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Not All Wrist Pain is Carpal Tunnel Syndrome
Lust writes "CNN has an article summarizing a study recently published in the Journal of the American Medical Assoc concerning carpal tunnel
syndrome (CTS) and its frequency in the general population.
One of the most important points was the last paragraph of the article:
"[Nerve conduction velocity] testing showed only 70 percent sensitivity among subjects with a diagnosis of CTS based on history and physical examination and a high rate of false-positive results (approximately 76 percent). Practitioners need to recognize these limitations and work to overcome them." "
Actually.
If you notice where your hand is as you are typing (go ahead and start typing and continue reading as you do), now is your wrist wresting on the edge of the table?
You're going to get nerve damage from that.
I also have a problem where I run about 20-30 miles a week, so I have a really slow heartbeat at rest. I wake up about once a night to return circulation to my arm. I also have very low blood pressure as well.
But I'm not obese anymore, it's not a tough trade off.
Depending on which window manager you use, you might have an option to change the keyboard layout to Dvorak (and other layouts). This is what KDE has; it's very nice. A little icon sits in the kpanel and you just click on it to toggle between qwerty and Dvorak layouts.
If your wrists hurt when you type, take it seriously! I didn't, and I have a nifty scar on the inside of my wrist from surgery that makes it look like I tried to off myself. And no, it wasn't CTS.
.75" dia to bulge out of my wrist. Uncool.
I developed a minor case of tendonitis during a particularly stressful contract (working 65-hour weeks on documentation for several months). The irritation caused internal swelling and fluid collection exactly where my wrist makes contact with the wristpad while typing. The pressure fron the fluid caused a rupture in the muscle wall below the skin, and the rupture in turn caused a fluid bubble about
I ignored it (and kept working at breakneck pace) for a couple of months before seeing a doctor. By the time I went in, I had a lot of damage, and neither drainage+therapy or steroid injections into the muscle would repair it. Surgery (the serious knock-you-out, dig-around-with-a-scalpel-and-rasp, and sew-the-muscles-back-together kind) was the only option. If I had just paid attention to my body and eased off the work, I probably wouldn't have had to have any problem.
Ignore trendy names like CTS or RSI. Don't seek labels because they facilitate easy misdiagnosis. Pay attention to your body, and make sure that your doctor pays attention to your symptoms rather than matching you to a diagnostic profile. If something hurts, stop! If it affects your work and you can't stop, at least vary your techniques. Remember that no job is worth permanently damaging your hands or any other part of your body.
I think not...(*poof*)
I've noticed that having to flick my wrist over to hit the backspace key sometimes is really bad when my wrist is hurting (every so often, like every few months, it gets really sore for a few days and then goes away). My solution has been to remap my backspace key to the left-hand alt key, so I can use backspace with my left thumb. Combined with a decent key-repeat rate it's probably faster and easier to delete that way than to move your hand *all the way over* and hit backspace.
:)
Then again, I also use a dvorak keyboard, so that isn't the only key in a strange position on my keyboard
Methyl-sulfonyl-methane: CH3-S-CH3
helpful for joint pain. It's involved in the formation of cartilage. 500 mg several times a day when I get arthritic from not eating the foods which naturally contain it, clears up the problem in a day or so.
At the console type "loadkeys dvorak" or something to that effect.
In X, go to http://www-unix.oit.umass.edu/~tetron/ dvorak to get a dvorak xmodmap file.
You are referring to the MS Natural Elite keyboard, which _is_ crap. The original MS Natural keyboard has the standard inverted "T" formation for the cursor keys, and is much better. And you should use the mouse for FPS games, anyway... ;)
I had a variant of tendinitis called DeQuervain's Syndrome when I was a word processor. (a horrible job, but I was eating during a recession, so I'm not complaining :) )
At the time (around 92-93), the medical thinking was explained to me this way:
First: reduce the inflammation. It is the inflammation that actually does the damage, by pinching the nerve between the swollen tendons and the surrounding tissue. This is usually done with anti-inflammatories. Ibuprofen is wonderful for this. There are also anti-inflammatories that are much, much stronger that are used in more severe cases. Naprosyn was one I was using for awhile.
