Tennis Elbow Treatment
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Tennis Elbow Treatment Without Surgery
Tennis Elbow & Golfer's Elbow: Non-Surgical Treatment in Palm Beach
Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are overuse conditions involving degeneration and micro-tearing of the tendons attaching the forearm muscles to the elbow. Despite the names, these conditions affect far more non-athletes than athletes. Anyone who performs repetitive gripping, lifting, or tool use can develop these conditions.
Both conditions respond well to orthobiologic treatment in many cases, making them among the more common presentations at Palm Beach Regenerative. Request an appointment at Palm Beach Regenerative.
What Are Tennis Elbow & Golfer's Elbow?
Tennis elbow involves the common extensor tendons on the lateral (outer) side of the elbow. Golfer’s elbow involves the common flexor tendons on the medial (inner) side. Both conditions involve a process of tendon degeneration (tendinosis) rather than true inflammation, which is why rest and anti-inflammatory treatments alone often provide only temporary relief.
The tendinosis process involves disorganization of collagen within the tendon, which reduces its ability to withstand repetitive loading.
Signs and Symptoms
- Tennis elbow: Pain on the outer elbow, worsening with gripping, typing, or lifting
- Golfer’s elbow: Pain on the inner elbow, worsening with gripping, throwing, or wrist flexion
- Weak grip strength
- Pain radiating from the elbow into the forearm
- Difficulty with everyday tasks such as shaking hands, opening jars, lifting a coffee cup
- Chronic, recurring symptoms despite rest
Common Causes and Risk Factors
- Repetitive gripping, lifting, or racket/club use
- Manual occupations involving tools or keyboards
- Sudden overload or change in activity level
- Age-related tendon degeneration
- Prior elbow injuries
How It Is Diagnosed
Clinical examination, including provocative tests for lateral or medial elbow pain, is usually sufficient for diagnosis. Ultrasound or MRI can confirm the degree of tendon degeneration and rule out other causes of elbow pain.
Dr. Ghattas uses diagnostic musculoskeletal ultrasound as part of the evaluation to directly visualize tendon quality and confirm the treatment target.
Conventional Treatment Options
- Rest and activity modification
- Physical therapy: Eccentric loading exercises shown to support tendon health
- Counterforce bracing to reduce tendon load during activity
- Steroid injections: May provide temporary relief but have been shown to weaken tendon tissue with repeated use
- Surgery (rare): For refractory cases that have not responded to extensive conservative and injection-based treatment
The Palm Beach Regenerative Approach
Tennis and golfer’s elbow are among the conditions best supported by orthobiologic treatment evidence. Image-guided platelet injection, delivered precisely to the degenerative area of the tendon under real-time ultrasound, provides growth factors that support the body’s natural tendon healing processes.
Dr. Ghattas uses Regenexx Super Concentrated Platelet (SCP) preparations, delivered with direct ultrasound visualization to confirm accurate tendon placement. This precision is critical for optimal outcomes.
Most patients with tennis or golfer’s elbow who have not responded to conventional care find this a well-tolerated and effective approach. Recovery involves a short period of activity modification followed by progressive loading of the tendon.
The BioMod Advantage: At Palm Beach Regenerative, treatment does not end with a single injection. Through our BioMod Lab, Dr. Ghattas may combine your orthobiologic procedure with MLS Robotic Laser Therapy to reduce inflammation and support tissue recovery, alongside customized Xymogen supplement protocols designed to optimize your body’s healing environment. This integrated, concierge approach is what sets Palm Beach Regenerative apart from a standard injection clinic.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Slipping Rib Syndrome Treatment
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Slipping Rib Syndrome Treatment Without Surgery
Slipping Rib Syndrome: Finally a Diagnosis for Your Unexplained Chest and Upper Abdominal Pain
Slipping rib syndrome is one of the most frequently missed diagnoses in medicine — often misidentified as a cardiac, pulmonary, or GI problem before the true cause is found. At Palm Beach Regenerative, Dr. Ghattas uses dynamic ultrasound to identify rib instability and image-guided orthobiologic treatment to address the root cause: weakened ligaments and costal cartilage that fail to keep the lower ribs in place.
What is slipping rib syndrome?
Slipping rib syndrome (SRS) — also known as Cyriax syndrome, rib tip syndrome, clicking rib syndrome, or costal margin syndrome — is a painful condition caused by excessive movement of the lower ribs (most commonly ribs 8, 9, and 10). These are called false ribs because they attach to the sternum indirectly through cartilage and interchondral ligaments rather than directly.
When these ligaments weaken or become injured, the rib loses its anchoring and can slip upward beneath the rib above — irritating the intercostal nerve and surrounding soft tissue with every breath, twist, or movement.
Despite being described in medical literature for over a century, SRS remains significantly underdiagnosed. Patients often undergo extensive cardiac, pulmonary, and GI workups — sometimes over years — before the true diagnosis is made. The pain pattern is highly variable and typically affects only one side, which adds to the diagnostic confusion.
Also known as: Cyriax syndrome | Rib tip syndrome | Clicking rib syndrome | Costal margin syndrome | Painful rib syndrome | Rib subluxation | Traumatic intercostal neuritis
Why do ribs slip? Understanding the structure
The rib cage consists of three types of ribs. The true ribs (R1–R7) attach directly to the sternum via their own costal cartilage and are well stabilized. The false ribs (R8–R10) attach to the sternum indirectly — their costal cartilage connects to the cartilage of the rib above, held in place by interchondral ligaments. When these ligaments are lax, torn, or degenerated, the rib tip can move freely and slip upward, catching on the rib above.
The slipping motion stretches the intercostal nerve running along the inferior edge of the rib, generating sharp, episodic pain. Because the rib is also attached posteriorly to the thoracic vertebra via the costotransverse ligament, instability at the front often corresponds to instability at the back — meaning both attachment sites may need to be addressed.
What causes slipping rib syndrome?
Slipping rib syndrome is fundamentally a problem of structural instability. The interchondral ligaments and costal cartilage that anchor the lower ribs fail to maintain proper rib position — either because they have been injured, have degenerated over time, or were never strong enough to begin with.
