus complex, where the sciatic nerve is dynamically entrapped

Nerves can also be compressed at their roots by spinal structures, either by a bulging or herniated disc, or by the joint facets – a condition called radiculopathy. Pinched nerves in the spine often resolve themselves over time as disc inflammation abates and spinal mechanics improves.

Radiculopathy can occur in one of
three spinal segments:

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Dr. Lev Kalika

Clinical director & DC RMSK

About Pinched Nerve Specialist Dr. Lev Kalika

NYDNRehab Clinical Director Dr. Lev Kalika is a nerve specialist and a leading expert in neuromuscular and myofascial disorders. He has developed his own proprietary approach to clinically examine and diagnose nerve-related disorders. Dr. Kalika’s holistic and integrative approach to patient care are at the core of his success as a pinched nerve specialist.

Dr. Kalika uses the most advanced diagnostic ultrasound equipment to examine neural bodies along their entire path, to identify nerves that are obstructed or entrapped in fascial tunnels. Dr. Kalika’s expertise in diagnostic ultrasonography is well-recognized among the scientific community, and he has published multiple peer-reviewed papers on the topic.

Dr. Kalika is an expert in multiple advanced therapies, including neuromodulation, extracorporeal shockwave therapy, and Stecco fascial manipulation therapy, all guided by ultrasound imaging to ensure precision. Ultrasound-guided procedures and diagnostics are all performed on-site at the clinic, saving patients time and money, and expediting the healing process.

With over 20 years of hands-on clinical experience, Dr. Kalika has raised the bar in rehabilitative medicine by embracing cutting-edge technologies that take the guesswork out of diagnosis, and innovative therapies that accelerate rehabilitation.

The NYDNRehab clinic features some of the most advanced rehabilitative and regenerative technologies currently available.

Accurate Diagnosis is Key to Quick Resolution of Pinched Nerve Pain

A nerve becomes impinged when another structure in the body gets in its way, preventing it from gliding freely. Because nerves are long structures, impingement can occur anywhere along the nerve’s path, and the site of entrapment may be distal to the locus of pain.

Many doctors focus on managing pain symptoms without taking measures to release the entrapped nerve, and patients are often referred to a neurologist for an electromyography nerve conduction study. However, this is only useful in cases of true neuropathy. In most cases, nerve pain is due to nerve compression, without damage to the nerve itself.

The best pinched nerve diagnosis involves a combination of a clinical diagnostic exam with precise muscle strength testing and special nerve entrapment tests, confirmed with diagnostic ultrasonography. Our high resolution ultrasound equipment lets us visualize nerves along their entire path in real time, to find the exact point of obstruction.

Compared to other diagnostic tests, ultrasound can help to:

  • Detect even the smallest changes in nerve diameter
  • Identify abnormal vascularization of the nerve
  • Visualize thickening of the fascia surrounding the nerve
  • Detect thickening of the nerve’s protective covering (epineurium)
  • Show thickening of nerve fascicles and inflammation between fascicles
  • Visualize edema in tissues surrounding the nerve
  • Show lesions occupying adjacent spaces
  • Alert us to alterations in nerve dynamics

Even with positive results from an electrodiagnostic test, diagnostic ultrasonography can help to uncover the underlying causes of nerve damage. Once we understand where and how the nerve is being obstructed, we create a personalized treatment protocol based on your unique profile, to get to the source of your pinched nerve pain and fix it for good.

High Resolution Diagnostic Imaging Means Accurate Diagnosis and Successful Treatment

At NYDNRehab, we use the highest resolution diagnostic ultrasonography available, to closely examine the nerves and their surrounding structures. Ultrasound enables us to view the entire length of entrapped nerves in real time. Ultrasound imaging takes the guesswork out of pinched nerve diagnosis, enabling us to identify the exact site of entrapment and the tissues and structures involved.

Ultrasound imaging takes place in the comfort of our clinic on your very first visit. Quick and accurate diagnosis means you can begin therapy right away, with no wait time for lab results.

With diagnostic ultrasound, we can:

  • View nerves, muscles, fascia and bones along their entire path
  • Identify fascial densifications and adhesions, and myofascial trigger points
  • Detect the exact site of nerve compression or entrapment
  • View multiple tissues and structures in a single session
  • Elicit patient feedback during the imaging session

Diagnostic Ultrasonography vs MRI

For years, MRI has been considered the gold standard for musculoskeletal imaging, but advancements in technology have catapulted high-resolution diagnostic ultrasonography to the top of the heap.