Second: Strengthen the tendon's supporting muscles. Apparently, a lot of the reason for this kind of problem is that the muscles are weak, and the tendons take too much of the load. Exercise is one of the best ways to improve things like carpal tunnel -- as long as the inflammation has been contained first. If you are still inflamed, exercise will probably worsen the problem, not help it.
Third: IMMEDIATELY get someone to look at how you sit and FIX IT. Raise your monitor, raise your chair, lower your keyboard... those are most frequently what needs to be done. Study the diagrams and get help doing this.
After I filed my comp claim as a word processor (which I hated to do... and should have done much sooner), they gave me these wonderful things I called 'robot arms'. They cost like $200 each, but they are basically supports for your arms. You rest your forearms in these padded cradles, and they support your arms as you move your hands around and type. They move very naturally with you, thanks to a clever dual-jointed system. It took a few days to get used to them, but they were incredibly good.
Now that I'm getting older (over 30), I'm seeing slight signs of problems again, even though I don't do that much typing anymore. I replaced my keyboard at home with a Kinesis Ergo (about $200 for the base model). On the whole I like the Ergo a lot. My discomfort has diminished significantly. Two caveats: the Ergo seems to suffer from a stuck shift key sometimes and needs to have the shift key pressed again. (the key mechanism is fine, it's a firmware problem I think.) Second, the layout is weird enough that it's not very suitable for most gameplaying. I usually plug in a standard keyboard for games where I need cursor controls. Also, the Ergo takes several weeks to really adapt to. Give it the time; it's worth it.
Last: if you strike QUICKLY when you're only a little sore and get it taken care of SOON, you won't take permanent damage. Full blown tendinitis is excruciatingly painful and will interfere with everything in your life. For all intents and purposes, you will be crippled until it heals -- and if you don't take care of it early enough, it *may never heal properly*.
If you don't have medical coverage and can't see a doctor, STOP TYPING. There is no project you could be doing that is worth losing the use of your hands.
You can also try over the counter anti-inflammatories; it is my understanding that if you keep the pain in check, you will also be stopping the damage. Real tendinitis is far too painful to be masked by something like ibuprofen. Caveat: I AM NOT A DOCTOR and you could be screwing yourself up pretty seriously if you pay too much attention to this advice. If you have ANY other option, take it -- that includes filing a Workers' Compensation claim if you have it in your state. As an option of *absolute last resort*, over the counter anti-inflams may help some.
Well, being a musician (and coder) myself, I can agree with you, for the most part. However, there are two things that I've found regarding keyboard setups that are absolute no-no's.
1) do not use wrist-wrests, ergonomic keyboards, keyboards in weird positions (those little "leg" things on the back should be ripped off the thing when you first buy it). Think like a pianist: your wrists should remain mostly level, and with those "enhancements", this is impossible.
2) mice. 'nuf said.
In general, keep your hands straight (but don't force them that way!), don't rest your arm on your desk, chair arm, whatever. Your keyboard should be just a little above waist height. And use the mouse as little as possible. Double-clicking is one of the worst, for some reason...
Not keeping your hands straight is the best way to increase muscle strain on the tops of the hands/fingers. This ultimately will lead to either CTS or some other form of RSI.
And above all else, *take breaks* every now and then! Every 15 min or so (if you type continuously), lift your hands away from the keyboard, move them around, let them relax, whatever... for maybe 30 seconds or so.
I got a Kinesis kbrd about a month ago (and I decided to switch to dvorak while learning the feel of the keyboard)... I recommend it highly... After about 3 weeks, the pain started to diminish and now it's almost gone and only returns when I have to use a normal keyboard for a while.
I haven't had any problems with the shift key, but I have read about others who have.... You might want to consider calling Kinesis for a replacement... rumour has it that a few of their kbrds have sticky keys and they'll replace them for free... You might want to check on it...