Slipping can occur at three locations: anteriorly at the rib-cartilage margin (chondro-rib instability), at the cartilage-sternum margin (sterno-rib instability), or posteriorly at the rib-vertebra junction (thoraco-rib instability).
- Ligament laxity or degeneration
Over time, the interchondral ligaments connecting the false ribs weaken, reducing their ability to stabilize rib position. This is the most common underlying mechanism and the primary target of orthobiologic treatment. - Trauma or direct chest injury
A direct blow to the chest, a fall, or a motor vehicle accident can damage the costal cartilage or tear the interchondral ligaments — initiating the instability cascade. Symptoms may begin immediately or develop weeks to months after the injury. - Repetitive overuse and sports
Activities involving repetitive trunk rotation, bending, or overhead motion — such as swimming, gymnastics, rowing, golf, and tennis — can progressively strain the rib attachments over time. Female athletes are at higher risk, possibly due to hormonal effects on joint laxity. - Hypermobile joints
Individuals with generalized joint hypermobility — including those with hypermobility spectrum disorder or connective tissue disorders such as Ehlers-Danlos syndrome — are at significantly higher risk due to reduced baseline ligament support across all joints, including the rib attachments. - Congenital and structural variations
Some individuals have structural differences in the rib cage or costal cartilage that predispose them to slipping. These may not produce symptoms until a triggering event — such as injury, pregnancy, weight change, or new physical activity — unmasks the underlying instability.
How does slipping rib syndrome feel?
The pain pattern in SRS is variable enough that it is frequently misdiagnosed as a cardiac event, pleurisy, costochondritis, or an abdominal condition. Several key features distinguish it from these other diagnoses.
| Characteristic | Description |
|---|---|
| Location | Lower chest or upper abdomen, usually one side only; occasionally bilateral |
| Character | Sharp, stabbing, or catching pain — often described as ‘something slipping’ or a pop/click in the rib cage |
| Triggers | Deep breathing, coughing, laughing, twisting, bending, reaching overhead, or lying on the affected side |
| Referred pain | May radiate into the upper abdomen, back, or groin — mimicking kidney stones, appendicitis, or GI disorders |
| Onset pattern | Sudden, episodic attacks interspersed with dull background aching; typically worsened by prolonged sitting or activity |
| Audible click | Some patients report an audible or palpable click when the rib slips — a hallmark feature when present |
Frequently misdiagnosed as: Cardiac chest pain, pleurisy, costochondritis, Tietze’s syndrome, kidney stones, appendicitis, IBS, or musculoskeletal back pain. SRS patients often undergo extensive cardiac and GI workups before the correct diagnosis is made. If standard investigations are negative and chest or upper abdominal pain persists, SRS deserves consideration.
How is slipping rib syndrome diagnosed?
SRS is primarily a clinical diagnosis confirmed by physical examination and dynamic ultrasound. Standard imaging — X-rays and CT scans — are static tests that cannot demonstrate rib movement and are typically normal in SRS patients, which further delays diagnosis.
- Clinical history
A detailed account of symptom pattern, triggers, and prior negative workups is the critical first step. The episodic, movement-triggered nature of the pain, combined with a normal cardiac and GI workup, raises suspicion for SRS. - Hooking maneuver test
The examining physician hooks fingers beneath the lower rib margin and applies upward pressure while the patient takes a deep breath. Reproduction of the characteristic pain — or an audible click — is a positive finding strongly suggesting SRS. This is the primary physical examination test for this condition. - Dynamic ultrasound
The most important diagnostic tool for SRS. Unlike static X-ray or CT, dynamic ultrasound allows real-time visualization of rib movement during breathing and provocative maneuvers — directly demonstrating the rib slipping beneath the adjacent rib. At Palm Beach Regenerative, diagnostic ultrasound is performed in-office and also used to guide treatment precisely. - MRI (selective)
MRI may be ordered to assess soft tissue structures including costal cartilage integrity, interchondral ligament status, and intercostal nerve involvement — particularly in complex or atypical presentations. It does not demonstrate dynamic rib movement but provides structural detail that informs treatment planning.
Standard treatments and their limitations
Conventional management of SRS progresses from conservative measures to increasingly invasive interventions — most of which address symptoms rather than the underlying ligament instability that allows the rib to slip.
| Treatment | What it involves | Limitation |
|---|---|---|
| Conservative care | Activity modification, NSAIDs, physical therapy, postural correction | May reduce symptoms temporarily but does not address underlying ligament laxity |
| Intercostal nerve block | Local anesthetic +/- steroid injected along intercostal nerve | Provides temporary pain relief; does not stabilize the rib or address the root cause |
| Botulinum toxin (Botox) | Injection into intercostal muscles to reduce muscle spasm | Limited evidence; palliative only; no structural benefit to the rib attachment |
| Costal cartilage excision | Surgical removal of the affected costal cartilage tip | Invasive; significant recurrence rate reported in literature; general anesthesia required |
| Rib stabilization surgery | Surgical fixation or reconstruction of rib attachments | Most invasive option; reserved for refractory cases; recovery time significant |
The core limitation of most conventional approaches: Intercostal nerve blocks and Botox injections treat the pain signal but do nothing to stabilize the rib. Surgery removes the cartilage tip but carries meaningful recurrence rates. The question is: can we address the ligament instability directly — non-surgically?
Stabilizing the Rib from the Inside Out — Without Surgery
Rather than blocking pain or removing tissue, our orthobiologic approach targets the fundamental problem in slipping rib syndrome: the weakened or injured ligaments and costal cartilage that allow the rib to move excessively. By delivering concentrated orthobiologic agents precisely to the unstable attachment sites — guided in real time by ultrasound — we aim to support your body’s natural stabilizing response and reduce the hypermobility driving your symptoms.
