peter@cunixf.cc.columbia.edu (Peter Wu) (01/06/91)
Hi. Thanks to you all you who responded! I think that the following can help others so I am posting the reponses that I received. Following the responses are the names of the people who wrote them in a different order to provide some level of anonymity since most of them were emailed to me and not posted to the net. I hope I haven't left out anyone by accident while editing the responses, if so I appologize. The name of the syndrome is "Carpel Tunnel Syndrome" and not whatever I had called it. I didn't summarize because there is just too much to be summarized here. I don't think I have Carpel Tunnel Syndrome, but after reading this stuff I was scared out of my wits. I plan to buy new desk and/or chair to change the keyboard level at which I have to type, plus whatever else I think is appropriate to prevent getting it. I'm not even out in the real world yet .. where even more (?) typing awaits me. --- You can buy wrist supports for (too much) money. You can make your own from an knee sock and some stuffing! Make it firm. Your wrists need to be above the tops of the highest keys. -- > Third, if you do have pain in your wrists, and especially if the pain > persists after typing, or if you find moving your fingers to be > uncomfortable, see a doctor immediately. If you ignore the warning > signs, the condition can become very serious. > Even better, if you believe it really is Carpal Tunnel Syndrome, visit your local chiropractor. He/She should be able to take care of the problem without surgery or medication. I'm not a MD or a DC (doctor of Chiropractic), but my dad _is_ a DC. --- Have you considered raising your chair? Also, try typing without resting your wrists on ANYTHING. (It helps a lot if you've already resolved the chair/keyboard height problem.) -- My wife types alot (330 pages in a 50 hour week). She finds that setting the keyboard as low as is possible and not resting your wrists on the desk helps quite a bit. --- ......the following is a synopsis of some therapy on tunnel carpal syndrome.... Carpal tunnel syndrome is caused by a number of different things and is basically a swelling in the wrist constricting the tunnel that the carpal nerve passes through. This causes pain and numbness in the hand and in particular the thumb and first fingers but may involve all the fingers. Some of the causes are improper position of the hands while doing repeatative motion, simply doing repeatative motion, and unacustom motion of the fingers and hands. Some of the jobs that lead to CTS are: typing with the hands in an incorrect position factory line assembly data entry dealing, as in blackjack incorrect use of tools, like a framing hammer. An almost sure sign of CTS is waking in the morning with a numb hand and/or part of your hand. The normal course is to consult your doctor who will tell you to stop what you are doing or have surgery, and then stop what you are doing. Because many people can not stop their job a number of doctors and therapists have developed a group of stretching and toning excesizes for the wrist. These involve bending the wrist and holding it for a short duration in various ways. However the most important thing is to be sure you are preforming your job in the correct fashion. Hold and use your tools correctly take short breaks while performing repeatative work and if you have incorrect equipment for the job get the right tools. How do I know all this stuff? I am a pit boss for a major casino in Reno and we have a large number of people who have CTS and who have had the surgery for it. IMPORTANT: I am NOT a doctor. This information is for your information and should not be considered medical treatment or any thing else for that matter Take your problems to a doctor for a medical opinion. I have additional printed material on CTS and will provide it to any one who would like it. Send $10 for reproduction fees and mailing to: CTS Box 11795 Reno Nv. 89510 Be sure to include your address. This is NOT a solicitation and has nothing to do with the medical profession. [Ed note: I have not send money for info, so if you do .. it's your decision. Not that this sounds risky or anything.] --- Carpal tunnel syndrome (the name for what it sounds like you've got) is serious! My sister is struggling with it right now; she's a copy editor for a daily newspaper and it's endemic in her profession. First of all, raise your seat so that when you type, your elbows are bent at not more than a 90 degree angle. Sit on phone books if you have to. (I'm assuming you can't lower the keyboard, which would be preferable.) Second and even more important, DON'T let your wrists rest on the table. Your wrists should be straight or even flexed slightly. (Flexion of the wrist is bending the hand downward toward the inner surface of your forearm.) A good way to achieve this is to get some sort of pad to rest your wrists on so they'll be raised without your having to hold them up. You can even fold up a newspaper or a towel and tape it to your desk. Hope this helps. My sister is now wearing wrist braces and going to physical therapy. Don't want to scare you, but be careful. --- I'm not sure of all the measures you might take to reduce this problem. You may find the following article