Ultrasound imaging is superior to MRI in multiple ways:

  • Much higher resolution means ultrasound can visualize small lesions and anomalies that are often missed by MRI
  • Ultrasound allows for dynamic evaluation that can reveal factors like ligament laxity, radial nerve entrapment, and other conditions that cannot be detected by static MRI
  • Ultrasonography is fast, effective and relatively inexpensive
  • Ultrasound imaging can be performed on-site in the doctor’s clinic, with no wait time for lab results
In the case of nerve compression, ultrasound imaging surpasses MRI in its ability to trace the entire paths of long neural bodies in real time, with the patient in motion. Once the site of obstruction is located, we use ultrasound imaging to guide certain procedures and to verify the effectiveness of our therapeutic approaches.

Tensegrity is the Secret to Pain-Free Mobility

Most people take everyday mobility for granted until an injury occurs or pain sets in. Sometimes pain and reduced mobility seem to arise out of nowhere, with no apparent cause of onset. Regardless of whether your pain is caused by trauma or by something less obvious, tensegrity plays a key role.

Tensegrity refers to tensile integrity – a state where a system of individual components is held together under continuous elastic tension. In the human body, tensegrity is created by the myofascial system, the network of muscles and fascia that work together to produce, control, and guide forces, and to hold the body’s various organs and structures in place during movement.

Tensegrity can be disrupted when myofascial tissues are injured or damaged in some way. When that happens, nerves and blood vessels can become entrapped, preventing them from gliding among other structures and producing pain. At the same time, the elastic tension that governs joint alignment and controls movement becomes compromised, creating motor deficits that undermine mobility and stability.

Factors that disrupt myofascial tensegrity include:

  • Traumatic injury that affects multiple tissue types
  • Overuse injuries from sports, exercise or occupation
  • Old injuries that were never properly rehabilitated
  • Sedentary lifestyle with excessive sitting
  • Obesity that overloads the body’s structures
  • Inadequate hydration that deprives soft tissues of water needed to function
  • Diet high in sugar and carbs that causes myofascial tissue glycation, making it dense and sticky

Many doctors do not understand the crucial role of the myofascial system in preventing pain syndromes, movement disorders, and disease. In fact, most medical doctors have no idea how to correct myofascial dysfunction or even recognize it as a factor. They simply treat pain symptoms with medications and eventually recommend surgery.

At NYDNRehab, we understand that the body’s systems work together as an integrated whole, and that treating pain is not enough to eliminate its source. We use dynamic high-resolution ultrasound to explore the myofascial system in real time. Ultrasound imaging lets us visualize muscles, fascia, nerves and other structures in motion, to identify places where tensegrity has been disrupted.

Once we identify the problem, we use the most advanced therapeutic approaches to restore myofascial integrity and promote tissue healing.

Why Physical Therapy Alone is Not Enough to Resolve Pinched Nerve Pain

Identifying and treating underlying issues prior to beginning physical therapy is key to getting fast and effective results. Failure to pre-treat your condition can completely undermine your treatment protocol, and in some cases, your condition may even worsen.

Obstacles to physical therapy success include:

  • Scar tissue and fascia adhesions
  • Neurogenic inflammation
  • Joint edema
  • Inflamed soft tissues
  • Myofascial trigger points
  • Compressed or entrapped nerves
  • Tendons that have degenerated and lost their elastic properties
  • Compensation patterns developed post-injury

At NYDNRehab, we use a broad range of regenerative technologies and integrative therapeutic approaches to resolve issues that can stand in the way of successful physical therapy. Our staff is certified in a diverse array of holistic treatment methodologies, and our one-on-one treatment sessions are personalized, based on your unique diagnostic profile.

Once we pre-treat your damaged tissues and eliminate compensation patterns, your body will be ready to begin physical therapy.

We Treat the Whole Patient, Not Just Your Symptoms

The human body is made up of integrated parts and systems, designed to work in harmony. Today’s reductionist approach to medical treatment fails to acknowledge the integral relationship between structure and function, focusing on the locus of pain without considering its broader implications.

Most injuries involve multiple structures and tissue types, and pain is only a symptom that signals your brain to protect and heal damaged tissues. It is not uncommon for an injury to stop hurting while damaged structures remain dysfunctional.

At NYDNRehab, our diagnostic process takes into account the interrelated nature of the body’s structures and systems, along with the unique anatomical characteristics of the individual patient. We use high resolution diagnostic ultrasound to visualize your injury dynamically, in real time, to determine whether structural (anatomical) changes are causing pain and dysfunction, or if dysfunction is causing structural changes.

