Margaret Mason came in complaining that her fingers were getting numb and she would like to see a neurologist. This was her introductory comment without the courtesy of waiting for her doctor’s diagnosis. Her friend already had given her the diagnosis. She had carpal tunnel syndrome and needed an operation and a neurologist was required to confirm the diagnosis prior to surgery.

Examination revealed loss of sensation in the small finger and one-half of the ring fingers of each hand. This was a typical ulnar neuropathy, caused by pressure on the ulnar notch at the elbow.  The usual cause is “elbows on the table or desk” or possibly reading in bed with the elbow supporting shoulder and head for extended periods of time. Her “tunnel” sign was negative. She wouldn’t accept this diagnosis and insisted on seeing a neurologist “just to make sure.”

The neurologist’s consultation was returned stating that the Neuro Conduction Studies revealed some mild conduction loss in her carpal tunnel area as well as in the ulnar notch area bilaterally. The neurologist thought this was non-diagnostic or not severe enough to require surgery. The Neurosurgeon was going to do a nerve transplanting in both elbows and a carpal tunnel release at both wrists. All he wanted from me was an Electrocardiogram to clear Margaret for the neurosurgery on both elbows and both wrists. Margaret could not be persuaded that all four operations were unnecessary.

When seen in routine follow up medical evaluation in six months, an inquiry into her operations revealed no improvement in any symptoms. Her fingers were still numb indicating the ulnar transplantation was not helpful. She had no symptoms or findings at her carpal tunnel site. Her tunnel sign was negative for carpal tunnel syndrome both before and after her surgery. But Margaret was still glad she had the surgery.  The neurosurgeon obviously had done a good job of selling her on the need for her unnecessary surgery which this exam confirmed. The absence of a positive result usually is not recognized by the patient.

This is the typical response for unnecessary surgery. It is extremely difficult for any patient to admit that her operation was unnecessary.  This makes controlling healthcare costs even more difficult. It will never be controlled as long as there is insurance that covers 100% of all costs. People just cannot say no to something that is free—even if it entails cutting the human body, leaving scars, and decreasing function.

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