interesting. ======================================================================== 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. ------- End of Forwarded Message --- I haven't had such problems, so I can't suggest a solution. HOWEVER: take this problem very seriously! I had a colleague in grad school who screwed up her left arm typing her thesis. Well over a year later it's still troubling her. She has to wear a wrist brace a lot of the time, and can't type much at all. See a doctor or occupational therapist about this SOON. You can probably get a quickie free consultation via your school health plan. --- Carpal Tunnel prevention. I just heard that some good things to do are: 1. Lower Your keyboard (on your lap or get one of those things that attach under the desk surface 2. Stop every 15 minutes or so and walk around for a minute or two, also flex your hands so that all digits are the way out and then make fists. Do this few times. Also lift your arms around and generally stretch. 3. Keep your wrists above the keyboard (1. facilitates this) -- i have carpal tunnel syndrome (cts) and i just had another exam at the docs office to see how it was doing. this doc is a specialist who only does hand a wrist opations. he said that pain in the wrist is not a good indication of cts. if however you wake up in the middle of the night and PART of you hand is numb and it is doing this on a frequent basis then you have probl. my left hand was numb every night for months before i had it checke out. if you have it in one hand then you almost always have it in both. i started wearing a brace to bed at night and started lifting heavy weights again and at the last checkup my grip strength has increased about 70 percent and my hand doesn't go numb anymore at night. the lifting is not what did it {, it is the brace at night. by the way if you think you have cts an you experience numbness it will be the thumb, the index finger, the middle finger, and HALF of your ring finger closest to your middle finger that will go numb. there are three nerves that control the hand and they come down the arm in three different ways and the doc told me if somebody tells him their whole hand is going numb he knows they are bs'ing him. --- If you really have carpel tunnel syndrome, you may need to see an orthopedist. To lower the keyboard relative to the desk you may try 1) Putting it in your lap if it's detachable 2) Getting a large, second hand typing table tha is lower than your desk, get a sliding keyboard drawer to hold the keyboard, and putting you computer on top of the keyboard drawer (that's what I've done in the office. 3) Get, for your desk, a sliding keyboard drawer that mounts underneath your desk (such as the Undercarriage), if such mounting is possible and permitted. 4) From office supply houses and discount stores or from Radio Shack, there are simple terminal tables that are fairly small and are the right height. --- Step 1: Get a higher chair, preferably with armrests. A "real" office chair (usually > $300) is desirable. Step 2: Try to keep your wrists off the surface of the desk. Putting the keyboard on your lap or in a keyboard tray is desirable. Step 3: Take regular breaks from typing, and try to minimize the number of keystrokes you make. Take a pain reliever with ibuprofen (Advil or Nuprin) when symptoms flare up. You'd be surprised at how much things like using the arrow keys can contribute to the problem. --- I guess I would try to block up the chair or something. I am a fulltime student, but also a parttime mainframe operator here at NDSU, and I do a lot of typing on 6 keyboards. The chairs are adjustable in height, and it seems that it is least tiring if I raise the chair all the way up, so the keyboard is below the level of my elbows. Failing that, I have seen keyboard platforms that attach to the edge of tables or desks. They stick out from the desk, and have adjustable heights, from about 2 inches above to about 2 inches below the level of the desk. Can't steer you to any particular vendor, but check computer catalogs, etc. --- I spend a lot of time at a keyboard. Both at work and at home. Here are some things that I have done to ease the fatigue. Raise your chair so that your elbows are nearly the same height as your wrists. Provide some kind of forearm support. Get some small weights and work on strengthening your wrists. Quit for a while and let the pain go away. My orthopedic surgeon insists that if you pay attention to the pain messages, you can avoid permanent damage. Unfortunantly most employers don't feel that way. ----- Above responses were written by the people listed here in a different order: Michael R. Volow <mvolo@uncecs.edu> macs!gruen (gruen) --Vicky Gruen crocker@alliant.com (Ben Crocker) enteles@tahoe.unr.edu (Philip Enteles) steveb@misg.csd.HARRIS.COM (Steve Bradley) eblinder@dorsai.com (Eva Blinder) Robert Greer <GREBM%CUNYVM@cuvmb.cc.columbia.edu> "MARK HOOVER - NTS CYPRESS (714)952-5911" <sysjj!HOOVERM@uunet.uu.net> Paul Hamlow <hamlow%sntekwv4.wv.tek.com@RELAY.CS.NET> Andrea Frankel <andrea@sdd.hp.com> lal@tc.fluke.com (Larry Loh Kamp) Dean Pentcheff <pentch@u.washington.edu> sal@grip.cis.upenn.edu (Marcos Salganicoff) Howard_Reed_Johnson@cup.portal.com Kerry Person <kperson@plains.NoDak.edu> PQ? ---------------------------------------------------------------------------