Your ultrasound exam takes place on-site, on your first visit, where we examine multiple areas of the body in a single session – with no waiting for lab results!

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Our Regenerative Technologies Accelerate Healing

The human body has its own innate healing mechanisms, but some tissues need a nudge to accelerate the healing process. Regenerative technologies help to jump-start healing by stimulating tissue repair at the cellular level. Our outpatient regenerative therapies expedite recovery with minimal discomfort for the patient.

Regenerative Therapies

At NYDNRehab

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave Electro-Hydraulic Shockwave Therapy

SoftWave is a groundbreaking regenerative mechanotransduction technology that accelerates tissue healing. Its patented electro-hydraulic applicator delivers high-speed soundwaves that can penetrate up to six inches in depth. SoftWave’s defocused and linear focused shockwaves recruit maximum stem cells to the treatment site to promote healing. SoftWave’s wider and deeper penetration using defocused energy is a preferred treatment option for a broad spectrum of conditions, ranging from orthopedic injuries to pelvic health. SoftWave is the only unfocused shockwave technology currently available. According to recent research, SoftWave defocused waves combined with focused and radial shockwaves have maximum regenerative potential.


Myofascial Acoustic Compression Therapy (MyACT)

MyACT is a new type of focused shockwave technology that allows for deeper compression of the focused waves. Its higher frequency allows for precise neuro modulation under ultrasound guidance, with a special linear head for treating myofascial pain. MyACT transforms the mechanical energy of shockwaves into biochemical signals that precisely target damaged tissues. Most injuries involve more than one tissue type. When used together, our advanced shockwave technologies enable us to specifically target multiple tissue types with the most effective shockwave treatment.

Myofascial Acoustic Compression Therapy (MyACT)
Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is used as a regenerative treatment for damaged tendon, muscle and bone tissue. This technology produces high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for chronic degenerative tendon disorders and myofascial pain syndrome.


Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT transmits high energy magnetic pulses to targeted tissues that synchronize with the body’s own magnetic fields, triggering a regenerative response. EMTT waves can penetrate deep tissues to target difficult-to-reach tendons, muscles, bones and nerves.

Extracorporeal Magnetic Transduction Therapy (EMTT)
Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, sometimes called defocused shock wave therapy, is not a true shockwave. It uses mechanical pressure waves to enhance blood circulation, improving oxygen and nutrient delivery to muscle and fascia tissues, but has minimal regenerative properties.The mechanical properties of EPAT make it especially effective for fascial manipulation in combination with focused shockwaves. We combine EPAT with different types of shockwaves for holistic treatment, without additional cost to the patient.


High Energy Inductive Therapy (HEIT)

HEIT delivers high-intensity magnetic pulses to peripheral nerve tissues, to stimulate neuroplasticity. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, for enhanced motor control.

High Energy Inductive Therapy (HEIT)
INDIBA Radiofrequency Therapy

INDIBA Radiofrequency Therapy

INDIBA is a form of TECAR therapy that helps to restore the ionic charge of damaged cells, for faster injury healing and rehabilitation.


NESA Neuromodulation Therapy

NESA generates a low-frequency electrical current of intermittent and cyclical stimuli that soothes hypersensitized nerves and restores optimal signaling between the autonomic nervous system and the brain. We leverage this FDA-approved methodology to treat pain and regenerate nerve fibers, to enhance motor control.

NESA Neuromodulation Therapy

We Guide Our Needling and Orthobiologic
Procedures with High-Resolution Ultrasound

Injection therapies use orthobiologic solutions that stimulate cellular repair by either nourishing or irritating the targeted cells. Guidance by ultrasound ensures that the injected substances hit their mark, for maximum effectiveness.

Ultrasound Guided Dry Needling

Myofascial trigger points often contribute to musculoskeletal pain and dysfunction. The dry needling procedure inserts filament-thin non-medicated needles into trigger points to evoke a twitch response, relaxing contracted fibers and immediately relieving pain. Ultrasound guidance eliminates the need for multiple insertions, reducing discomfort for the patient.

Our Therapies Icon

SM Neuromuscular Electrical Stimulation (SMNMES)

SM neuromuscular electrical stimulation (NMES) dynamically interacts with the patient during therapeutic exercises, providing real-time sensory, auditory and visual biofeedback to the patient. This breakthrough technology helps patients to recalibrate muscle actions, to optimize joint function. SMNMES has helped numerous patients to avoid unnecessary shoulder, knee and ankle surgeries, even in complex scenarios.

