I. EMG/NCS & Ultrasound

Nerve and muscle pain are among the most misunderstood categories of pain in medicine. The burning, tingling, numbness, weakness, and electrical shooting sensations that patients describe are often dismissed, misattributed, or treated empirically without ever identifying the actual source. Accurate diagnosis is not a luxury in nerve and muscle pain — it is the prerequisite for effective treatment.

Electromyography and nerve conduction studies — known as EMG and NCS — are the gold standard diagnostic tools for evaluating the health and function of nerves and muscles. An NCS measures how quickly and how strongly an electrical signal travels along a nerve, identifying slowing, blockage, or amplitude loss that indicates damage or compression. An EMG evaluates the electrical activity within muscle tissue, identifying patterns that distinguish between nerve injury, muscle disease, and normal function.

Together, EMG and NCS can precisely localize nerve injuries, confirm radiculopathy, diagnose peripheral neuropathy and entrapment syndromes such as carpal tunnel syndrome and ulnar neuropathy, evaluate for neuromuscular diseases, and distinguish between conditions that appear similar clinically but require entirely different treatment approaches. Dr. Mahajer performs these studies personally — not delegated to a technician — which means the clinical interpretation is integrated directly with the examination findings and the patient’s history in real time.

“Physician-performed and interpreted electrodiagnostic studies demonstrate superior diagnostic accuracy and clinical correlation compared to technician-performed studies interpreted remotely, with direct impact on treatment planning and patient outcomes.” — American Association of Neuromuscular & Electrodiagnostic Medicine. Muscle Nerve. 2006;34(4):536–539.

Diagnostic musculoskeletal ultrasound adds a real-time visual dimension to nerve and muscle evaluation that no other bedside tool can match. Dr. Mahajer is a nationally recognized authority in musculoskeletal ultrasound — a skill he has trained in extensively, taught at national conferences, and applies daily in both diagnostic and procedural contexts. With ultrasound, he can visualize nerves directly, identify sites of entrapment or compression, assess tendon and muscle integrity, evaluate soft tissue masses, and guide therapeutic injections with precision that cannot be achieved by landmark technique alone.

The combination of EMG/NCS and diagnostic ultrasound gives Dr. Mahajer a diagnostic capability for nerve and muscle conditions that few outpatient practices can match. Conditions that have gone undiagnosed for months or years are frequently identified and explained at a single comprehensive visit.

If you have been living with numbness, tingling, burning, weakness, or unexplained pain that has not been adequately explained by prior evaluations — or if you have received a nerve-related diagnosis but are uncertain whether it is accurate — a comprehensive electrodiagnostic and ultrasound evaluation with Dr. Mahajer may provide the diagnostic clarity that has been missing. He will explain what the studies show, what they mean for your condition, and what the treatment options are in plain, accessible language.

II. Nerve & Fascia Hydrodissection

When a nerve becomes entrapped, compressed, or tethered by surrounding scar tissue, adhesions, or fascial restrictions — it loses its ability to glide freely through its anatomical pathway. That loss of mobility is not just a mechanical problem. It generates inflammation, alters nerve signaling, and produces the persistent burning, aching, and hypersensitivity that characterizes peripheral nerve entrapment syndromes.

Hydrodissection is a minimally invasive ultrasound-guided technique in which a carefully selected fluid — typically a combination of dextrose solution, local anesthetic, or in some cases a biologic agent — is injected under real-time visualization around a compressed or tethered nerve. The fluid mechanically separates the nerve from the surrounding tissue, releasing adhesions, restoring glide, and reducing the inflammatory environment that perpetuates pain.

Dr. Mahajer performs nerve hydrodissection across a broad range of peripheral nerve entrapment conditions. These include median nerve entrapment at the wrist and forearm, ulnar nerve entrapment at the elbow and wrist, radial nerve entrapment, lateral femoral cutaneous nerve entrapment causing the burning thigh pain known as meralgia paresthetica, common peroneal nerve entrapment at the fibular head, tarsal tunnel syndrome, and sural nerve entrapment, among others. The approach is the same in every case: precise sonographic identification of the affected nerve, real-time visualization of the entrapment site, and careful hydrodissection under direct image guidance.

