General Practitioners

• Arthritis
  There are two main types of arthritis that many people ultimately suffer from usually after they are in their 50s or beyond. Degenerative arthritis, overwhelmingly the most common, is a breakdown of the cartilage in a joint because the genetic code does not account for enough repair and maintenance of the cartilage in the joint, which is normally alive, dynamic tissue.  Imagine an abandoned house that never gets painted and the roof falls apart, the window shutters dangle and perhaps the windows themselves are broken.  Another type of arthritis, inflammatory, includes relatively small numbers of people by comparison afflicted with rheumatoid arthritis. With RA, antibodies are made by attacking one’s own body, setting off an inflammatory response.  Gout is also a fairly common inflammatory arthritic disease.  This is a poorly understood common ailment wherein crystals of urate are engulfed by WBCs that release caustic enzymes into the joints.
• Fibromyalgia
  Normally the patient complains of tenderness upon squeezing the epicondyle and the extensor muscle just towards the hand. There is rarely any significant tenderness over the posterior interosseous nerve in the radial tunnel. Absence of pain in the outer elbow upon resisting turning the forearm palm upwards with elbow extended or flexed helps to rule out radial tunnel syndrome-a rare diagnosis of exclusion. X-ray is usually normal and CAT scan and MRI are not indicated. Unfortunately the controversial questionable diagnosis of "fibromyalgia" lists outer elbow tenderness as one of its cardinal sites! This often delays correct treatment.
• Plantar Fasciitis
  Painful heel syndrome usually occurs in markedly overweight people and is sometimes due to nerve entrapment at the tarsal tunnel rather than "plantar fasciitis", another common problem.
• Medical Weight Loss
  Once the doctor has examined your knee and x-rayed it (preferably weight-bearing) to clarify the cartilage thickness if there is residual cartilage in the joint, then he can help you work on weight reduction if it is feasible.  This is usually most successful only in very dedicated patients and in those who are willing and physically able to take appetite-suppressant medication. Appetite-suppressant protocols seem to be the most effective while exercise contributes to the overall physical fitness of the person and the reduction of carbohydrate consumption (decrease volume of bread, pasta, rice, potatoes, sweetened drinks, and confections such as cakes and pastries, and candy).
• Emergency Care
  The diagnosis of shoulder instability is based upon taking a careful history and review of necessary diagnostics such as basic x-rays and a careful physical exam.  Usually instability is related to trauma and there is a clear-cut history of a physical incident wherein the person’s shoulder is painfully knocked out of position requiring heavy sedation in the emergency room or an operating room to pull the shoulder back into place.  Most people who think that they have dislocated their shoulder have only injured the acromioclavicular joint, the minor joint on the top of the shoulder.  When we talk about shoulder instability we are talking about the main glenohumeral joint.  There is really no ball-and-socket.  The ball is stabilized by ligaments and the overlying muscles.  A full rotator cuff muscle can act like a guidance system for the shoulder while the larger, bulky muscles are on the outside of the shoulder- most notably the deltoid, latissimus dorsi, teres major and pectoralis major and minor tendons- make the powerful motions of the shoulder occur.

Internists

• Internal Medicine
  A person who has painful degenerative arthritis of the knee not responding to or intolerant of medication, unable to use a cane successfully if appropriate, and otherwise healthy enough to undergo an operation under spinal or general anesthesia as determined by their internal medicine doctor.  Diabetics need to have their diabetes well under control with a hemoglobin A1c, i.e., average serum glucose, of close to normal, or their risk of infection skyrockets.  It has been determined that patients who undergo removal of a joint replacement because of infection are basically living the life profile of a person with cancer, very costly and has a lower life expectancy.  It may be that these people are just typically less healthy, to begin with.

Neurologists

• Neurology
• Carpal Tunnel Syndrome
  A huge amount of non-factual "information" regarding the non-proved entity "cumulative trauma" and its counter-part "repetitive strain injury" (RSI) appears on the internet. This includes quack treatment such as vitamins, exercise, magnets, copper bands, crystals, food supplements, bogus medication such as carpal tunnel cream, and the list goes on. See the section on History of Endoscopic Carpal Tunnel Release for scientific information on the diagnosis and treatment of carpal tunnel syndrome.
• Neurolysis

Psychiatrists

• Anxiety

Endocrinologist

• Diabetes Care

Radiologist

• Ultrasound
  Answer: This is a research tool. Ultrasound data comes out and is looking at shades of gray. The interpretation is very subjective. It is not objective like measuring the speed of nerve conduction with a nerve conduction test. You really can’t determine how the nerve is functioning.
• MRI
  Imaging such as CT and MRI are kept to a minimum since they are  rarely really needed for hand to elbow problems
• X-Rays