I also recommend getting a remappable keyboard (I have the classic) if you have to use it in Windows or on a Mac... After using it, you might decide that some of the keys are in bad positions...
If you are right-handed, switch your mouse to your left hand.
As a programmer (VC++), most of the input I do is not typing words of code, but moving around in the code using the mouse and the cursor keys. I suspect many non-programmers may experience a similar usage pattern, if you do more editing than entry.
Most keyboards have cursor keys on the right hand side, so having the mouse on the right side puts extra stress on your right hand because it's doing most of the work.
I experienced this a couple of years ago; my right wrist was getting sore all the time but not my left. I switched my mouse to the left side and the problem disappeared. It also made me faster since now I can mouse and cursor at the same time.
There is a period of adjustment; it takes about 2-3 days before you're not totally stumbling around with the mouse, and your quake game will take 1-2 weeks to rebound, but then you can easily mouse on either side with no problems.
(I also use a microsoft natural keyboard (the old kind, which is great, not the new one with the cursor keys in the moronic + configuration), in addition to a fully adjustable keyboard tray and an adjustable chair. So the mouse switch thing was only a partial solution.)
Yup...
I'm right handed and I went to the left handed mouse when I found my Quake aiming to be much... MUCH better! I now use the mouse lefthanded for everything. However, today's Mice really suck in the left hand. I rotate between different pointing devices (Logitech, MS... Track Mouse) just so I don't strain my fingers.
With the mouse on the left, the F and J keys are actually centered and you have full movement with the arrow keys and the keypad as well... The perfect Quake setup...
Brian
Gung Gee Fook Fei Fu - Taming the Flabby Tiger
I'm fortunate to have a classic guitar background, so I know what you mean.
:) keyboards and mice go, I've found the Trust ergonomic keyboard to be useful, and logitech mice over m$loth ones, to be useful... but I need a better chair than this crappy bar-stool all day long...
Initially, when you're either out of practice or positioning is bad, the left hand hurts like blazes.
If all you do is "powerchord" (wth?) then the chances are you could benefit from a bit of proper fingering instruction.
One thing to work on: you don't need to grip the neck like grim death - you should be able to at least play a full bar-chord without the thumb touching the neck at all.
As far as (back to computing
~Tim
--
~Tim
--
Rushing on down to the circle of the turn
For those of you who don't know, that's more or less what a chiropractor does to you ( align various vertebrae and joints). Falling asleep in your chair will pinch nerves in the neck that go to the arm. Happened to a friend of mine.. his arm went so numb he thought it was a stroke. The chiropractor got him working properly again.
Agree. Anyone thinking of a m$loth "natural" keyboard, take a good look at the cursor key set before you buy. I cannot fit all 3 pinkies on to an area so small, so it'd rule out Duke Nukem for starters. :)
Guess that's why I'm not using one of them either
~Tim
--
~Tim
--
Rushing on down to the circle of the turn
For the first time I had pain from typing about 10 years ago. It was so bad I thought I would never be able to type again. However, then I found out about these Chinese balls you let roll over your hands. You get them in different sizes, made from different materials, with and without "sound". After practicing a couple of months the basic technique of letting two balls roll over my hands, my pain started to disappear.
Since then, whenever I start to feel some pain in my wrists, I make sure I use these balls for a couple of minutes every day, and the pain goes away after some time.
Anyway, I agree with all who said that a proper typing technique is very important. And my opinion, drag and drop is really the worst of all (that's why I learned all keyboard commands of emacs. I try not to use programs that demand heavy mouse usage).
In around 1985, someone marketed a "head mouse" for the Mac, that was this IR headband you wore, that put the cursor where you were looking (apparently you don't need to totally track the eyes, since your head moves slightly but perceptibly when you look elsewhere, and the feedback loop took care of the rest.)
But I heard it didn't really work all that well.
Many people operate the mouse with their feet. There are companies that sell oversized mice for this. You can also get foot-pedals for your Control/Shift/Meta keys.