“Ultrasound-guided hydrodissection of the median nerve produced significant improvements in pain, symptom severity, and nerve conduction parameters in patients with carpal tunnel syndrome, with effects sustained at six-month follow-up.” — Wu YT, et al. Ann Neurol. 2018;84(4):601–610.

Fascial hydrodissection extends this principle to the connective tissue planes that envelop muscles and neurovascular structures throughout the body. Fascial restriction and thickening — whether from prior injury, overuse, postural adaptation, or systemic inflammation — can generate significant pain and movement limitation that does not resolve with stretching, massage, or standard physical therapy alone. Targeted hydrodissection of restricted fascial planes restores glide, reduces tension, and allows the surrounding structures to move as they were designed to.

Both nerve and fascial hydrodissection are performed as office-based procedures under real-time ultrasound guidance, typically requiring no sedation and minimal recovery time. They represent a meaningful option for patients who have not found adequate relief from conventional treatments for nerve entrapment or myofascial pain syndromes.

If you have numbness, tingling, burning, or regional pain that has been attributed to nerve compression or entrapment — or if you have been told that surgery is required for a nerve entrapment syndrome — hydrodissection may offer a nonsurgical alternative that addresses the mechanical source of your symptoms directly. Dr. Mahajer will evaluate whether your nerve entrapment is a candidate for hydrodissection, explain what the procedure involves, and discuss realistic expectations for relief.

III. Trigger Point Injections

A trigger point is a hyperirritable spot within a taut band of skeletal muscle — a point that is painful on compression and that reliably refers pain to a predictable distant location. Trigger points in the upper trapezius refer pain into the neck and head. Trigger points in the gluteus medius refer pain into the buttock and thigh. Trigger points in the infraspinatus refer pain into the shoulder and down the arm. When a patient presents with regional pain that does not follow a clear dermatomal or myotomal pattern, trigger points are frequently the unrecognized source.

Trigger point pain is not imaginary and it is not nonspecific. It is a well-characterized physiological phenomenon — the product of sustained muscle fiber contraction, local ischemia, and sensitization of the nociceptive system within the affected tissue. It responds poorly to rest and medication alone. It responds well to direct, targeted intervention.

Dr. Mahajer performs trigger point injections using ultrasound guidance, which allows him to visualize the taut band within the muscle, confirm needle placement within the target tissue, and avoid adjacent neurovascular structures. The injectate — typically a local anesthetic with or without a small dose of corticosteroid — is delivered directly into the trigger point, disrupting the contracted tissue, reducing local inflammation, and interrupting the self-perpetuating pain cycle that sustains chronic myofascial pain.

“Trigger point injections with local anesthetic produced significant reductions in pain intensity and referred pain patterns compared to dry needling and placebo, with ultrasound guidance improving accuracy and clinical outcomes.” — Ga H, et al. J Rehabil Med. 2007;39(5):374–378.

The conditions that respond to trigger point injection include chronic myofascial pain syndrome, tension-type headache and cervicogenic headache with cervical trigger point involvement, shoulder and periscapular pain, thoracic outlet syndrome with muscular contributors, hip and buttock pain with gluteal trigger points, and piriformis syndrome. In many cases, trigger point injection is not a standalone treatment but an important component of a broader rehabilitation plan — releasing the muscular restriction that has prevented effective physical therapy or exercise from achieving its full effect.

Dr. Mahajer approaches trigger point care the same way he approaches every intervention: with a thorough evaluation to confirm that trigger points are genuinely contributing to the patient’s symptoms, with precision technique to ensure the right structures are treated, and with a clear plan for follow-up and rehabilitation that addresses the underlying factors driving trigger point formation.

If you have been managing neck pain, shoulder pain, back pain, headaches, or regional muscle pain with massage, stretching, or medication without achieving lasting relief — active trigger points may be a significant and untreated contributor to your symptoms. A musculoskeletal ultrasound evaluation with Dr. Mahajer can identify the specific trigger points involved and determine whether injection therapy is appropriate as part of your overall treatment plan.

PAIN SHOULD NOT DEFINE WHAT YOU ARE ABLE TO DO

Dr. Mahajer is ready to help you find a better path forward.