- Prolotherapy to interchondral ligaments
Prolotherapy — image-guided injection of a concentrated dextrose solution — is the foundational treatment for SRS at Palm Beach Regenerative. Delivered precisely to the interchondral ligaments of the affected false ribs (typically R8–R10) under real-time ultrasound guidance, prolotherapy initiates a controlled healing response in the ligament tissue, supporting your body’s natural stabilization response over a series of treatments. Importantly, proximity to the lungs makes image guidance essential — palpation-based injection alone is not appropriate for this region. - Platelet-Rich Plasma (PRP) to costochondral and costovertebral junctions
For more significant ligament or cartilage involvement, image-guided PRP delivers a concentrated preparation of your own platelets — rich in growth factors — directly to the affected attachment sites. This may be applied at the anterior costochondral junction, the interchondral ligaments, or posteriorly at the costovertebral junction where the rib meets the thoracic vertebra, depending on where instability is identified on dynamic ultrasound evaluation. - Perineural injection for intercostal nerve irritation
When intercostal nerve irritation is a significant component of the pain — particularly in patients with chronic SRS or prior nerve block history — image-guided perineural injection targets the inflammatory environment around the affected intercostal nerve directly. This addresses the neurogenic component of pain while the prolotherapy and PRP work on the underlying structural instability. - Posterior costovertebral and costotransverse treatment
Because a loose rib anteriorly is often also loose posteriorly, Dr. Ghattas assesses the posterior rib-spine junction as part of every SRS evaluation. When costovertebral or costotransverse joint instability is identified, posterior image-guided treatment of these joints is incorporated into the protocol — addressing the full rib stabilization picture.
Why image guidance matters for slipping rib syndrome
The thoracic region presents unique procedural risks due to the proximity of the lungs. Prolotherapy injections performed by palpation alone — without image guidance — carry real risk of pneumothorax in this area. At Palm Beach Regenerative, every injection for slipping rib syndrome is performed under real-time ultrasound visualization, allowing Dr. Ghattas to confirm needle position before any injection, and to visualize the dynamic rib movement that confirms the diagnosis and guides the exact treatment location.
| Feature | Description |
|---|---|
| Dynamic ultrasound diagnosis | Visualizes rib slipping in real time during provocative maneuvers — not possible with X-ray or CT |
| Image-guided treatment | Every injection placed under direct ultrasound visualization — essential given lung proximity |
| Full rib assessment | Both anterior (costochondral, interchondral) and posterior (costovertebral, costotransverse) sites evaluated |
| Treating the root cause | Targets the ligament instability driving the slipping — not just the nerve pain it causes |
| Board-certified neurologist | Dr. Ghattas’s neurology background adds clinical depth for the intercostal nerve component of SRS pain |
Candidacy for orthobiologic SRS treatment
Not every patient with slipping rib syndrome is a candidate for orthobiologic treatment. During your consultation, Dr. Ghattas will evaluate your imaging, physical examination findings, and symptom history to determine whether this approach is appropriate — or whether a different path is more likely to help.
May be appropriate if you:
- Confirmed or clinically suspected SRS based on history and positive hooking maneuver
- Dynamic ultrasound demonstrating rib hypermobility at the costochondral or interchondral junction
- Symptoms not adequately controlled by conservative care or physical therapy
- Desire to explore non-surgical options before considering costal cartilage excision
- Hypermobility or connective tissue laxity as a contributing factor
May not be appropriate if you:
- SRS suspected but not confirmed — diagnosis must be established before treatment
- Active infection, fracture, or tumor involving the affected rib or costal cartilage
- Severe structural deformity requiring surgical rib stabilization or cartilage excision
- Contraindications to injection-based procedures (bleeding disorders, anticoagulation, etc.)
- Symptoms suggesting an alternative diagnosis (cardiac, pulmonary, GI) not yet ruled out
Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. Prolotherapy and PRP for slipping rib syndrome represent off-label applications based on clinical evidence and physician discretion. Given the proximity to the lungs in the thoracic region, all injections at Palm Beach Regenerative are performed under real-time image guidance. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options — including when surgical referral is the more appropriate path. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment.
Frequently Asked Questions
SRS is more common than the medical literature suggests — it is simply underdiagnosed. Many patients carry incorrect diagnoses (costochondritis, atypical chest pain, IBS) for years before SRS is identified. Awareness of the condition and access to dynamic ultrasound are key to earlier diagnosis.
Standard X-rays and CT scans are static and almost always normal in SRS — which is part of why the condition is so frequently missed. Dynamic ultrasound, which captures rib movement in real time, is the most useful imaging modality for both diagnosis and treatment guidance.
The number of treatment sessions varies by severity, the extent of ligament laxity, and individual response. Dr. Ghattas will discuss realistic expectations based on your specific findings during consultation. We do not make fixed treatment promises — results vary.
If orthobiologic treatment does not provide adequate improvement, Dr. Ghattas will discuss the next appropriate steps — including referral for surgical consultation with a thoracic or chest wall surgery specialist. We are committed to honest reassessment throughout your care.
Think you might have slipping rib syndrome?
Many patients with SRS have been told their tests are normal for years. Dr. Ghattas offers dynamic ultrasound evaluation and a comprehensive assessment of the rib cage — not just the disc or the spine. Schedule a consultation to finally get a clear answer.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Pudendal Neuralgia Treatment
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Pudendal Neuralgia Treatment Without Surgery
Pudendal Neuralgia: Specialized Treatment in Palm Beach
Pudendal neuralgia is a chronic, often debilitating pain condition caused by irritation or compression of the pudendal nerve, which runs through the pelvis and supplies sensation to the perineum, genitals, and lower pelvic floor. It is often misdiagnosed or underdiagnosed, and patients frequently endure years of symptoms before receiving an accurate diagnosis.
Dr. Ghattas’s specialized training in interventional pain management and nerve procedures positions Palm Beach Regenerative to offer a precise, image-guided approach to pudendal neuralgia that many standard pain practices do not provide. Schedule your appointment with Dr. Ghattas today.
What Is Pudendal Neuralgia?
The pudendal nerve can become compressed or irritated at several points along its course through the pelvis, most commonly at the Alcock’s canal. Irritation or inflammation of this nerve produces pain in the perineum, genitals, anus, and inner thighs that is characteristically worsened by sitting and relieved by standing or lying down.
