carpal tunnel

[dickm]

All due respect to Adam's experience, but the difficulty in areas like this is that there is actually remarkably little statistically valid data on surgical success rates or proper definition of "success". (I'm married to a retired medical statistician, and she would be the first to accept this.) So we are forced to rely on the expertise of those we happen to encounter.
The scientific and other literature on Dupuytrens is vast, but it's still unclear what causes it . And it's very difficult to know how to be sure you find a surgeon with the time and the microfine manual dexterity to do good work on the damage when that's necessary.
So talk to as many experts and sufferers as you can before making any irrevocable decisions.

 

[wobblycogs]

FWIW, my mum developed really bad CT in one wrist / arm and stuggled on for about 18 months before going for sugery. I was amazed how long she was off work for (and how long it took to fully heal) but now her arm is as good as new. I'm sure it doesn't work for eveyone and I would always choose surgery as a last resort but it looks like when it works it works well.

When it comes to asking for professional advice don't forget that to a man with only a hammer every problem looks like a nail.

 

[frugal]

Being intimately involved in this sort of thing (I have forgotten how many of these operations I have anaesthetised for) my advice is this : unless people on this forum are orthopaedic surgeons with an interest in hand surgery, then the advice they give is at best anecdotal, and worst scaremongering.

I am sure that you have a much better clinical knowledge of this operation than I do, but from a vendor management point of view, asking for advice from someone who may benefit financially from giving you surgery will always result in a pro-surgery point of view.

Not directly related, but when my orthopedic surgeon looked at the MRI of my back he said that if it got any worse he would recommend surgery to remove the disc and there was no problem as he did 4 of these a week. My GP recommended Physio looked at the same MRI and said that surgery was not going to help as the problem was not the disc but the vertebrae. My Chiropractor told me that he had a person on his books who had had the surgery and was in a worse state than before and he recommended rehabilitation exercises.

Which of them is correct?.. they all have differing points of view, each of which is going to be biased by their professional training and the services that they can offer. what is a layman like me to do when presented with diametrically differing opinions from a series of profesionals.

Personally I distrust the opinion of someone who charges £250 for a 15 minute consultation purely on the basis that he makes his money as much on the basis of selling his services as helping patients.

I would rather that my health was seen as the professional's priority rather than their golf club membership fees.

Of course the same thing can be equally said about the plumber who tells you that you need a new boiler because it makes him more money than fixing the old one; or the mechanic who tells you that you need things fixed when you do not; or the salesman who pushes the inferior product because it has a better commission than the superior one. I even do it at work, I give advise to projects that will further the goals of my team as much as the goals of the company.

Every relationship has two parties that each want something and it is rare that either party knows exactly what the other one wants. In this case I want my health to improve (which a medical professional would almost certainly assume), however I have no idea if the medical professionals goal is to improve my health or pay for his/her next holiday.

I am always amazed that we are taught to get second opinions and check references when we when we engage a builder or plumber, but that we are also taught that doctors and surgeons are right and that we should just trust them.

hmmm.. that started as a response to 'only orthapadic surgeons are qualified to discuss carpal tunnel' and ended up as a 'you can't trust anyone' rant. Adam, please don't take this as an attack against your comments or the medical profession as a whole (2 of my closest friends are a Theatre Nurse and a Senior doctor), rather a statement on societies acceptance of the truth based on the job title of the person saying it rather than the reasons for which it is said.

 

[Kalimna]

Just to reassure you, I take no offence at all from the various comments
It does, however, disappoint me slightly that people still equate advice from someone not trained in the investigation, diagnosis and complex treatment of a condition with that given by a friend, the media, or someone whose training does not cover these points. You would not, for instance, heed counsel regarding the preparation and execution of french polishing from a site carpenter who may use only a tin of Ronseal (and please don't take this personally anyone who happens to be a site carpenter and also a practioner of fine FP - I am using this only as an example on a woodworking forum!)

To further the plumber second opinion analogy - you may very well want to get a second opinion regarding a broken boiler, but you would get it from another plumber, and not an electrician, orthopaedic surgeon or red top newpaper.

The notion that NHS doctors get paid by procedure completed or patient seen is frankly absurd, however. Given the current governments position on waiting times and ridiculous edicts for reducing same, it would actually more likely benefit the surgeons to treat fewer, not more people.
Private practice (be it surgical, physio or chiropractor) I cant comment on, however, as I am not involved there.

This is a very complicated and emotive issue, frequently discussed by people who may have personal experience of a particular condition, but who don't have the many years of knowledge and expertise that a medically qualified practioner does. Success rates are especially tricky to understand as a simple number does not take into account the multitude of factors specific to an individual patient. And that is something I am sure any medical statistician would confirm.
Further, it is surely more likely that this highly trained practitioner will 'hit the nail upon the head' than a lay person. Doctors are human and certainly don't always get things right, but they are much more likely to get it right in matters medical and surgical than non-medics.

There is a considerable amount I would like to add to this discussion, but I think I shall hold fast here. Orthopaedics is not my speciality, anaesthetics is. I will happily reply to any questions regarding one, but not the other.

Dont forget too, that when advice is sought from a man who only has a hammer, it is likely that you seek that advice because you have a nail. In which case, that advice is likely to be sound advice.

Cheers,
Adam

 

[Max Power]

Thank you to everyone who have taken the time and effort to reply , I am seeing my gp on fri to arrange a referral to the consultant and will keep you updated

 

[Benchwayze]

I suffered mild RSI in my right hand (mouse-hand). Tingling figers etc.

Just putting the mouse on a hardback book about 50mm thick solved the problem. If I ever get 'a round tuit' and build a new desk, at least I'll know how high to make the surface where the mouse will repose.

Even mild RSI isn't a nice experience.

John