RSI isn't just for hands. I've read about problems that people have had with voice-recognition systems: without proper training on how to talk, saying the same words over and over all day caused serious strain to the vocal chords. Anything you do repetatively can be bad for you, our bodies aren't built for that, there was no evolutionary pressure to support it.
One interesting anecdote - the author Vikram Seth (Golden Gate, A Suitable Boy) relates how he was writing a 1400 page novel by hand on paper, which lead to a wrist injury. His solution was to use a notebook PC to type the rest of the novel instead of writing by hand - a rather ironic story in today's world where the keyboard is the cause rather than the cure of wrist injury.
Ultimately, the KB is used simply to create text, something humans have been doing for a long time. During the early days of the pen pilot craze, the assumption was that keyboards were crude and cumbersome, and that a machine that read handwriting was the ultimate brilliant thingie. Lately, that viewpoint has died altogether. I'm not sure what the best interface would be - voice rec. isn't really there, and even if it was, it's not good for composing text.
Is there an alternative?
L.
I also find it harder to do: drawing lines with the mouse down is harder than drawing them with the mouse up, for example. TrackPoints (those eraser nubby thingies) are much better for this, both because you don't have to keep lifting and moving your hand, and also because you can operate the motion with one hand while holding the buttons down with the other.
Too bad they seem to only exist on laptops, which have the worst keyboards in the world.
Before you all get your panties in a twist you may want to look at what a Syndrome actualy is.
It is no more and no less than a set of coinciding symptoms it is not a diagnosis nor a cure.
This is insane advice! Hiding the symptom is only going to hurt you, it doesn't make the problem go away.
Also, over-use of ibuprofin is bad for you: while it reduces swelling, it also inhibits growth of cartilage, and is now believed to cause liver damage in large doses or over long periods of time (along with acetominophen, AKA Tylenol.)
Don't be an idiot. If it hurts, go to a doctor and get it fixed.
No. If you're leaning on your hands or wrists or elbows while typing, you're typing wrong, and you're going to hurt yourself.
Depending on what's wrong with you, this could be good advice, or very bad advice.
If the problem is muscle strain, wrist braces can help by giving the muscles a rest, and time to rebuild themselves. But If you wear them for too long, you'll cause the opposite problem: the muscles will atrophy from lack of use.
Can I get a test to indicate early warning signs of this disease before it occurs? I would glady pay for such a test if it occured. I wouldn't mind if the test was conducted yearly.
The best "test" is your own symptoms. The symptoms are related to median nerve compression - clumsiness, weakness, pain, or numbness (typically in the thumb, index, and middle fingers - but can vary) in the affected hand. You are unlikely to have irreversible damage "all of a sudden" from CTS without having significant symptoms first.
Nerve conduction studies can show electrical evidence of nerve compression before any symptoms occur. However, the presence of abnormal conduction data in the absence of any symptoms of CTS doesn't really help much since it doesn't really tell you if you are going to develop clinical CTS.
There is no single test that is completely sensitive and specific for CTS - the diagnosis requires a suggestive history and exam, and can be supported or refuted with electrical studies.
I would suggest not worrying about it if you have no symptoms - just excercise good posture and ergonomics. If you get symptoms, then it is important to pay close attention to the nature and progression of the symptoms (e.g. don't let it progress to significant weakness and clumsiness without treatment because the median nerve can become permanantly damaged from CTS). In the advanced stages of CTS, the pain may actually get better, but the weakness becomes permanant and some of the hand muscles are visibly atrophied. Surgery is the most definitive treatment since it directly addresses the problem (a tight carpal tunnel compressing the median nerve), but the symptoms will often resolve with splints and anti-inflammatory medications.
Most doctors know nothing about RSI. In fact, the medical profession as a whole knows very little about RSI. So unless you are lucky enough to find a doctor who had a dual practice among athletes and concert musicians (and there are probably only a few such doctors in the US), you aren't likely to get much real help.
RSI is a wastebasket term (very nonspecific) that can be attached to a wide variety of problems that have been associated in some way with repetitive strain. It is just common sense that repetitive strain will cause wear and tear on the body as it does with any other type of machine. That's why we have the joke "Doc it hurts when I do that. Doc replies: don't do that". Repetitive strain contributes to many problems in variable degrees, but is not the only contributing cause for many of the illnesses that it is associated with.