Signs and Symptoms
- Burning, stabbing, or aching pain in the perineum, genitals, or rectum
- Pain that is worsened by sitting and relieved by standing
- Sensitivity to clothing or touch in the pelvic region
- Urinary urgency or frequency
- Pain with sexual activity
- Constipation or pain with bowel movements in some cases
Common Causes and Risk Factors
- Compression from prolonged cycling or narrow bicycle seat use
- Pelvic floor muscle tightness compressing the nerve
- Prior pelvic surgery or childbirth injury
- Sacral or coccyx trauma
- Inflammatory conditions in the pelvic region
How It Is Diagnosed
Pudendal neuralgia is a clinical diagnosis supported by the characteristic symptom pattern, physical examination findings, and response to a diagnostic pudendal nerve block performed under CT or fluoroscopic guidance.
Dr. Ghattas performs the diagnostic block with real-time imaging guidance to accurately place anesthetic adjacent to the pudendal nerve at the ischial spine.
Conventional Treatment Options
- Pelvic floor physical therapy
- Oral medications including tricyclic antidepressants and nerve pain agents
- Image-guided pudendal nerve blocks with local anesthetic and steroid
- Nerve hydrodissection to release perineural adhesions
- Surgical decompression in confirmed entrapment cases
The Palm Beach Regenerative Approach
Dr. Ghattas performs image-guided pudendal nerve hydrodissection using fluoroscopic guidance, delivering precise platelet and anesthetic preparations around the pudendal nerve at the site of compression to reduce perineural inflammation and free the nerve from adhesions.
This is delivered as part of a compassionate, comprehensive care plan that coordinates with pelvic floor physical therapy and appropriate oral medications. Patients with pudendal neuralgia deserve the same precision and thoroughness as any other complex pain condition.
The BioMod Advantage: MLS Robotic Laser Therapy applied to the sacral and pelvic region reduces neurogenic inflammation in the pudendal nerve distribution. Xymogen nerve support and anti-inflammatory protocols provide systemic support for nerve recovery, complementing the precision injection treatment.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Tarsal Tunnel Syndrome Treatment
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Tarsal Tunnel Syndrome Treatment Without Surgery
Tarsal Tunnel Syndrome: Treatment in Palm Beach
Tarsal tunnel syndrome involves compression of the posterior tibial nerve as it passes through the tarsal tunnel behind and below the inner ankle. It produces foot and ankle pain, numbness, and tingling that is frequently misdiagnosed as plantar fasciitis, delaying effective treatment.
Dr. Ghattas’s neurological expertise and proficiency with lower extremity nerve hydrodissection make Palm Beach Regenerative well-suited to accurately diagnose and treat tarsal tunnel syndrome. Contact us today to schedule an appointment at Palm Beach Regenerative.
What Is Tarsal Tunnel Syndrome?
The tarsal tunnel is a narrow passageway formed by the ankle bones and the flexor retinaculum ligament on the inner ankle. The posterior tibial nerve, along with tendons and blood vessels, passes through this tunnel. Compression or irritation of the nerve here produces the characteristic symptoms of tarsal tunnel syndrome.
Signs and Symptoms
- Burning, tingling, or numbness on the bottom of the foot and toes
- Symptoms that may radiate from the inner ankle down into the arch and heel
- Pain that worsens with prolonged standing, walking, or activity
- Tenderness and a positive Tinel’s sign with percussion behind the inner ankle
- Symptoms that may worsen at night in some cases
Common Causes and Risk Factors
- Flat feet (overpronation) increasing tension on the posterior tibial nerve
- Prior ankle fracture, sprain, or surgery creating scar tissue
- Space-occupying lesions within the tarsal tunnel (cysts, lipomas)
- Systemic conditions affecting nerve health (diabetes, hypothyroidism)
- Prolonged standing or walking on hard surfaces
How It Is Diagnosed
Electrodiagnostic testing (nerve conduction studies of the medial and lateral plantar nerves) objectively confirms posterior tibial nerve dysfunction and distinguishes tarsal tunnel syndrome from plantar fasciitis and peripheral neuropathy.
Ultrasound allows direct visualization of the posterior tibial nerve at the tarsal tunnel and identifies any space-occupying lesions contributing to compression.
Conventional Treatment Options
- Orthotic arch support to reduce nerve tension from overpronation
- Anti-inflammatory medications and nerve pain agents
- Corticosteroid injection into the tarsal tunnel
- Surgical tarsal tunnel release for confirmed entrapment with adequate trial of conservative care
The Palm Beach Regenerative Approach
Dr. Ghattas uses real-time ultrasound-guided posterior tibial nerve hydrodissection at the tarsal tunnel, delivering targeted platelet preparation around the nerve to reduce perineural inflammation and free compressive adhesions.
Accurate diagnosis differentiating tarsal tunnel syndrome from plantar fasciitis ensures that treatment is directed at the correct structure, which is the most important factor in achieving relief.
The BioMod Advantage: MLS Robotic Laser Therapy applied to the inner ankle and foot reduces posterior tibial nerve inflammation and the surrounding soft tissue that compresses the tarsal tunnel. Xymogen nerve support and anti-inflammatory protocols provide systemic support for nerve recovery and reduce the inflammatory burden on the tarsal tunnel.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Radial Tunnel Syndrome Treatment
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Radial Tunnel Syndrome Treatment Without Surgery
Radial Tunnel Syndrome: Treatment in Palm Beach
Radial tunnel syndrome involves compression of the radial nerve as it passes through the radial tunnel in the outer forearm, just past the elbow. It is frequently confused with tennis elbow because both cause lateral forearm and elbow pain, but the underlying mechanism and treatment approach are fundamentally different.
Accurate differentiation of radial tunnel syndrome from lateral epicondylitis is an area where Dr. Ghattas’s nerve expertise provides significant value to patients who have not responded to tennis elbow treatment. If you are suffering from this condition, contact our office today.
What Is Radial Tunnel Syndrome?
The radial nerve divides just past the elbow into the superficial radial nerve and the posterior interosseous nerve (PIN). The PIN passes through the radial tunnel, where it can become compressed at the arcade of Frohse (the leading edge of the supinator muscle), producing lateral forearm pain without the grip weakness typical of PIN palsy.
