34AEJ7D@CMUVM.BITNET (Bill Gorman) (07/07/90)
Index Number: 9053
Here is a reposting (with permission) of information about this
condition which may be of interest
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Date: Wed, 27 Jun 90 09:40:34 CDT
From: Andrea Frankel <andrea@sdd.hp.com>
Carpal Tunnel Syndrome:
This is a slightly edited reposting; apologies if you've seen it before,
but many people who read this on an internal HP notes group have found
it useful and asked for it to be more widely distributed.
Disclaimer: I am not a doctor (but I sometimes play one on the Net ;@).
This is from my own personal experience with the malady, supplemented by
a little research and lots of talking to doctors and such. Carpal
Tunnel Syndrome is being seen more and more frequently among the
computer set (my neurologist jokingly refers to it as "hacker's hand");
when caught early, conservative treatment can completely cure it.
However, if you let it go on long enough you can cause irreversible
damage. If you have any question at all, PLEASE SEE A DOCTOR! Better
safe than sorry.
1. The setup
The bones in your wrist form a 3-sided tunnel, with the fourth side
closed off by a very tough piece of cartilage. In this carpal tunnel
run the tendons of the muscles which flex your fingers, as well as the
very important median nerve which ennervates the thumb and the first two
fingers.
If something happens to cause the contents of the tunnel to swell, or to
cause the tunnel itself to get smaller, the pressure exerted on the
median nerve results in carpal tunnel syndrome. Pregnancy, sudden
weight gain, drugs which cause water retention, and repetitive overuse
(or abuse) which causes tendinitis in those flexor tendons, can all cause
carpal tunnel syndrome. (I recently learned that hypothyroid condition
can also cause CTS.)
Positions where the wrist is bent back while being used really
exacerbate the problem (e.g. bicycling with drop handlebars, if you are
not careful about hand positioning).
Other things can contribute as well - if you are doing carpentry in your
spare time and twisting many screws by hand, for example. When you
become aware of the problem, start becoming aware of both the wrist
position and the stresses on it in various activities.
The median nerve runs up the heel of the hand onto the palm, along the
"life line". Direct repeated blows to this area can mimic or add to the
carpal tunnel syndrome, and are often lumped in with it. Our HP
keyboards are awful in this respect. Kayaking, bicycling, gardening
without heavy gloves, all sorts of things can bang on this exposed
nerve.
2. The symptoms and diagnosis
Any or all of the following: pain, numbness, tingling, or sensations of
fullness in the fingers, hands, or shooting up or down the arms.
Quick test #1: make an "O" with thumb and forefinger, insert the thumb
and forefinger of the other hand, and resist while trying to force the
"O" apart with the other hand. The "O" should not come apart!
Quick test #2 (Tinnel sign): place the backs of your hands together,
bend each hand 90 degrees towards the inner wrist, fingers pointing down
(forearms parallel to the floor, held out in front of you).
=======oo========= key: === forearms
|| o wrists
.. | metacarpals
.. . fingers
Press the backs of the hands together and hold for 30-60 seconds. If
you start getting some numbness or tingling or pain, this is suspicious.
Loss of grip strength is a sign that you may have a more advanced case.
(I finally sought help when I was unable to open a can of tuna fish with
a standard Swingline manual can opener.)
I believe the best specialist for diagnosis is a neurologist. A
neurologist will do nerve conduction studies, comparing rates of
conduction above and below the wrist, and between hands. A good one
will also do electromyography, to see if the muscles enervated by the
nerve are firing properly or not. (As a techie, I was fascinated to
watch the 'scopes while he poked me!)
3. The treatment
Standard treatment is to start with the most conservative, least
invasive approaches, and move up only if they don't help. The old
RICE formula - rest, ice, compression, and elevation - is the place
to start, but omit the compression as this is not a muscle strain.