Surgeons

• General Surgery
  Part of Dr. Ichtertz's family came from Blue Hill, NE and ultimately ended up in Illinois. Dr. Ichtertz spent his childhood through college age in southern California and attended the University of Southern California (USC) graduating with a Bachelor's degree in biology. He then attended Baylor College of Medicine (BCM), the anchor of the Texas Medical Center- the largest medical center in the world. According to U.S. News & World Report, BCM has been among the nation's top 20 medical schools since 1994. After graduating from medical school Dr. Ichtertz completed his orthopedic residency at the University of California in San Francisco (UCSF). This is also a top tier medical center and northern California's premier tertiary care center serving very sick and unique patients. At UCSF Dr. Ichtertz spent a rotation with numerous experts in each of the subspecialties of orthopedics and general surgery. UCSF Department of Orthopedics is especially strong in total joint replacement and trauma. In fact, UCSF staffs the two largest county hospitals in northern California, San Francisco General Hospital and Highland General where Dr. Ichtertz served as chief resident.
• Orthopedics
  Thank you for choosing Nebraska Hand & Shoulder Institute, your orthopedics provider. My staff and I at the Nebraska Hand & Shoulder Institute, P.C. believe that prevention and elimination of painful or debilitating conditions of the upper and lower extremities can consistently be achieved. Our success is made by a strong effort at patient education via frequently updated brochures, video and verbal instruction, and ongoing clinical outcomes research. We bring these services to you for sports injury, fracture, nerve entrapment and arthritis at four convenient locations across Nebraska.
• Arthroscopy
  Most tears are degenerative and involve the inner edge of the mid to posterior meniscus. They result in joint line soreness and typically result in a limp. The doctor will note localized joint line tenderness and pain with guarding against full motion.  An x-ray is used to make certain there is no broken bone. It is necessary to be certain the person's pain and tenderness are not just due to a ligament strain or sprain or early degenerative arthritis. Non-steroidal anti-inflammatory medication (NSAID) such as meloxicam is very useful. A torn meniscus will usually continue to hurt and require arthroscopy while ligament injury and arthritis will feel better.
• Pinched Nerve
  Unfortunately many people in the age group with symptoms of impingement have multiple degenerative processes simultaneously such as arthritis of the neck or a pinched nerve making isolation of the problem and solutions to or even improving these pain syndromes difficult. Sometimes the problem is narrowed down by the process of elimination by treating each of the separate entities.
• Minimally Invasive Surgery
  If pain persists, affecting one's job or prevents one from sleeping at night, then after a few months of failed treatment, an outpatient should consider minimally invasive surgery. This surgery could solve the problem. Dr. Ichtertz has extensive experience in performing arthroscopic surgery of the shoulder. The inside of the shoulder is viewed with a fiberoptic scope through small puncture wounds. Then the prominent bone is trimmed as are other damaged tissues. The outer clavicle at the AC joint needs trimming in about 40% of the cases. This minimizes discomfort and frequently allows the doctor to do surgery without putting any absolute restrictions on a patient's activities afterwards. Recuperation from the initial surgery is quick with return to work in under a week. Usually, about 3-6 months are allowed for a person to reach their endpoint with full or almost full motion and minimal to no residual pain.
• Ankle Surgery
• Joint Replacement
  In fact, Dr. Ichtertz was among the first involved in arthroscopic meniscal repair (1984), arthroscopic wrist surgery (1986) and has been doing arthroscopic shoulder surgery since 1985. You have come to the right site. Dr. Ichtertz has broad-based experience with the most modern techniques for common and unusual problems of the upper and lower extremities. We have the only pressure-specified sensory device in the state of Nebraska to help in the diagnosis and treatment of tarsal tunnel syndrome, particularly in diabetics. Total joint replacement for arthritis of the major joints of the body is also offered.
• Arthritis Surgery