Signs and Symptoms
- Aching pain in the outer forearm and lateral elbow
- Pain worsening with resisted forearm supination or wrist extension
- Tenderness approximately 4 to 5 centimeters distal to the lateral epicondyle (distinguishes from tennis elbow tenderness directly at the epicondyle)
- No significant grip weakness in most cases
- Symptoms that persist despite appropriate tennis elbow treatment
Common Causes and Risk Factors
- Repetitive forearm rotation activities
- Fibrous bands or anomalous vessels at the radial tunnel
- Direct forearm compression
- Prior radial head fracture or elbow surgery
How It Is Diagnosed
Clinical examination with the specific resistance tests and tenderness location are the primary diagnostic tools. Electrodiagnostic studies are often normal in radial tunnel syndrome. A diagnostic ultrasound-guided injection at the radial tunnel that relieves symptoms confirms the diagnosis.
Conventional Treatment Options
- Activity modification and forearm stretching
- Physical therapy targeting the supinator and radial nerve mobility
- Ultrasound-guided injection at the radial tunnel
- Surgical decompression at the arcade of Frohse for refractory cases
The Palm Beach Regenerative Approach
Dr. Ghattas uses real-time ultrasound guidance to identify and treat the radial nerve compression at the radial tunnel with targeted nerve hydrodissection and platelet injection, addressing the perineural inflammation and freeing the nerve from compressive adhesions.
Ensuring the correct diagnosis before treatment is a hallmark of the Palm Beach Regenerative approach. Treating radial tunnel syndrome as tennis elbow will not provide relief. Request an appointment at our clinic today.
The BioMod Advantage: MLS Robotic Laser Therapy applied to the lateral elbow and proximal forearm reduces inflammation at the radial tunnel and surrounding soft tissues. Xymogen nerve support protocols provide nutritional support for radial nerve recovery from chronic compression.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Trigger Finger Treatment
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Trigger Finger Treatment Without Surgery
Trigger Finger: A Treatable Tendon Problem With a Non-Surgical Solution Worth Exploring.
Trigger finger — medically known as stenosing tenosynovitis — occurs when inflammation and thickening of the tendon sheath around a flexor tendon causes the finger to catch, lock, or snap when bending or straightening. It is a common, painful, and often progressive condition.
At Palm Beach Regenerative, Dr. Ghattas offers image-guided orthobiologic treatment as an alternative to corticosteroid injections and surgical release in appropriately selected patients.
Results vary. Not all patients are candidates. Dr. Ghattas will discuss realistic expectations for your specific condition.
What is trigger finger — and what causes it?
Each finger flexor tendon passes through a series of tight fibrous tunnels (pulleys) that hold the tendon against the bone as the finger moves. In trigger finger, the tendon sheath surrounding this pathway becomes inflamed and thickened — narrowing the tunnel. The tendon develops a nodule at the site of friction and can no longer glide smoothly through the sheath. The result is a catching, locking, or triggering sensation when the finger is flexed or extended — and in advanced cases, the finger becomes locked in a bent position.
Any finger can be affected, though the ring finger and thumb (trigger thumb) are most common. Trigger finger is more prevalent in patients with diabetes, rheumatoid arthritis, or hypothyroidism, and in individuals whose work or hobbies involve repetitive gripping.
Severity grading — how bad is it?
| Grade | Presentation | Treatment consideration |
|---|---|---|
| Grade 1 — Pre-triggering | Pain and tenderness at A1 pulley; no triggering yet | Conservative care; orthobiologics may prevent progression |
| Grade 2 — Active triggering | Finger catches but can be straightened without assistance | Image-guided PRP or prolotherapy to tendon sheath; good candidate range |
| Grade 3 — Passive triggering | Finger locks; requires other hand to straighten | Orthobiologics in selected cases; surgical release discussed honestly |
| Grade 4 — Fixed contracture | Finger cannot be fully extended even passively | Surgical release typically more appropriate; referral provided |
Recognizing trigger finger
| Symptom | Description |
|---|---|
| Catching or locking | Finger catches during flexion or extension; may snap free |
| Morning stiffness | Worse in the morning or after periods of inactivity |
| Nodule at base of finger | Palpable tender nodule at the A1 pulley (palm base of finger) |
| Pain with gripping | Discomfort with gripping, pinching, or prolonged use of the hand |
| Locked position | In advanced cases, the finger becomes stuck in a bent position |
Standard treatments and their limitations
Conventional treatment follows a stepwise approach from conservative measures to surgery. Each step has meaningful limitations that drive patients toward exploring alternatives.
| Treatment | What it does | Limitation |
|---|---|---|
| Splinting | Resting the finger in extension overnight | May relieve symptoms temporarily; does not address tendon sheath inflammation |
| NSAID medications | Oral anti-inflammatories | Systemic side effects; limited local effect on tendon sheath |
| Corticosteroid injection | Steroid injected into tendon sheath | Provides temporary relief in many patients; high recurrence rate; repeated injections may weaken tendon; diabetes patients respond poorly |
| Surgical release (A1 pulley release) | Open or percutaneous division of the pulley | Effective but invasive; recovery time; risk of nerve injury, infection, bow string deformity; general/regional anesthesia required |
Image-guided orthobiologic treatment for trigger finger
Rather than mechanically dividing the pulley or suppressing inflammation with steroids, our approach uses image-guided orthobiologic injections to target the inflamed tendon sheath directly — supporting your body’s natural tissue response while allowing the tendon to move more freely within the sheath.
- Ultrasound-guided PRP to the tendon sheath
Platelet-rich plasma is delivered directly into the tendon sheath surrounding the affected flexor tendon under real-time ultrasound guidance. This allows precise placement at the A1 pulley — the site of maximum thickening — without the tendon-weakening risks associated with repeated corticosteroid injection. Many patients with Grade 2 and selected Grade 3 trigger finger respond well to this approach. - Tendon sheath hydrodissection
Image-guided hydrodissection uses a small volume of fluid injected under pressure to gently release adhesions between the thickened sheath and the tendon, restoring gliding freedom. This technique is particularly useful when the tendon is mechanically tethered within a fibrotic sheath and can be combined with PRP in the same procedure. - Prolotherapy to the A1 pulley region (selected cases)
In patients with significant ligamentous laxity or chronic low-grade inflammation around the pulley, prolotherapy to the fibrous structures of the A1 pulley region may complement the tendon sheath treatment. Dr. Ghattas determines the appropriate combination based on ultrasound findings at the time of evaluation. - Iatrogenic (post-surgical)
Slippage developing after spinal surgery, typically laminectomy, that destabilized the posterior elements. Adjacent segment disease after fusion is a related presentation.