A wrist splint (basically a velcro-and-ace-bandage type of thing with a
bent metal strip in it to hold the wrist in the right position) is worn
at night for a month to see if it helps; it can also be worn during the
day for stretches. (Do not make it tight - it is for positioning only.)
In many cases, that plus correcting one's work habits is sufficient.
Some people find that a month is all it takes; others use the splint at
night for the rest of their lives, or off and on as needed. I still use
mine occasionally when I've been overdoing it. It's also a good idea to
wear it in situations where you might be tempted to do something silly
(like lugging suitcases or lifting weights), both as protection and as a
reminder to be careful.
Non-steroidal anti-inflammatories (e.g. Motrin) are used, if it looks
like inflammation is a major cause of the problem.
Icing the wrist helps alot, both for the pain and the swelling. (Be
aware that over-icing has a rebound effect as the body attempts to warm
the area by increasing circulation. Best is to ice for 10-20 minutes
max each time, leaving at least an hour between icings.) I keep a
couple of the soft gel-type blue ice packs in a little fridge near my
desk, so that I can ice several times a day if I need to. Bags of
frozen peas work great (hit 'em a couple whacks on the counter to
loosen them up, then pat the bag around your wrist so it conforms
to the curves). For obvious reasons, jacuzzis (especially if you
leave your arms in) will tend to make things worse.
If water retention is a problem, you might try a mild OTC diuretic.
(Women: it isn't uncommon for CTS symptoms to be worse during PMS
time.) Also, simply elevating the wrist (for example, resting it on the
back of a padded chair or car seat, or sleeping with your splinted wrist
wresting next to your head on the pillow) can help relieve some of the
discomfort at least temporarily by reducing the swelling.
As a long-time fan of vitamins, minerals, and Prevention magazine,
I of course asked my doctors about B6 as a treatment for CTS.
Unfortunately, the original article reporting success from B6 treatment
was not reproducible by other experiments. What's more, excessive doses
of B6 (over 50 mg/day supplement to a normal diet) can actually cause
peripheral neuropathy, mimicking some of the symptoms of CTS. My doctor
said it wouldn't hurt if I wanted to take up to 50 mg/day, but since I
had been taking that amount for quite some time for other reasons, he
advised against increasing it.
Some doctors go for cortisone injections, although mine cautioned that
the carrier substance is not well absorbed, and can actually make the
problem worse by increasing the fluid pressure in the tunnel. Your doctor
will decide based on the type of CTS and how it is responding to other
treatment (or not).
The final stage is surgery. I had mine a few years ago; if you're
facing it, I'd be glad to chat with you about it. The surgery itself
was a piece of cake, taking maybe 10 minutes once I was fully prepped -
very simply, they slit that piece of cartilage along the "life line" and
onto the wrist, and it spreads apart before it heals up, making the
tunnel larger. Instant relief, although the recovery and rehab takes a
couple months. For those interested in such things, I talked them into
skipping general anaesthesia in favor of a Bier Block, which worked
splendidly - I was out of there and wolfing down antipasto and garlic
bread an hour after surgery.
A friend notes that not everybody who has had the surgery finds it a
piece of cake. His advice would be to make sure you have absolutely the
best doctors when it come to surgery on one's hands, with which I heartily
concur! Hands are incredibly complex, considering all the different types
of finely coordinated movement they are capable of (and all the muscles and
nerves that requires).
I would strongly recommend that you look for an orthopedic surgeon who
is board certified in Hand Reconstruction Surgery - my scar is almost
invisible, compared to some pretty horrific looking ones I've seen. (I
asked the neurologist, who was really top-notch, to look through my CCN
[preferred provider] booklet and recommend someone to me.) An
orthopedic surgeon who handles a little bit of everything - shoulder
tears, knee arthroscopy, back problems - probably won't be as good at
carpal tunnel surgery as someone who spends their entire professional
life specializing in the elbow down. For example, my surgeon stopped
the surface cut at the first wrist fold, lifted the skin, and continued
the surgery under the skin to minimize the scarring; other surgeons (who
don't specialize in hand reconstruction surgery) often don't think to do
that. It doesn't affect how effective the surgery is, but it sure makes
a difference in how pretty your hand looks afterwards!
