Carpal Tunnel

About Carpal Tunnel Syndrome

Carpal tunnel syndrome symptoms arise from compression of the median nerve within the carpal tunnel, a passage created by the wrist bones and the transverse carpal ligament near the base of the thumb. Within the carpal tunnel, the median nerve shares space with nine flexor tendons that bend the fingers and thumb. Inflammation of the synovial tissues that surround the flexor tendons reduces the tunnel space, placing pressure on the medial nerve and producing pain and numbness.

However, the median nerve has its nerve roots at the neck, and travels down the upper arm and forearm, and through the carpal tunnel to innervate the hand and fingers. Carpal tunnel symptoms can arise from median nerve compression anywhere along its path, rendering conventional treatment approaches ineffective. They may also arise from hypersensitization of the median nerve related to trauma or overuse, requiring specialized alternative carpal tunnel treatment.

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Dr. Lev Kalika
Dr. Lev Kalika

Clinical director & DC RMSK

About Neuropathy
Specialist Dr. Lev Kalika

Dr. Lev Kalika, NYDNRehab’s clinical director, has over 15 years of clinical experience, working with pain syndromes, neuropathies and movement disorders. His dedication to finding drug-free solutions that treat the patient and not just the symptoms has made Dr. Kalika a premier healthcare provider in NYC.

Dr. Kalika is an expert in diagnostic ultrasonography, with multiple scientific articles to his credit. The NYDNRehab clinic features the highest resolution expert-grade ultrasound equipment available. Dr. Kalika’s unique and proprietary approach to carpal tunnel treatment includes ultrasound-guided dry needling, electromagnetic transduction therapy, percutaneous neuromodulation therapy, and radial and focused shockwave therapy. Non-invasive extracorporeal shockwave therapy (ESWT) is one of the most effective treatments for carpal tunnel syndrome.

Dr. Kalika specializes in the treatment of peripheral neuropathies of the hand and arm. His research and expertise in dry needling and regenerative therapies, and his mastery of diagnostic ultrasonography, set him apart as a leader in alternative solutions for carpal tunnel rehab in NYC.

Why NYDNRehab is Your Best Choice for Carpal Tunnel Therapy

Why NYDNRehab is Your Best Choice for Carpal Tunnel Therapy

Run-of-the-mill physical therapy clinics often take a one-size-fits-all approach to diagnosing and treating carpal tunnel symptoms, prescribing cookie-cutter exercises and generic devices that often fall short of resolving symptoms. When all else fails, surgery is often recommended, with several inherent risks and no guarantee of successful results.

At NYDNRehab, our commitment to personalized patient care ensures that your treatment is customized to your unique needs. Our diagnosis is not based on symptoms alone, but on the knowledge and expertise of our team, coupled with high resolution diagnostic ultrasound imaging.

Dr. Kalika is a seasoned specialist in diagnostic ultrasonography for nerve entrapment. Ultrasound allows us to travel the length of the median nerve, from shoulder to hand, to identify the exact site of compression. Accurate diagnosis takes the guesswork out of carpal tunnel therapy, and ensures that your personalized treatment plan will yield quick and lasting results.

Our clinic features some of the most advanced technologies for carpal tunnel therapy, giving our patients access to superior cutting-edge treatment options that really work!

Symptoms, Causes and Risk Factors of
Carpal Tunnel Syndrome


  • Pain, numbness or burning sensation around your wrist and thumb

  • Tingling sensation that radiates to your forearm or shoulder

  • Muscle weakness when gripping or performing fine motor tasks with your hands and fingers

  • Loss of grip strength when holding objects

  • Loss of kinesthetic awareness of your hand position in space

  • Shooting pains in your wrist and forearm

  • Achy stiffness around the base of your thumb and wrist

Causes and Risk Factors

  • Genetically small carpal tunnel space

  • Being female, with increased symptoms during pregnancy

  • Older age

  • Wrist trauma

  • Metabolic disease and chronic inflammation

  • Neurological disorders

  • Repetitive overuse from keyboarding, using tools, or sports and exercise

Accurate Diagnosis is Key to
Successful Treatment


Carpal tunnel symptoms are brought on by compression of the median nerve — a long nerve that travels from your neck, all the way down your arm. Many doctors are quick to diagnose carpal tunnel syndrome based on symptoms alone, without considering other potential causes. This can lead to ineffective treatment that prolongs your pain and costs you time and money.

In some cases, despite symptoms in the wrist and hand, median nerve compression is not within the tunnel itself, but further up the arm in the upper pronator teres of the forearm, under the lacertus fibrosus near the elbow, or in the brachial plexus of the shoulder. In such cases, carpal tunnel release surgery is completely ineffective.

At NYDNRehab, we use high resolution diagnostic ultrasound for carpal tunnel to view the median nerve from end to end, in real time, and with the patient in motion. Ultrasound imaging lets us identify the exact location of nerve entrapment, ensuring that our treatment protocol hits its target in the most effective way.


Best Treatment Options for Carpal Tunnel

Conventional medical treatment for carpal tunnel syndrome involves night-time splinting, steroid injections, reduced activity and nerve gliding exercises. When those approaches fail to resolve the condition, surgery — called carpal tunnel release — is often recommended.

During this procedure, median nerve pressure is relieved by cutting the transverse carpal ligament, to create more room for the median nerve and tendons. However, carpal release surgery only addresses the symptoms, without resolving the underlying causes of carpal tunnel syndrome. If nerve compression occurs higher up the arm, tunnel release surgery may be a complete failure.