Candidacy for trigger finger treatment
The root problem in degenerative spondylolisthesis is instability—the segment’s supporting structures (facet joints, posterior ligaments, multifidus) are no longer holding the vertebra in position. Our FSU treatment approach targets each of these structures to support your body’s natural stabilizing capacity, reduce inflammation, and decrease pain without surgery in carefully selected candidates.
May be appropriate if you:
- Have Grade 1, 2, or selected Grade 3 trigger finger
- Have not responded adequately to splinting or conservative care
- Have had corticosteroid injections with recurrence or poor response
- Have diabetes (which reduces corticosteroid effectiveness)
- Want to explore options before considering surgical release
May not be appropriate / surgical referral recommended if you:
- Have Grade 4 fixed contracture that cannot be passively extended
- Have had multiple failed conservative treatments including prior injections
- Have significant tendon nodule causing mechanical block unlikely to resolve without release
- Have a condition requiring surgical correction of the pulley anatomy
- Prefer the high success rate and definitive nature of surgical release
Like all medical procedures, orthobiologic treatments have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all options — including when surgical referral is more appropriate. This content is for informational purposes only and does not constitute medical advice, diagnosis, or treatment.
Ready to explore your options?
Dr. Ghattas will review your imaging and history, assess your candidacy honestly, and discuss whether orthobiologic treatment is appropriate for your specific condition.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
TFCC Tear Treatment
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TFCC Tear Treatment Without Surgery
TFCC Tears: Non-Surgical Treatment in Palm Beach
The triangular fibrocartilage complex (TFCC) is a cartilage and ligament structure on the ulnar (small finger) side of the wrist that stabilizes the joint between the radius and ulna and cushions the carpal bones. TFCC tears cause ulnar-sided wrist pain, weakness, and clicking, and are common in athletes and active individuals.
Image-guided orthobiologic treatment of TFCC tears offers a precision non-surgical approach at Palm Beach Regenerative for appropriately selected patients. Schedule a visit to find out if you qualify.
What Are TFCC Tears (Wrist)?
TFCC tears are classified as traumatic (Type 1, from a fall or rotational injury) or degenerative (Type 2, from age-related wear). The location and type of tear significantly influence whether non-surgical treatment is appropriate.
Signs and Symptoms
- Pain on the ulnar (small finger) side of the wrist
- Pain worsening with forearm rotation or weight-bearing through the wrist
- Clicking or clunking with wrist movement
- Weakness of grip
- Wrist instability with loading
Common Causes and Risk Factors
- Fall on an outstretched hand with a rotational component
- Repetitive forearm rotation in racket sports, gymnastics, or golf
- Age-related TFCC degeneration
- Positive ulnar variance (longer ulna than radius)
How It Is Diagnosed
MRI of the wrist (with or without arthrogram) is the primary imaging tool for TFCC evaluation. Diagnostic ultrasound-guided wrist injection can assess for the characteristic pain relief that confirms TFCC involvement.
Conventional Treatment Options
- Wrist immobilization splinting for acute tears
- Physical therapy for wrist stabilization
- Intra-articular wrist steroid injection for inflammation
- Arthroscopic TFCC debridement or repair for persistent cases
The Palm Beach Regenerative Approach
Dr. Ghattas uses ultrasound-guided injection of platelet preparations into the wrist joint and directly around the TFCC to support the fibrocartilage’s healing response and reduce the inflammatory component of the tear.
Peripheral (outer edge) TFCC tears have better blood supply and greater healing potential. Central tears with poor blood supply may have more limited response to biological treatment and may ultimately require arthroscopic evaluation.
The BioMod Advantage: MLS Robotic Laser Therapy applied to the ulnar wrist reduces intra-articular inflammation around the TFCC and supports fibrocartilage recovery. Xymogen joint support protocols provide the nutritional building blocks for fibrocartilage healing.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Golfer's Elbow Treatment
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Golfer's Elbow Treatment Without Surgery
Tennis Elbow & Golfer's Elbow: Non-Surgical Treatment in Palm Beach
Tennis elbow (lateral epicondylitis) and golfer’s elbow (medial epicondylitis) are overuse conditions involving degeneration and micro-tearing of the tendons attaching the forearm muscles to the elbow. Despite the names, these conditions affect far more non-athletes than athletes. Anyone who performs repetitive gripping, lifting, or tool use can develop these conditions.
Both conditions respond well to orthobiologic treatment in many cases, making them among the more common presentations at Palm Beach Regenerative. Request an appointment at Palm Beach Regenerative.
What Are Tennis Elbow & Golfer's Elbow?
Tennis elbow involves the common extensor tendons on the lateral (outer) side of the elbow. Golfer’s elbow involves the common flexor tendons on the medial (inner) side. Both conditions involve a process of tendon degeneration (tendinosis) rather than true inflammation, which is why rest and anti-inflammatory treatments alone often provide only temporary relief.
The tendinosis process involves disorganization of collagen within the tendon, which reduces its ability to withstand repetitive loading.
Signs and Symptoms
- Tennis elbow: Pain on the outer elbow, worsening with gripping, typing, or lifting
- Golfer’s elbow: Pain on the inner elbow, worsening with gripping, throwing, or wrist flexion
- Weak grip strength
- Pain radiating from the elbow into the forearm
- Difficulty with everyday tasks such as shaking hands, opening jars, lifting a coffee cup
- Chronic, recurring symptoms despite rest
Common Causes and Risk Factors
- Repetitive gripping, lifting, or racket/club use
- Manual occupations involving tools or keyboards
- Sudden overload or change in activity level
- Age-related tendon degeneration
- Prior elbow injuries
How It Is Diagnosed
Clinical examination, including provocative tests for lateral or medial elbow pain, is usually sufficient for diagnosis. Ultrasound or MRI can confirm the degree of tendon degeneration and rule out other causes of elbow pain.