4. The progression
The symptoms may come and go with heavy bouts of typing, bicycling, etc.
When it gets really bad, it can hurt all the time or start aching
spontaneously.
In the early stages, relieving the pressure on the median nerve will
quickly reverse the symptoms (in a matter of days to weeks).
Untreated, the pressure on the nerve will eventually cause it to die
back to the point of constriction. When this happens, the muscles
atrophy. (The large adductor which forms the mound at the base of my
thumb had shrunk to half its size by the time I was operated on.)
If you don't catch it quickly at that point, the nerve sheaths (which
the nerve had been inside before it died back) start to fray. This is
bad news. If you have surgery while the sheaths are still intact, the
nerve will grow back along the sheath (around 2 mm/day - you can
actually track it!) and pretty much recover all of its connections and
functions. I have a tiny patch less than 1/4" diameter on two finger
tips which is numb, and otherwise have full function back. If the nerve
sheaths have frayed, however, the nerve can't find its way back to make
the right connections, and you're screwed.
IF YOU THINK YOU MIGHT HAVE CARPAL TUNNEL SYNDROME, GET IT LOOKED AT
*NOW*!!! Don't delay, or you might not make a full recovery. Workman's
comp studies looking at prognosis for recovery give very low odds,
based on most factory workers (who used to account for most of the CTS
claims before computeritis hit) being too macho or too scared of losing
their jobs to file a claim before it was too late.
5. Prevention
The optimal position for your wrist is with the hand bent back just
20-30 degrees; you want the position where the front of your wrist
makes a straight line with the first inch of the heel of the palm.
Play with it a bit until you find the place where the wrist seems
to be maximally "open", but without bending the hand back so far that
you feel strain.
Look down at your hands as you type - if you are dropping your wrists,
you are at risk. Think about how they used to teach piano technique: an
almost straight line along the back of the forearms, through the wrist, onto
the back of the hand; fingers dropping down. (My sister's piano teacher
used to place pennies on the back of her hands while she played, to
teach keeping it level.) Practice typing that way, and instead of
resting the heel of your hands on the edge of the keyboard when you're
thinking or reading, rest them in your lap instead.
I got a very nice padded wrist rest from a local office supply house,
that allows me to rest my forearms or wrists while I type in this
position; I have one under my 320 keyboard, and one for my Vectra.
You can also improvise by taking a length of bubblewrap, rolling it up
and securing the ends with rubber bands, then taping the roll to your
desk in front of the keyboard. Warning: this padded wrist rest can
actually make it worse for some people, if it distorts the normal typing
motion or presses too hard against the wrist.
I currently have a keyboard draw from Devoke (about $115) that has a
full 6" height adjustment, slides in and out and swings to both sides.
It mounts with two screws, and I have one in the "L" of my workstation
table at work, and on the desk at home where I have my PC. This has
made the most difference when my CTS flared up again (along with rest
and splinting).
Wear padded gloves for anything which might bang on your hands. Bicycling
gloves with Spenco pads can be used for many things (I wear mine ice
skating!). The Spenco pads are definitely superior to leather or other
types when it comes to cushioning that area against shocks. (After the
surgery, I was warned that the median nerve would always be a bit more
exposed and sensitive, and it definitely made me a connoisseur of bicycling
gloves!)
Learn to back off when you realize you're about to lift or torque
something heavy with your wrist bent. If you can't rethink the movement
so you can keep your wrist straight, get help (person or tool)!
p.s. Feel free to copy and distribute this to anyone who might be helped.
I only request that you not delete anything, especially the disclaimer.
Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664
UUCP : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea
USnail : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USADan_Jacobson@uunet (05/28/91)
Index Number: 15819
{via sci.med newsgroup --DJ}
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subject: Carpal Tunnel Syndrome (fwd)
date: 01-Mar-91 18:06
from: Christopher.Colby@F.GP.CS.CMU.EDU
A friend from M.I.T. just sent me a copy of a memo that has been going
around there. Those of you who know nothing of Carpal Tunnel Syndrome should
definitely read this. Those of you who have heard of it might want to read
it anyway, as it includes some helpful hints for prevention. (Background
information: 6.170 is an undergraduate software engineering lab at M.I.T.)
-chris
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This message has very little to do with 6.170, but since you will all be doing
intense ammounts of typing this term and probably in the future, you should
know about Carpal Tunnel Syndrome. I apologize to all those who already
know about this.
Carpal Tunnel Syndrome is an advanced form of Forearm Overuse Syndrome and
tendonitis in the wrists. Basically, the bones in your wrist form a 3-sided
tunnel (called the Carpal Tunnel). Your tendons, blood vessels and nerves
pass through this tunnel. If your tendons swell up too much, it can pinch
your blood vessels and nerves, causing numbness in the fingers. If it is
ignored, permanent damage can occur. Even if it doesn't advance to the
numbness stage, it is extremely painful and can render your hands pretty
useless.
In the past, mostly factory workers were the victims of this type of injury,
which is caused by repetitive motion (aka Reptitive Motion Syndrome.)
However,
most cases now are related to computer use. I developed this infliction last
year when i was taking 6.170. I developed pain in my wrists, that sometimes
ran from my fingers all the way to my elbow. I was stupid and ignored it,
thinking it would go away as soon as the class was over and i got to take a
rest from typing. I rested it 3 weeks and it seemed fine until i started
typing again at my job. The pain got worse and worse until i could barely
write, or even tie my shoes. Then one day i woke up and i couldn't feel the
tips of my fingers. I ran to the med center.
I had both my hands in casts, and then splints for the remainder of the summer.
Even though I've taken almost 6 mos. of rest from typing, i still experience
severe pain whenever i type. (Not good news for a 6-3). Almost a year later,
I am taking strong anti-inflamatory medication and pain killers (equal to
7 Advil) everyday. I am in physical therapy 3 times a week getting ultrasound
treatment, and i ice my wrists all the time. My orthropedic doctor has
diagnosed it as chronic, although we are trying everything to correct it,
possibly even surgery. Basically, I'm trying to say that this is VERY SERIOUS.
It can really interfere with your career... And it CAN HAPPEN TO YOU!!!
My doctor says he currently has 15 cases of students with chronic variations
of Forearm Overuse Syndrome.
I probably got this because I typed wrong. Do the following to avoid
developing CTS/Tendonitis:
1) Keep your wrists UP while typing. DO NOT PUT YOUR WRISTS ON THE TABLE!!!
It might seem uncomfortable at first, but you'll get used to it.
KEEP YOUR WRISTS UP! KEEP YOUR WRISTS UP! This is VERY important.
2) If you feel your wrists might need support in the "up" position, put a
pillow under them or something.
3) Make sure you are using the Shift Keys properly. Do not hit the shift
key with the same hand you hit the other key.
4) Try switching your mouse to the left side now and then if you are a righty,
and viceversa for lefties. There are lefty configured workstations in 38-344.
5) Make sure that the key board is low enough. It should not be too high,
so that you would have the temptation to rest your forearm on the table.
If the keyboard is too high (as it often is in Athena clusters) put the key
board in your lap. Good posture while typing can make an amazing difference.
6) If you experience any pain, ice it and Go to the Med Center.
7) If it hurts too much to type, for God's sake, give your hands a rest.
I worked through it last year, and I got a good grade in 6.170, but i'm not
sure if that good grade was worth screwing up my hands for possibly the rest
of my life (not very optimistic, i know.) I'm currently looking into Law
School since I don't know what else I'd be able to do if I can't get rid of
this... :)
Party On and Keep your Wrists Up,
[name withheld]
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