Our Therapies Icon

Ultrasound Guided Percutaneous Neuromodulation (PENS)

During PENS treatment, filament-thin needles are inserted through the skin into muscle tissue adjacent to the targeted nerve. A low frequency electrical current is then delivered via the inserted needles to stimulate the dysfunctional nerve. PENS normalizes nerve activity, improves brain plasticity and optimizes muscle recruitment patterns. This therapy is so effective that patients typically need only 4-6 treatment sessions.

Pinched Nerve Symptoms, Causes
and Common Type

Symptoms

  • Sensation of numbness in the innervated tissues
  • Piercing or burning pain that radiates outward.
  • Sensation of tingling, pins and needles
  • Muscle weakness in the affected area
  • Extremities that feel as though they have “fallen asleep”
  • Pain that increases during physical activity
  • Pain that keeps you awake at night

Causes

  • Overuse injuries from sports or exercise
  • Inflammation that impedes nerve gliding
  • Compression from connective tissues, muscles or bony structures
  • Poor posture
  • Excessive sitting
  • Being overweight and out of shape
  • Degenerative disc disease

Common Types

  • Tennis elbow
  • Peripheral neuropathy
  • Carpal tunnel syndrome
  • Chronic back or neck pain
  • Piriformis syndrome
  • Hamstring syndrome
  • Other peripheral pain syndromes

Get Personalized Pinched Nerve Physical Therapy, Designed Just for You

At NYDNRehab, we treat the whole patient, not just your symptoms. We never use one-size-fits-all rehab protocols or antiquated recovery timelines. We believe that every injury is unique, and treatment should be based on a holistic approach that factors in the patient’s unique profile.

Once we have successfully pre-treated damaged tissues, we can begin one-on-one physical therapy to restore strength and stability, optimize mobility, and re-establish optimal neuromuscular pathways and muscle coordination patterns.

Your physical therapy protocol may include a combination of the following approaches:

  • Stecco fascial manipulation, to eliminate densifications and adhesions and restore fascia’s gliding properties
  • Postural restoration therapy to optimize total-body joint alignment
  • Dynamic neuromuscular stabilization (DNS) to restore developmental motor strategies
  • Integrated systems model (ISM) to optimize function and performance
  • Anatomy in motion (AIM) to enhance movement quality
  • Neurodynamics, to restore communication pathways between the brain and body
  • Conventional eccentric loading and strengthening exercises
Your back-to-sports physical therapy protocol may include sport-specific training to optimize motor skills and restore peak athletic performance. We carefully monitor patient progress with ultrasound imaging to confirm complete recovery.

Our Advanced Therapies and Technologies Produce Superior Results

Advancements in technology are changing the game in rehabilitative medicine, enabling us to accelerate healing and restore performance at an unprecedented pace. The clinic at NYDNRehab features some of the most advanced therapeutic equipment currently available, and rarely found in private clinics.

Your tendinopathy therapy may include the use of high-tech equipment:

C.A.R.E.N Computer Assisted Rehabilitation Environment

Originally developed to rehabilitate injured soldiers, this multifaceted system gives us a broad range of tools for assessment, feedback and performance enhancement. Dr. Kalka has integrated his own unique selection of technologies to optimize the ways in which C.A.R.E.N helps patients to achieve their goals.

Blood Flow Restriction Training (BFRT)

Rebuilding muscle strength while joints and connective tissues are still healing is a challenge for athletes who need to return to sport in the shortest time possible. BFRT enables you to increase muscle size and strength at much lower training volumes, to reduce stress on still-healing structures while rapidly restoring muscle performance.

Kineo Intelligent Load System

We use the Kineo intelligent loading system to create customized training and rehabilitation programs for our patients. With Kineo, we can customize variable load protocols for functional training, core training, agility drills and more. The Kineo variable resistance system lets us design a personalized variable load curve based on the needs of the individual patient.

Cryotherapy

Cold therapy has long been used for injury treatment and recovery from sports and exercise. Modern cryotherapy has replaced ice baths and ice packs with a dramatically faster and more convenient technology using nitrogen gas, directed via a specialized device to target injured tissues.

Preventing Pinched Nerve Pain

While nerves can sometimes become compressed consequent to traumatic injury, many patients suffer from nerve entrapment as a consequence of everyday activities. You can dramatically reduce your risk of pinched nerve pain by making certain lifestyle changes.