  Denervation of joints has been used by select surgeons including myself for many years.  This was prompted by the lack of resources that were available medically until the 1960s for dealing with arthritis.  Anatomists in the 1800s outlined nerve endings to many of the joints in the body and, in fact, from the first arthritis surgery done for hips was the excision of the obturator nerve and geniculate nerve of the knee, etc.  Identifying those nerves is sometimes very difficult and would give incomplete relief of pain depending on the joint involved.  Joint replacement surgery is easier than the denervation of these.  There is now a whole book written by A. Lee Dellon, M.D. (Joint Denervation: An Atlas of Surgical Techniques, 1st ed. 2019 Edition.), that has been published on denervation of various joints in the body including the knee.  I started using it in about 1987 on the wrist.
• Hand Surgery
  Hand surgery as a specialty has evolved in the 1930’s and 1940’s in response to wartime injury. Hand surgery is an art that is different from other areas of surgery. The anatomy of the hand is more complex than anywhere else in the body. Nowhere else are so many structures acting in harmony to produce motion, sensibility, and motion.
• Neurosurgery
  Gervasio O, Gambardella G, el al “Simple decompression versus anterior submuscular transposition of the ulnar nerve in severe cubital tunnel syndrome: A prospective randomized study.” Neurosurgery 2005; 56:1:108-117.
• Arthroscopy
  The practice emphasis is on diagnosis and treatment of compressed nerves resulting in discomfort and/or limitation of activity. Minimally invasive surgical techniques (arthroscopy and other percutaneous methods) are emphasized in solving hand, elbow and shoulder and knee problems thus minimizing discomfort and accelerating recovery.
• Hip Replacement
  The next has been pushing the concept of robotics hoping that expensive, computer-guided cutting jig and perfection of the cuts would improve the outcome of patients.  No well-performed study to this date, and there have been a few, has been able to demonstrate improved patient outcome with the use of robotics for hip or knee replacement surgery.  It increases the operative time which increases cost, and the machines are very expensive which also increases cost.  Robotics are being used as a gimmick to try and draw patients in such as Fillmore County Hospital in Geneva (see tv ads on Me TV late night).  A lot of surgeons jump on a bandwagon hoping to gain market share because they want to all give the public what they are asking for rather than following science and rational reasoning.  This ties closely with the next gimmick, which was to push the concept of anterior hip replacement using a $100,000 Hana surgical table.  Regardless of how one performs hip replacement, from the front or the back or side, the risk of dislocation the same.  There are no improved outcomes from using the Hana, and the Hana table is not even necessary for doing anterior hip surgery if one wants to do it.  No special table is necessary in skilled hands.
• Knee Replacement
  When patients come to me complaining of knee pain, the first thing I recommend is a thorough examination. I want to get a clear sense of the source and severity of the pain before recommending any course of treatment. Knee pain can be triggered by a variety of causes that may not be suitable for a partial or full knee replacement such as
• Knee Arthroscopy
  Much has been written about treatment advances for knee injuries. Yet, the knee is a relatively simple anatomic structure and most of the surgical techniques applied to the knee are simple as compared to the hand. From the advances made in fiberoptics for knee arthroscopy came advances in hand surgery when the same principles were put into play. In fact Dr. Ikutsu's first endoscopic carpal tunnel releases were performed with knee arthroscopy equipment!
• Reconstructive Surgery
  Damage to the rotator cuff has become an increasingly more frequent event. Twenty-eight years or more ago it was seen almost exclusively in the realm of retirees in their late 60s on up. Now we are frequently treating people in their 50s and occasionally their 40s or earlier. In general in the 1980s, there was a big controversy around how to diagnose a torn rotator cuff and many then and before went undiagnosed and people just suffered. In the 1990s, treatments formerly only available through open surgical techniques shifted to arthroscopic techniques with better visualization afforded with the arthroscope; though technically more difficult, new technically demanding procedures and equipment to perform those procedures evolved. In the early 1980s latissimus dorsi and serratus anterior muscles which become very large and bulky and prominent in bodybuilders found extensive use in microvascular reconstructive surgery. Portions of each of these muscles can be taken and moved with its blood vessel and nerve and reattached elsewhere in the body to fill a large void from trauma or tumor resection. This is true without sacrificing function of the shoulder. Since the late 1990s the latissimus dorsi muscle has gained limited use in reconstruction of massive rotator cuff deficiency to help stabilize the shoulder and also to strengthen external rotation.