Carpal Tunnel Syndrome is a specific entity with many different contributing causes, including repetitive strain in many cases. The symptoms of CTS are crystal clear to anyone with knowledge of anatomy - the symptoms relate to the median nerve. Any competant neurosurgeon or orthopedic surgeon, and most primary care physicians are intimately familiar with this problem as it is quite common and usually simple to diagnose.
you have to think twice (or 50 times) about going to a doctor and getting a diagnosis of RSIwritten down in your folder.
Why? If you go to the doctor and get your CTS treated, why would future employers discriminate against you. If you are disabled by your CTS (e.g. permanant weakness), then you have a disability and all of the related laws regarding disabilities apply.
Well one reason for that is that they probably would have just called it arthritis or something.
But another theory for this is that manual typewriters happen to be better for you than computer keyboards, both because of the force with which you have to hit the keys (causing different muscle groups to be used) and because of the longer distance your fingers have to travel (causing more extension, instead of a series of very short repetitions.) Also, the way they were angled, coupled with the distance you had to move your hands, meant that you really just couldn't slouch.
Supporting this theory is the history of the telegraph operators: they tended to have exactly the kinds of problems we're seeing today with computer users. Think about how you'd hit a telegraph key -- it's much more like the way we type today, than the way one would type on a manual.
Also, if your mom was a typist, she was probably trained to do so, and probably had better posture as a result.
I love manual typewriters. There's nothing
more satisfying than really nailing those keys. Especially satisfying is the return bar. I would nail that thing so hard the typewriter would walk across the desk.
Of course, the piano training helped there -- I once broke the second bflat below middle c key on my school's piano trying to play loud enough to be heard above the jazz band....
Sounds like what I've heard called "overuse syndrome." Most folks don't rest their elbows and wrists on anything when they're typing, so there's musculature in the forearms (volar or palmar side of the forearms, usually) that is usually used to support the hands. After some time of this, the muscles tend to swell a little bit, which stretches the muscle sheaths, which makes the muscles feel as if they're being squeezed while they're working -- which tends to hurt just a bit.
It appears that the best way to resolve it is usually just what your doctor prescribed -- strength and endurance training. Also, elbow and wrist support seem to help.
ws23
Be careful of quotes like " RSI is now much less common in Australia, where a system of education, combined with more openminded diagnoses has helped differentiate between natural fatigues and the beginnings of physical problems. "
This sounds exactly like what the New Zealand ACC (Accident Compensation Corp) would say about the incidences of OOS/RSI/CTS in New Zealand. In fact, what is happening is that ACC is putting pressure on staff to get diagnoses of Fibromialgia (spelling?), as this is not ruled work related, and no compensation is payed. This seems to be practice on long term cases where expenses could go on for years. I know of people who have had OOS or RSI for a year or two, and then it has "mysteriously changed" into Fibromialgia.
OOS sufferers in New Zealand, be warned
Caveat, this is only from what I have heard from OOS sufferers and "through the grapevine", I couldn't give statistics.
postmoderncore - art and creation are a higher purpose
A whole lot of people (including myself) have gone in for wrist pain and had Conduction Studies tests done to see whether it was the hands, nerves, muscles or something else that was troubling them. Noted example of a case where
Carpal Tunnel was NOT the case for wrist pain/arm pain, is legendary Hammond B3'er Keith Emerson of Emerson, Lake & Palmer. Keith broke his pinky one night when he smashed his hand against the edge of the organ's cabinet. After that, he went through months of not being able to play, etc.