Follow these tips to reduce your risk of pinched nerve pain:

  • Avoid excessive sitting – sitting for long hours can cause muscle weaknesses and imbalances that force your joints out of alignment, putting pressure on nerves.
  • Pay attention to posture, especially when using electronic devices, to avoid nerve pain in the neck, shoulder and upper back regions.
  • Begin a daily walking program to activate your joints and restore optimal alignment.
  • Do resistance training 2-3 times per week to promote strength and stability.
  • Stretch daily to relieve tight joints, muscles and connective tissues.
  • Drink plenty of water to promote healthy muscles and fascia, to optimize nerve gliding.
  • Avoid sugar and simple carbohydrates to prevent fascial tissue glycation that reduces its slippery properties.
  • Achieve and maintain a healthy weight to take excess load off your body’s structures.
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Get the Best Care for Your Pinched Nerve in Manhattan NYC

A pinched nerve can interfere with your daily life, keeping you from being productive at work and enjoying time with your friends and family. Drugs and steroids can temporarily relieve pinched nerve pain, but unless the underlying cause is identified and corrected, recurring bouts of pain and dysfunction are likely.

The pinched nerve doctors at NYDNRehab take a holistic approach to treatment. We understand that the body’s systems are interdependent, and that pain in one area can originate from somewhere else. Our high-tech equipment for diagnosis and treatment sets us apart from run-of-the-mill clinics and their one-size-fits-all approach to patient care.

You don’t have to live with pinched nerve pain. Contact NYDNRehab today for drug-free holistic pinched nerve treatment that really works!

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    Clinical Case Studies
    NYDNRehab


    Case Study: Ulnar Neuropathy in the Cubital Tunnel

    Our Patient Our patient is a 53 year-old female who came to us complaining of left shoulder/neck pain, elbow pain, and numbness and tingling extending to her fourth and fifth fingers. In the two weeks prior to her visit to our clinic, her elbow pain had begun to intensify. The Challenge The patient had previously […]

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    Pinched Nerve FAQs

    How can I tell if my leg pain is caused by a pinched nerve?
    All pain is nerve-generated, so if you are experiencing pain there is a nerve involved. Pain that starts near the upper gluteal muscle and travels through the buttocks and down the legs is most likely caused by a pinched sciatic nerve – the longest and widest nerve in the body. However, it is impossible to tell whether a nerve is pinched without ultrasound imaging. If you have persistent pain, it’s best to get a holistic evaluation from a nerve pain specialist who uses diagnostic ultrasonography.
    How serious is a pinched nerve?
    Generally speaking, a pinched nerve is not necessarily a serious problem, and nerve impingement sometimes resolves itself. However, if left untreated, a nerve entrapped in densified fascia or scar tissue can begin to interfere with muscle actions and cause mobility problems. For physically active people, an untreated pinched nerve can increase your risk of injury during exercise. If you have persistent pain you should see an integrative nerve pain specialist.
    How long will it take to get rid of my pinched nerve pain?
    Timelines for pinched nerve recovery can vary from one patient to the next, and many factors come into play:
    • Size and location of the nerve
    • Site of nerve entrapment
    • Types of structures involved
    • Type of therapy received
    • Patient health status and activity level
    At NYDNRehab, we use the most advanced therapies and technologies available to eliminate your pinched nerve pain in the shortest time possible.
    Do muscle relaxers help with pinched nerve pain?
    If a nerve is entrapped or compressed by a tight muscle, muscle relaxers may provide temporary relief, but they will not fully resolve the problem in the long run. Best to see a chiropractor or physical therapist if pain persists.
    How does sitting cause pinched nerve pain?
    Long hours of sitting without bouts of physical activity can contribute to pinched nerve pain in the following ways:
    • Causing lax and weakened hip extensor (gluteal) muscles and tight hip flexor muscles that cause hip and pelvic misalignment.
    • Causing weak abdominal and pelvic floor muscles that reduce low back stability.
    • Causing a “head-forward” posture while using electronic devices that affects nerves in the neck, shoulders and upper back.
    • Reducing the elastic properties of muscles and fascia that guide movement and hold structures in their place.
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    In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

    Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

    The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

    Dynamic ultrasonography examination demonstrating
    the full thickness tear and already occurring muscle atrophy
    due to misdiagnosis and not referring the patient
    to proper diagnostic workup

    Demonstration of how very small muscle defect is made and revealed
    to be a complete tear with muscle contraction
    under diagnostic sonography (not possible with MRI)

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    Complete tear of rectus femoris
    with large hematoma (blood)

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    Separation of muscle ends due to tear elicited
    on dynamic sonography examination

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