Helping hands

By Meg Hagerty mhagerty@poststar.com | Posted: Saturday, November 14, 2009 11:00 pm | (0) Comments

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Erin Reid Coker Erin Reid Coker - coker@poststar.com LPN Nancy Jones, left, assists Dr. Harold Kirkpatrick with carpal tunnel surgery on Paul Loguercio using a MicroAire Carpal Tunnel Release System on Wednesday November 11, 2009 at Glens Falls Hospital.

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Dr. Harold Kirkpatrick recalled having to stop and shake his hands during a procedure in the operating room because they had gone numb. He also felt a strange tingling in his fingers when he played the bagpipes.

"There wasn't much discomfort except it would wake you up at night with pain. And really, the pain at night ... I don't know why the pain was so bad at night," he said.

It was 25 years ago when Kirkpatrick had incisions made on the palms of his hands with the open-surgery technique for carpal tunnel syndrome.

Now, the Glens Falls plastic surgeon and otolaryngologist is practicing an endoscopic method of surgery for carpal tunnel syndrome, a less invasive technique than he underwent all those years ago.

According to Kirkpatrick, he is the only area surgeon using the endoscopic method for the common hand procedure, having performed it at Northwest Hand Specialists in Seattle for about a year and a half before returning to Glens Falls.

The major benefit of endoscopy over the open technique is a much smaller incision and a speedier recovery.

Carpal tunnel syndrome occurs when the median nerve, which runs from the forearm into the hand, becomes pressed or squeezed at the wrist. Nine tendons and one nerve pass through the carpal tunnel on the palm side. The tendons swell and compress the nerve in the small tunnel, causing symptoms.

Initially, people experience numbness from time to time, but it increases as time goes by. Eventually there is pain that also gets worse. By disregarding the numbness and pain, the nerve can be killed off by the pressure. The muscle on the palm-side of the thumb begins to shrink, causing a concavity and weakness in the thumb.

"Once it gets to that point, the operation doesn't help," Kirkpatrick said.

Those most likely to develop carpal tunnel syndrome have heavy or repetitive use of their hands, though Kirkpatrick also sees patients who don't do much with their hands.

Kirkpatrick has done about a dozen procedures since returning from Seattle. He sometimes uses endoscopic surgery for arthritis of the wrist, too.

The basic surgery is to cut the transcarpal ligament that is compressing the nerve to alleviate the pressure. The open technique involves making an incision about two inches long on the palm to the ligament that is then transsected.

With the endoscopic technique, however, an incision is made on the wrist about three quarters of an inch long. The scope is placed in that spot and tunneled into the carpal tunnel and the incision is made from underneath the ligament. The recovery time is relatively short.

"If you're on a job that doesn't require a lot of heavy work, you could be back to work in two weeks (with the endoscopic technique). You might be still a little bit tender but you're not endangering the healing," Kirkpatrick said.

A patient who makes heavy use of his hands may still have tenderness where the ligament was cut under the skin and may still be out of work three or four weeks with the endoscopic method.

With the open technique, if there is a large incision and it doesn't heal, there can be serious problems and healing time will be at least four weeks to heal or longer, Kirkpatrick said.

Surgery isn't always warranted for carpal tunnel syndrome. In mild cases developed from overactivity, some patients may benefit from a splint being put on to let the hand rest.

Some doctors might inject a steroid in the carpal tunnel, hoping to reduce the swelling of the tendons and reduce the tightness of the nerves. This is a temporary measure, however.

"It might last two months, it might last a week," he said.

In Kirkpatrick's experience, most patients seek treatment for moderate cases in which they haven't gotten relief from the splint. Then, surgery is the permanent fix.

Kirkpatrick warned that people should not ignore the numbness indicative of carpal tunnel syndrome. It's important to treat it while the nerve is still alive.

If the numbness won't go away or is very difficult to get rid of, however, the nerve may die.

"Once the nerve is dead, it's not going to come back," Kirkpatrick said.

Posted in Local on Saturday, November 14, 2009 11:00 pm Updated: 11:43 pm. | Tags: Health, Glens Falls Hospital

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