(The article of what he went through can be found in KEYBOARD MAGAZINE's back issues...). Lots of wrist pain is due to repetitive stress injury, but in Emerson's case, it was "(ulnar?) nerve entrapment syndrome that resulted from his accident with the front side of the B3 he was playing on stage. He went through microscopic surgery to repair the problem, and was basically told not to play for a good LONG time. Can you IMAGINE not hearing his work? Anyway-so, in my case I found out that it was a MUSCLE that I had pulled that was grating on the nerves in my arms/hands/back. So, even though Carpal IS legitimate, and it does affect those who type lots, or even play piano lots...like every day for 3 hours a day or more), It is real. But if your doctor tells you it isn't Carpal, ask him what else it could be. If it IS Carpal, get arm and wrist braces and sleep in those when you're not working. ("Chicago" drummer, Tris Imboden HAS TO sleep with two braces each night to prevent
much pain during their performances.). He's said in interviews that he "learned to play wrong" to start with, and is RE-LEARNING drums. The right way. It improved his playing but it also keeps his hands from really being trashed.
Either way, Carpal Tunnel is wicked. It can prevent otherwise useful and talented folks from doing their jobs and whatever makes them happy.
So, if you think you have it, you might consider getting tt checked out. Yes, conduction studies exams hurt. But man, are they helpful.
Anonymous Cowlings
oj@did.it
So where did that IP-stack in a PIC hoax go?
IMOH, if you put this sort of stuff up, you should keep it on the site, even if it turns out to be a blatant hoax.
However, there have been two cases where I've began to develop wrist/hand pain which were due to mouse usage: in games (no, not action games either). When I quit the games, I quit having problems. So: I conclude that the problem has more to do with correct hand posture than anything.
The one woman I know with CTS problems has her chair practically lowered all the way down to the floor with the keyboard *way* too high. This is a horrible position for her hands, and her wrists of course suffer. Mine almost ache just thinking about it.
The moral of the story: ditch the games, and lift your chairs up so that your wrists aren't all torqued while you type!
DFL
Never send a human to do a machine's job.
I know that CTS is a very real illness, and there are people out there who suffer severely from it, but I think that the IT industry has jumped the gun on a lot of diagnosis, and if poeple had wrist pain, it was almost automatically said to be CTS. Repetitive tasks did not begin with typing on the keyboard. Think of carpenters who drive hundreds of nails per day. That's an extremely repetitive task, also places a great deal of stress on the wrist muscles. I don't know too many of them who have CTS, if their wrist is sore, they just work through it. I think this CNN article reflects this tone. I do believe that one should be careful and practice safe typing habits, just in case.
How do they ever find out that the maximum number of people for this
elevator is twenty-two? I mean do they get into the elevator and
do some experiments:
"Twenty-one people. Still OK."
"Twenty-two people. Still OK."
"Twenty-three people. Aaaahhhhh............."
I thought I had CTS, but it turned out to be bad posture -- more of a form of RSI. The easiest way to releive fatigue Caused by this problem is to place one arm straight up and down, thumb facing straight back (you don't have to stick it out) and rotat the hand down to the left. Keeping it horizontal, rotate it forward until you are facing palm up to the right. It's amazing how much it helps.
That and don't rest your forearm on your chair. that restricts movement in a bad way.
Lowmag.net
CTS is just the tip of the repetative strain iceburg, all sorts of things can cause pain from overuse. There is an excellent book called Repetitive Strain Injury : A Computer User's Guide by Pascarelli and Quilter.
This book talks about all sorts of things from symptoms to how to recover, both physically as well as some mental issues as well. I found it at the library and found it to be very enlightening. Even if you're without pain a little education could very well keep you that way. If you're already having problems it's a must read.
As a sidenote after the article on this a few months ago I went out and got a Kinesis keyboard, it's made a big difference. What an excellent keybaord, well worth the price.
Get a girlfriend... and if she won't put out... make her arm do the work!
Best way to avoid wrist pain is to get a good keyboard.
I swear by my Kinesis Ergo. Hell, I even converted over to typing on the Dovorak system to reduce wrist strain.
You can get thier web site at www.kinesis-ergo.com
Oh, and avoid those crappy MS "ergo" boards. Their a waste.
Having been struck by hand/wrist pain late last year, I've been spending the past six or seven months trying to work out what to do about it. For reasons of pure paranoia (I'm a sysadmin) I went to my doctor as soon as I had the first twinges, and from there I've had physiotherapy of various sorts, which has helped. It pays to be paranoid: talk to your doctor.