Plastic Surgeons

• Plastic Surgery
  In 2002 Dr. Ichtertz visited with A. Lee Dellon, M.D., Professor of Plastic Surgery and Neurosurgery at Johns Hopkins University Medical Center and author of over 250 scientific articles. The goal was to gain a full understanding of the technique and application of quantitative sensory examinations using the NMT Pressure-Specific Sensory Device (PSSD) which had been developed and studied in the diagnosis of peripheral neuropathy - most specifically diabetic peripheral entrapment neuropathy and FDA approved. Dr. Ichtertz added this to his clinical armamentarium and has utilized the technology to further enhance the diagnosis and improve the treatment of ulnar nerve entrapment, both nonoperative and operative - specifically cubital tunnel syndrome.

Dermatologists

• Cyst
• Ulcer
  Non-steroidal anti-inflammatory medication (NSAIDs) are the mainstay for the treatment of degenerative arthritis throughout the body, and they are also used in conjunction with cortisone, disease-modifying drugs such as Enbrel, and methotrexate in the management of autoimmune (rheumatoid) arthritis.  NSAIDs were derived from analysis of the chemical pathway of aspirin which is apparently extracted from tea made from willow bark by American Indians.  Aspirin in large quantities, however, causes ringing in the ears, gastritis, ulcers, and can affect one's kidneys as well.  The NSAIDs derived from this chemical pathway mostly in a satisfactory, safe form, really began with ibuprofen in the late 1960s.  These medicines do not cross the blood-brain barrier, i.e., they are affecting the tissue, not the brain, and pain relief comes by decreasing inflammation and cutting down on painful chemical pathways in the joint tissue.  One of the problems we have with NSAIDs or with any medication is just getting the patient to take it.  Studies have shown that people are unreliable and uncooperative in taking medication and the least frequent medication is taken substantially more often than medication requiring frequent dosing.  Most patients can tolerate the NSAIDs without side effects as long as they have normal kidney function and do not have a true allergy to NSAIDs (rash, shortness of breath, or throat swelling) or a history of a definite ulcer or severe esophagitis.  One can tell within about four to six weeks whether they are going to get substantial benefits and will be able to live comfortably with NSAIDs.  These have to be taken on an ongoing basis because arthritis cannot be stopped, and we cannot roll the clock backward and generate new cartilage.
• Lesions
  Meniscal lesions are more significant when they occur at the time of anterior cruciate ligament (ACL) rupture from sports injury. Arthroscopic partial meniscectomy is the preferred treatment for a shredded, degenerative meniscal lesion since it has been available beginning about 1980. It causes minimal discomfort along the joint line where the injury occurred in the first place.
• Burns

Physical Therapists

• Sports Medicine
• Physical Therapy
  The same day of surgery you will probably be telling others that your suffering has ended! Our patients from many occupations return to their activities in just hours. NO BRACES, NO LARGE SCARS, NO PHYSICAL THERAPY IS NEEDED. Patients frequently tell us they're amazed!
• Occupational Therapy
  It's rare for a person who undergoes ganglion removal to require hand therapy afterwards if treated at Nebraska Hand & Shoulder Institute, P.C. There is usually minimal discomfort after surgery. Since there are no restrictions necessary, the patient is allowed to move her fingers and wrist immediately. Significant stiffness develops only if the patient babies herself and refuses to do simple exercises. Total ganglion removal provides 85-90% chance of permanent cure. Surgery achieves difinitive tissue diagnosis and treatment in one sitting. If the specimen appears classical for a benign (non cancerous) ganglion, it may not be necessary to send it to a pathologist and incur an additional charge, though hospital regulations may mandate having the pathologist look at the specimen. Having an absolute tissue diagnosis often provides an unparalleled measure of confidence in a person by eliminating the fear of an undiagnosed cancer.
• Frozen Shoulder
  If you are experiencing the inability to reach behind your back accompanied by decreased motion throughout your shoulder, you may be suffering from frozen shoulder. Frozen shoulder is much more common in the diabetic community than in those without diabetes. While frustrating and painful, the encouraging news is that this condition typically can be treated without surgery. Schedule an appointment today and let our expert staff diagnose and develop a treatment plan for your frozen shoulder.
• Tennis Elbow
  Radial tunnel syndrome is most often mistaken for tennis elbow. While the symptoms may seem similar, the treatments for these two conditions are very different. For this reason, obtaining an accurate diagnosis is very important. In about half of the cases where radial tunnel syndrome is diagnosed, surgery is not required. You can trust the experts at Nebraska Hand & Shoulder to provide you with an accurate diagnosis and treatment.
• Shoulder Pain
• Heel Pain
• Neck Pain
• Back Pain

Podiatrists

• General Podiatry
  Dellon, AL, "Computer-assisted sensibility evaluation and surgical treatment of the tarsal tunnel syndrome." Advances in Podiatric Medicine and Surgery, 1996; 2: 17.
• Heel Pain
• Plantar Fasciitis
  Many people diagnosed with “plantar fasciitis" actually have entrapment of a branch of the tibial nerve as it enters the heel hence the treatment of plantar facial release which actually decompresses the nerve branch. Usually, before offering surgical release for a painful heel thought to be plantar fasciitis, stretching, shoot inserts to take direct pressure off of the heel and a cortisone injection are tried first.

Allergists

• Allergies