Dr. Ghattas uses diagnostic musculoskeletal ultrasound as part of the evaluation to directly visualize tendon quality and confirm the treatment target.
Conventional Treatment Options
- Rest and activity modification
- Physical therapy: Eccentric loading exercises shown to support tendon health
- Counterforce bracing to reduce tendon load during activity
- Steroid injections: May provide temporary relief but have been shown to weaken tendon tissue with repeated use
- Surgery (rare): For refractory cases that have not responded to extensive conservative and injection-based treatment
The Palm Beach Regenerative Approach
Tennis and golfer’s elbow are among the conditions best supported by orthobiologic treatment evidence. Image-guided platelet injection, delivered precisely to the degenerative area of the tendon under real-time ultrasound, provides growth factors that support the body’s natural tendon healing processes.
Dr. Ghattas uses Regenexx Super Concentrated Platelet (SCP) preparations, delivered with direct ultrasound visualization to confirm accurate tendon placement. This precision is critical for optimal outcomes.
Most patients with tennis or golfer’s elbow who have not responded to conventional care find this a well-tolerated and effective approach. Recovery involves a short period of activity modification followed by progressive loading of the tendon.
The BioMod Advantage: At Palm Beach Regenerative, treatment does not end with a single injection. Through our BioMod Lab, Dr. Ghattas may combine your orthobiologic procedure with MLS Robotic Laser Therapy to reduce inflammation and support tissue recovery, alongside customized Xymogen supplement protocols designed to optimize your body’s healing environment. This integrated, concierge approach is what sets Palm Beach Regenerative apart from a standard injection clinic.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Carpal Tunnel Syndrome Treatment
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Carpal Tunnel Syndrome Treatment Without Surgery
Carpal Tunnel Syndrome: Non-Surgical Treatment in Palm Beach
Carpal tunnel syndrome (CTS) occurs when the median nerve, which runs through the carpal tunnel in the wrist, becomes compressed or irritated, causing numbness, tingling, and weakness in the hand and fingers. It is one of the most common nerve compression conditions, particularly affecting individuals with repetitive hand use or prolonged wrist positions.
At Palm Beach Regenerative, Dr. Ghattas offers Nerve Hydrodissection, an image-guided technique that uses precise injection to free the median nerve from surrounding adhesions and reduce compression, as a non-surgical alternative for appropriate CTS cases. Give us a call for more information.
What Is Carpal Tunnel Syndrome?
The carpal tunnel is a narrow passageway in the wrist formed by bones and ligaments. The median nerve passes through this tunnel, as do the tendons of the hand. When swelling, inflammation, or structural narrowing compresses the nerve within this space, the characteristic symptoms of carpal tunnel syndrome develop.
Signs and Symptoms
- Numbness and tingling in the thumb, index, middle, and half of the ring finger
- Symptoms typically worse at night or upon waking
- Weakness and difficulty gripping or pinching
- Sensation of the hand ‘falling asleep’
- Pain that may radiate up the forearm
- Dropping objects due to reduced grip strength
Common Causes and Risk Factors
- Repetitive hand or wrist movements
- Prolonged wrist flexion (typing, sleeping with wrists bent)
- Pregnancy-related fluid retention
- Thyroid or metabolic conditions affecting nerve health
- Inflammatory arthritis
- Obesity
How It Is Diagnosed
Electrodiagnostic testing (nerve conduction studies and EMG) provides objective confirmation of median nerve compression and helps grade severity. Ultrasound imaging allows direct visualization of the median nerve at the wrist, assessing nerve swelling and mobility within the carpal tunnel.
Dr. Ghattas uses diagnostic ultrasound to evaluate the nerve and plan the hydrodissection procedure.
Conventional Treatment Options
- Wrist splinting, especially at night, to maintain neutral wrist position
- Activity modification and ergonomic adjustments
- Anti-inflammatory medications
- Steroid injections: Temporary relief by reducing inflammation within the carpal tunnel
- Carpal tunnel release surgery: Cutting the carpal ligament to decompress the nerve, effective for moderate-to-severe cases
The Palm Beach Regenerative Approach
Nerve Hydrodissection is a specialized ultrasound-guided technique where precise injection of fluid, typically a platelet preparation, is used to separate the median nerve from surrounding scar tissue and adhesions within the carpal tunnel.
This technique reduces the mechanical compression on the nerve and may help support the nerve’s own healing response. It is performed under real-time ultrasound guidance to ensure the needle and injectate are precisely positioned adjacent to the nerve.
Nerve Hydrodissection may be an appropriate option for patients with mild-to-moderate CTS who wish to explore non-surgical alternatives before committing to surgery. Patients with severe nerve compression and significant muscle wasting (thenar atrophy) typically require surgical evaluation.
The BioMod Advantage: At Palm Beach Regenerative, treatment does not end with a single injection. Through our BioMod Lab, Dr. Ghattas may combine your orthobiologic procedure with MLS Robotic Laser Therapy to reduce inflammation and support tissue recovery, alongside customized Xymogen supplement protocols designed to optimize your body’s healing environment. This integrated, concierge approach is what sets Palm Beach Regenerative apart from a standard injection clinic.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L
Elbow Osteoarthritis Treatment
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Elbow Osteoarthritis Treatment Without Surgery
Elbow Osteoarthritis: Non-Surgical Treatment in Palm Beach
Elbow osteoarthritis is less common than knee or hip arthritis but can be significantly disabling, particularly in athletes, laborers, and individuals with a history of elbow injury. Arthritis of the elbow joint causes pain, stiffness, loss of extension, and in some cases locking from loose bodies within the joint.
For appropriately selected candidates, image-guided orthobiologic injection into the elbow joint offers a non-surgical approach to managing elbow OA symptoms at Palm Beach Regenerative. Reach out to schedule a consultation.
What Is Elbow Osteoarthritis?
The elbow joint is a hinge joint formed by the humerus, ulna, and radius. Primary elbow OA is most common in throwing athletes and manual workers who subject the joint to repetitive loading. Secondary OA follows prior elbow fractures, dislocations, or inflammatory arthritis.
