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Dr. Patrick McCulloch Offers Surgical Options for Carpal Tunnel Syndrome
By Nancy Kennedy

Dr. Patrick McCulloch

Women are three times more likely than men to develop carpal tunnel syndrome, a nerve compression condition that causes numbness and pain in the hands. A common assumption is that carpal tunnel syndrome is occupation-related, and that it is specifically caused by typing. But according to one regional expert on the condition, writers and typists are not at greater risk, and in fact, the actual cause of carpal tunnel syndrome remains a mystery. "We're not sure why carpal tunnel syndrome occurs; we know that there are certain factors that contribute to the development of it, such as obesity, diabetes and hypothyroidism, but it looks like it has more to do with genetics than anything else," says Patrick McCulloch, M.D., a board-certified orthopaedic surgeon who specializes in treatment of the hand and upper extremity with Advanced Orthopaedics and Rehabilitation. "One recent study showed that typing may actually be protective and may prevent the development of carpal tunnel syndrome. The only type of work that directly causes it is the repetitive use of heavy vibrating equipment, like a jackhammer."

The condition is characterized by various degrees of numbness and pain in the thumb, index finger, middle finger and part of the ring finger. The pain is likely to worsen at night. The hallmark sign, says McCulloch, is numbness. People who have hand pain without numbness most likely do not have carpal tunnel syndrome.

Medical treatment of carpal tunnel syndrome may include wearing splints at night, to keep the wrist from flexing. "We tend to sleep with our wrists flexed, and this reduces the space in the wrist that the median nerve passes through. Compression of the nerve causes the numbness and pain." Steroid injections can help relieve symptoms when pain is mild and has been present for less than a year. Ignoring carpal tunnel syndrome is not a good idea; it rarely gets better on its own, and will probably get worse. It can progress to the point that the nerve signals can't get through to the muscle at the base of the thumb, leading that muscle to atrophy. Once the muscle function is lost, it may not recover."

Diagnosis of carpal tunnel syndrome is based on history, examination and sometimes, diagnostic studies, including nerve conduction tests and electromyography. Surgery for carpal tunnel syndrome is an outpatient procedure and can be performed with a local anesthetic, so that sedation is avoided. "The patient has options," explains McCulloch. "In my practice, more people are having it done with a local. There are advantages to having it done this way: you can drive yourself to and from the hospital. You can shower and possibly even return to light duty work the next day. You don't need to have the pre-op bloodwork, chest x-ray and EKG. If you prefer to have it done with IV sedation, it's still an outpatient procedure, but you will need to fast before surgery and have all the pre-ops done. You'll need a driver and someone to stay with you on the first post-op night. For me, as a surgeon, it makes no difference; the procedure is the same."

Shivani Duggal, D.O.

Carpal tunnel surgery has a 90% success rate. Post-operatively, the patient will have a one-inch incision with the stitches underneath the skin. There may be tenderness in the palm of the hand for up to six months, McCulloch says, and sometimes there is a minor loss of hand strength, but not enough to make a functional difference or affect daily living.

Carpal tunnel is a common complication of the third trimester of pregnancy, affecting as many as 40% of women according to some studies. A local steroid injection is safe in these cases and almost always effective for pain relief. Women who develop carpal tunnel syndrome during pregnancy are at higher risk of developing it again later.

McCulloch enjoys being able to help patients in many different ways. "I'm happy with my work. I like the diversity of it and being able to help patients so quickly and effectively. As a surgeon, I like the complexity of hand surgery - working with the bones, tendons, nerves and muscles."

McCulloch is from Wheeling and attended the University of Dayton, where he received a degree in philosophy. He graduated from West Virginia University's medical school and completed a residency in orthopaedics there, followed by a fellowship at UPMC. He is board certified in orthopaedic surgery with a subspecialty certification in surgery of the hands, and is a fellow of the American Academy of Orthpaedic Surgeons. McCulloch joined Advanced Orthopaedics and Rehabilitation right after his fellowship, six years ago. He performs surgery at Advanced Surgical Hospital, St. Clair Hospital, Washington Hospital and Canonsburg Hospital. He is a resident of Cecil, where he enjoys spending time with his wife and two young children.

To contact Dr. McCulloch, visit www.advancedorthopaedics.net.

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