At NYDNRehab, we use the latest technologies and innovative therapies to provide fast and effective relief for carpal tunnel syndrome. Your treatment protocol may include physical therapy for carpal tunnel, along with one or more of the following carpal tunnel rehab options:

Focused Extracorporeal Shock Wave Therapy (ESWT)

Focused ESWT is a regenerative technology that uses high frequency sound waves to stimulate the body’s own reparative mechanisms. It is especially effective for reducing inflammation associated with median nerve compression, allowing the nerve to glide freely.

Extracorporeal Magnetic Transduction Therapy (EMTT)

EMTT is a fairly new technology that transmits high energy magnetic pulses to targeted tissues. The magnetic waves synchronize with the body’s own magnetic fields, causing a disturbance that triggers a regenerative response at the cellular level to promote healing.

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

Extracorporeal Pulse Activation Technology (EPAT)

EPAT, also known as defocused shock wave therapy, uses acoustic pressure waves to enhance blood circulation to targeted tissues. This speeds up the delivery of oxygen and nutrients to damaged tissues and stimulates cellular metabolism, to accelerate the healing process.

High Energy Inductive Therapy (HEIT)

HEIT uses electromagnetic fields to penetrate cells, tissues, organs and bones, to reactivate the electrochemical function of cells and cell membranes. HEIT generates a magnetic field 600 times stronger than the field of a normal magnet, to stimulate healing of nerves, muscles and blood vessels.

INDIBA CT9 Radiofrequency Device

INDIBA CT9 Radiofrequency Device

Our INDIBA machine converts electrical current into a stable frequency of 448 kHz, designed to increase and stabilize the exchange of ions in damaged cells, evoking a regenerative response that accelerates healing.

Percutaneous Neuromodulation

Carpal tunnel symptoms are sometimes due to hypersensitivity of the median nerve, brought on by sensory and motor impairments. Percutaneous electrical nerve stimulation uses thin needle electrodes, closely placed along the median nerve, to apply an electrical current. The electrical stimulation helps to calm the hypersensitized median nerve, thereby reducing pain and improving function.

Percutaneous Neuromodulation

Why NYDNRehab is Your Best Choice for Carpal Tunnel Therapy

Carpal tunnel syndrome is mainly caused by inflammation. Chronic inflammation can become a dangerous condition that ultimately affects your cardiovascular system and undermines your metabolic health. There are several actions you can take right away to prevent inflammation and reduce your risk of carpal tunnel syndrome and metabolic disease.

  • Get regular exercise

  • Avoid processed and sugary foods

  • Stop smoking

  • Stay hydrated

  • Lose weight

  • Don’t over-grip

  • Take regular work breaks

  • Stretch and strengthen your hands and fingers

  • Seek early treatment

Why NYDNRehab is Your Best Choice for Carpal Tunnel Therapy

Carpal Tunnel Syndrome Physical
Therapy in NYC

Median nerve compression can seriously interfere with your productivity, especially if your daily work relies on the use of your hands and fingers. Conventional treatment approaches can take weeks or even months, with only modest relief, and surgery does not guarantee success.

The nerve pain specialists at NYDNRehab take a holistic approach to carpal tunnel treatment. We understand that pain in the wrist and hand can have its origins farther along the median nerve. Our personalized one-on-one treatment plans ensure that you will get the very best care, based on your personal profile. Our advanced technologies speed up the healing process while minimizing pain and discomfort for the patient.

If you think you may have carpal tunnel syndrome, contact NYDNRehab today. Our quick and accurate diagnosis and cutting-edge treatment options ensure that your carpal tunnel syndrome will be resolved in the fastest time possible, without drugs or surgery.

Range of Available Unique Physical Therapy
Treatments at Nydnrehab

Lev Kalika Clinical Director and DC, RMSK

Dr.Kalika revolutionized foot and ankle care by using high resolution diagnostic ultrasonography for structural diagnosis, combined with with gait and motion analysis technology. Dr.Kalika’s motion and gait analysis lab is the only private lab in the US that features research-grade technology found only at top research universities, made available to patients in his private clinic.

Our Specialists

Dr. Mikhail Bernshteyn MD (Internist)
Dr. Michael Goynatsky DPT
Dr. Daniela Escudero DPT
Dr. Michelle Agyakwah DC
Dr. Tatyana Kapustina L. Ac.

Our Awards

Carpal Tunnel Syndrome

The initial symptoms of weakness and paralysis of the fingers and the hands.

Causes of Carpal Tunnel Syndrome

Tingling is usually a sign of nerve injury. Nerves generally have two major functions. There are sensory nerves which sense information in the skin, and there are moto occur in people that use the computer frequently, use the cash register, or are involved in activities that involve repetitive motion at the wrist. There is greater frequency of carpal tunnel syndrome among post-menopausal women.


The diagnosis of carpal tunnel syndrome is made using a nerve test called EMG/Nerve conduction study. Since there are multiple other causes of hand tingling, nerve testing is crucial toms could progress and become permanent.


Once the diagnosis of carpal tunnel syndrome is made we will determine the best possible treatment for the patient trying to our attention the chances of recovery are less, the patient could develop permanent paralysis, and surgical procedures might be required even though they could have been avoided early in the disease course. Patients with carpal tunnel syndrome could have full recovery with minimal intervention if they seek medical attention and treatment early.


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)


Complete tear of rectus femoris
with large hematoma (blood)


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

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