:-)
The key, though, is that a little therapy will do you no good at all on its own. You have to look at every aspect of how you live, and particularly how you work with computers.
Posture is important, so don't just look at pictures of stick men on the web and think "that's about how I sit, I'm okay"; get someone else to look at how you're sitting. The equipment you use to operate computers is important: experiment with different keyboards and mouse-substitutes until you find out what works for you. When you find one, keep looking, because often in this area a change is as good as a break. The software you use is important, too. Some people swear that emacs killed their wrists, others that it was all that mousing in Windows that did it. What exercise do you do? A lot of people recommend swimming: see what works for you.
I'll second everything jwz said -- particularly about xwrits, which was the only keyboard use monitoring software persistent enough to get me to pay attention to it -- and add that even in the midst of pain, it's possible to have some fun: play with all the fun technology there is out there! I'm writing this at the moment with the voice recognition package DragonDictate, which is at turns the most wonderful and the most frustrating piece of software in my life at the moment
...some is just a good old-fashioned justice system, depending on where you live...
This article appeared in newscientist quite recently. It suggests that RSI comes from doing many repeated sensitive movements. This is why carpenters and mechanics don't get RSI from hammering / spannering whereas typists do.
The authors believe that it is all to do with the brain inventing pain as it isn't designed to do these gentle motions over and over again.
May be that's why old typewriters didn't cause RSI.
Back in college I conducted an experiment on mice ergonomics. We determined that right handed people using their mouse with the left hand were up to 30% more efficient than when they used their right hand. This had to do with being able to pull a menu down and clicking enter almost simultaneously, or faster data entry and navigation in spreadsheets (we used IBM PS/2 keyboards and Microsoft 2-button rats). Most people had a period of about 48 hours adjusting to using the mouse as lefties, but most never went back to using it with the right hand.
I've been using my mouse with the left hand since 1989. Then, sometime in the mid-1990's, Microsoft and Logitech introduced their hunchbacked mice. And I began developing what I think is CTS since. Does anyone know of any similar studies? Ours was college research for someone's thesis, so I doubt it was published widely, or publicized.
DISCLAIMER: I suffered a motorcycle accident in 1995, in which I broke the fall with my left hand. I also kickbox, and once in a while I've injured my hand, so I don't know if what I perceive is CTS or just the result of too many hormones and lack of common sense.
Cheers!
Eugenehttp://eugeneciurana.com | http://ciurana.eu
Yeah but doesn`t that affect your eyes as well.
I've been using computers for years, all the way back to the Vic20, and I only really started to develop pain after I had to do a lot of data-entry at work. It was very repetitive, with lots of inane, microscopic pulldowns, and all sorts of user interface sins...AND I had a dirty mouse (this has since been resolved) I think it can all be traced back to bad hardware/UI design along with repetitive tasks.
Funny this should come up today - I was watching a Nat. Geog. documentary on Plagues last night (in Sweden) and one of the subjects covered was "syndromes" that sweep areas, but which are thought to be largely mentally caused.
:-)
The documentary showed that RSI swept through Australia several years before it became a well-known problem in the States. The Australian medical system spent a long time working on surgery and other techniques to treat the symptoms. Eventually the medical system realised that the classification of RSI was too broad and there were actually several different causes - some physical, but many of them stress related.
Then the Los Angeles Times (I think!) were covered. They were also swept with cases of RSI. However they also after some time decided to analyse each case separately. Again it was found that though there definitely were some cases with medical causes (overextended tendons etc), a large proportion were stress related. The cause here was often found to be that a small, natural pain associated with overruse would be magnified in the brain to be the first signs of RSI. People then would begin to use their wrists unnaturally, which in time magnified the effects.
There was a great scene with a manager who discussed posters that had been on the office walls at the time with pictures of wrists overlaid with lightning flashes! As he said, it's no wonder so many people were developing these symptoms, every time they had the slightest twinge of pain, they thought it was the beginning of the end of their working life! It was actually fear that was helping RSI to spread.
