KKK syndrome – Kai Kal Kodaichal Syndrome – கை கால் கொடைச்சல் Syndrome

In the continuing series on what I wonder to the question Why Plastic Surgeon, Why Plastic Surgery – for a particular condition, I say Pour Quoi  Pas.?, WHY NOT ?. I have the pleasure of sharing yet another interesting set of conditions which I have treated. We are in an era where EBM (evidence based medicine) rules supreme and other EBMs, namely Eminence Based Medicine or Experience Based Medicine is generally given a cold shoulder and has a bad name. However, most do believe that EBM in whatever form can be useful to discuss and make some sense of it. Today, I am going to discuss the “KKK syndrome” which every medical student in Tamil Nadu would have heard in his lifetime. To me it is almost synonymous with the OPD’s we do in medicine in medical collages as house surgeons. Much talked about and ridiculed but never taken seriously.

On a serious note, aches and pains in the neck, hands and foot pose a real challenge to the GP’s. They refer them to various specialist for further care. A small minority have a substantial and “diagnosable” cause and the specialist treats them. A vast majority continue to suffer taking lifelong analgesics, anti depressants and generally suffer. A plastic surgical encounter by accident changes their plight. On encountering such a case, the possibility of carpal tunnel syndrome is evaluated. This could be the cause of the misery being labelled as KKK syndrome and left to their suffering fate. The picture of median nerve during surgery shows the state of the median nerve at the wrist. The nerve gets compressed in the wrist and could be the cause of the symptoms of KKK syndrome. The pictures show the actual appearance of the median nerve at surgery. In the minimal compressive state as seen in the first picture, there is just redness of the nerve, the rest of the nerve displaying the typical appearance of the nerve- pearly white in colour. Next stage of severity causes swelling of the nerve and finally the nerve could become haemorragic and fibrosed ,Pic 3.

Another possible cause of unexplained neck pain, hand pain and general feeling of tiredness and misery is, to our surprise, the massive size of breast some of these women have. Breast hypertrophy. This is where the bra doesn’t fit the breast but the bra is filled with the breast. Lack of knowledge of how to buy a correct bra, unavailability of different sizes of bras, but it is the general and the utter massive size of the breasts. This happens in teens and the pre child birth. Post child birth, this becomes a major problem with lactating and post lactating breast attaining huge proportions sometimes. Symptoms are however vague like what we experience in KKK syndrome. Thankfully all these symptoms disappear completely and permanently after breast reduction surgery.

As I said, experience is what the patient experiences and share with us doctors. I feel very proud to share the comment by one of the several patients after successful breast reduction surgery.

I quote a patient who has written to me after breast surgery.

“For years I had suffered from acidity fullness and bloating. I couldn’t eat spicy food, or drink coffee. Anything would cause acidity. I had heavy breasts that hung low to my navel. I had constant neck and shoulder pain and a bloated stomach everyday. I would have to lift my breast to burp many a times. After my breast reduction surgery, I feel like my stomach can finally breathe. Today is the thirteenth day after my surgery, I had palak paneer and two rotis without any issues. These are foods I used to avoid and only nibble on for fear of indigestion. As for as I am concerned, my reduction surgery, far from being a cosmetic procedure has been a medical one. It has solved many nagging recurrent issues that have been plaguing me for most of my life”.

Similarly the huge abdominal apron can be the cause of yet another set of symptoms, this time related to the back and the legs. Evaluation of back pain and lower extremity symptoms should include possibility of the massive over hanging abdomen and lax abdominal wall as possible causes of these non specific but miserable symptoms these unfortunate patients have to endure.

In the comment above on the breast, I was witness to a totally bizarre and unimaginable set of symptoms related to GI system, which I never heard ever before.

I am very grateful to share my experience as a plastic surgeon in dealing with some of the patients who could be loitering around being labelled “KKK syndrome.”

I also would like our family doctors and GP’s to keep us as possible partners in the management of hand, neck, back pain. Kauvery has excellent research facility and would urge our GP friends to take up this as a project to get insights into the often labelled as KKK syndrome. We may be the first to get an answer.

So next time you think Why a Plastic Surgeon, Why Plastic Surgery, Say loudly, “WHY NOT !!!”

Prof. V. B. Narayana Murthy
Sushrutha Professorship Plastic Surgery
Senior Consultant Plastic Surgery