Signs and Symptoms
- Elbow pain with gripping, lifting, or end-range extension
- Loss of full elbow extension (straightening) as a characteristic early finding
- Stiffness, particularly in the morning
- Grinding or clicking with elbow movement
- Locking episodes if loose bodies are present
- Swelling around the elbow joint
Common Causes and Risk Factors
- Repetitive loading from throwing sports, heavy labor, or weightlifting
- Prior elbow fracture or dislocation
- Inflammatory arthritis (rheumatoid, gout) affecting the elbow
- Osteochondritis dissecans in younger athletes
How It Is Diagnosed
X-ray shows joint space narrowing, bone spurs, and loose bodies. MRI provides additional detail on cartilage quality and soft tissue involvement. Dr. Ghattas reviews imaging and clinical findings to determine candidacy for treatment.
Conventional Treatment Options
- Activity modification and activity-specific splinting
- Physical therapy for elbow range of motion and strength
- NSAIDs and pain medications
- Intra-articular steroid injections
- Arthroscopic debridement or elbow replacement for advanced cases
The Palm Beach Regenerative Approach
Image-guided orthobiologic injection into the elbow joint, delivered under real-time ultrasound guidance, reduces joint inflammation and supports the joint environment in appropriately selected candidates with mild to moderate elbow OA.
These treatments do not regenerate cartilage but may provide meaningful pain relief and functional improvement as part of a comprehensive management plan.
The BioMod Advantage: MLS Robotic Laser Therapy reduces elbow joint inflammation and supports soft tissue recovery around the arthritic elbow. Xymogen joint support and anti-inflammatory protocols provide systemic support for arthritic elbow joints, completing a comprehensive treatment approach.
Like all medical procedures, interventional orthobiologics have potential risks and benefits. Results vary by individual. Not all patients are candidates. Dr. Ghattas will discuss your specific situation, realistic expectations, and all treatment options, including when surgery or other interventions may be more appropriate.
Quick Appointments Available
Don't wait in pain. We can see you within 1-2 weeks. Get the orthopedic care you need, fast.
●PATIENT OUTCOMES
Real Patients. Real Results.
No medical procedure can guarantee an outcome. What you should expect is an honest discussion of the evidence, a careful assessment of candidacy, and a recommendation based on your condition.
"Honestly one of the best experiences, I’ve had a really stiff neck for a couple weeks I tried seeing a chiropractor for and it helped marginally but the real jump in relief was coming to see Dr. Ghattas! He has been incredible, wonderful staff, and minimally invasive technique for my pain relief which was super important to me! Thank you Dr. Ghattas recommending to anyone with pain!"Monica A
"Ghattas was instrumental in helping my torn rotator cuff. I did Barbotage for the stone, and then PRP. Great experience. Been about a month or 2 since and I feel great."Ahmet B
"I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them."Roger L
"Over a year ago, both my daughter and I underwent PRP treatment with Dr. Ghattas—PRP for my left knee and PRP for my daughter’s L4-L5 and sacral region. We wanted to wait long enough to truly evaluate the results before sharing our experience. I am pleased to say that the outcomes have been outstanding. My daughter’s improvement has been remarkable, and the treatment has made a significant difference in her quality of life. I have also experienced excellent results with my knee. Dr. Ghattas is an exceptional physician who combines expertise, professionalism, and genuine care for his patients. We are incredibly grateful for the treatment we received and the positive impact it has had on our lives. Thank you, Dr. Ghattas. We are truly grateful for everything you have done. You are simply the best."Dr Jorge A
"Dr. Ghattas is very knowledgable and a sympathetic doctor. Hard to find in America. All questions answered, my procedure went very smoothly, very little pain. Follow up is excellent, I highly recommend his practice."Luciana D
“ I had severe knee pain and was looking for proper knee pain treatment, which is how I found Dr. Ghattas on Instagram. I was a bit hesitant at first, but it turned out to be one of the best decisions I’ve made for my health. Francia was amazing at coordinating all my consultations and making the whole process easy and stress-free. If you’re dealing with knee pain and looking for a reliable doctor and team, I highly recommend them. ”Roger L
“Dr. Ghattas was terrific today. He spent a good amount of time examining me and explaining the regenerative process which I intend to have done next month. More to come after the procedure.”Louie R
“I found Dr Ghattas and his staff very welcoming and informative. The process was well explained and gave me encouragement about the potential for fully restoring my knee joint integrity.”Eric C
“I received two treatments from Dr. Ghattas With excellent results, he takes great care in his assessment and in his treatment you couldn’t be in better hands. I highly recommend his work.”Gisela S
“Apart from the exemplary personal service by the reception and the staff that makes us feel we're at home at the clinic, I have experienced remarkable healing in several episodes from shoulder issue to knee injuries and hip pain. The doctor is so thorough in the diagnosis phase that he administered exactly what was needed, no more no less! Thank you folks for a wonderful experience.”RG G
“Went to Dr. Ghattas for chronic knee and neck issue. I’ve already had multiple procedures done on my neck and multiple epidurals with minimal success. My knee I was told needed surgery to fix. I already had surgery in the past with minimal difference. I ended up getting stem cells in my knee and neck and could t be happier with the outcome. Anyone considering surgery I recommend checking out Regenex first. Next I’m doing the ganglion block and look forward to the results.”Logan H
“Dr. James Ghattas and his team are truly top-notch. His office is equipped with state-of-the-art technology and a staff that's exceptional in their fields. I've referred several clients to him, and they've all been incredibly satisfied. Dr. Ghattas is absolutely ahead of the curve, and I wholeheartedly endorse his work.”Ron H
“I am quite active and go to pilates 3-4 times per week. I was having left knee pain and which was treated with PRP. It took about 3 months for me to feel better but then the pain completely subsided. I now am able to exercise without the fear that I will tear a ligament and am pain free.”Ellipsis P
“Transparency, thoroughness, attention to detail, immediate, high quality, follow ups and follow through are just a few words that come to mind throughout my experiences with Palm Beach Regenerative Sport and Spine.”Milton L