According to the documentary, RSI is now much less common in Australia, where a system of education, combined with more openminded diagnoses has helped differentiate between natural fatigues and the beginnings of physical problems.
This is not to say that the effects of RSI are not very real. I have also been feeling wrist pains from mouse use, but am taking steps to alter my work environment and my working practises in order to eradicate the pain before it becomes a serious problem. So far it is working and the documentary I saw last night has also helped me realise that awareness of one's body, proper diagnosis and a sensible approach to the problem means that I don't need to add it to the list of things I worry too much about
(Disclaimer: Everything here is from memory, I'm not claiming to have all the details 100% accurate! My memory is another source of worry <grin)
A little planning goes a long way...
"Don't be an idiot. If it hurts, go to a doctor and get it fixed."
In theory, good advice. In practice, not as useful, for 2.5 reasons:
1) Most doctors know nothing about RSI. In fact, the medical profession as a whole knows very little about RSI. So unless you are lucky enough to find a doctor who had a dual practice among athletes and concert musicians (and there are probably only a few such doctors in the US), you aren't likely to get much real help.
1.5) Some doctors, and some of the medical profession, still hold to the view that RSI doesn't exist. Now, I don't discount the theories that RSI might be primarily _caused_ by the mind. But the fact that some seriously advocate that RSI doesn't even _exist_ tells me there are serious problem with the analysis model being used by the medical world.
2) Insurance. Particularly with the upcoming federal regulations that will open you medical records to just about anyone, you have to think twice (or 50 times) about going to a doctor and getting a diagnosis of RSI written down in your folder. You could very well start looking for a new job and suddenly find that doors previously open to you are slammed in your face. Or that even if hired you are denied the top tier of medical benefits. And so on. Something to think about.
sPh
Can I get hazard pay if I have to use a mouse and keyboard at work?
They have this funny little life-cycle, which in the end causes more problems than it fixes. And not just CTS, either. I'm thinking of the dyslexia/ADHD "epidemic" particularly among young boys, and the tranquilized housewifes of a previous generation. The latter had an interesting analogue at my college -- female students (not sure whether that is coincidence or not, but I never heard of this happening to a male student) were given anti-depressants like candy, and NO other counseling. This, even after one of my friends committed suicide with said anti-depressants. We also, to an extent, saw this situation with AIDS.
The life-cycle:
1. A bunch of people who have some sort of similarity (typists, gay men, 10-year-old boys, housewives) all begin to have a certain problem. Note that it does not affect all members of that category, but the problem is found mainly if not entirely within that category, at least in the beginning.
2. The problem is given a name. Members of the appropriate category begin to be diagnosed with the problem. Eventually, to everyone's surprise, someone who doesn't fit the category comes in with the appropriate symptoms. (This is why AIDS is no longer called GRID - Gay-Related Immune Disease - as it once was.)
3. The disorder enters the mainstream consciousness as a public health problem. A weird double-standard occurs: members of group X get this disorder, but "it can happen to anyone."
4. Overdiagnosis and mis-diagnosis of similar problems as the "trendy" disorder begin to occur. Some people begin to question whether the disorder is either "real" or a "real" public health concern, seeing as how it only effects a targeted subgroup of the population.
5. People begin to use the disorder, or fear of getting the disorder, as an excuse for bizarre or inappropriate behavior. "I'm dyslexic -- of course I didn't do the reading assignment!" (This character annoyed the hell out of my best friend, who is ALSO dyslexic but managed to struggle through.) "Oh, my son can't help being destructive -- he has ADD." "I have to go out on worker's comp because I think I have carpal tunnel syndrome [at the same time as the person asked for a vacation that was denied]." "I can't go camping - I might get bit by a mosquito and get AIDS!"
6. The public begins questioning the validity of the diagnosis, even though doctors are still diagnosing the trendy problem constantly. Meanwhile, people who HAVE the problem aren't getting help for it, or are getting one-size-fits-all therapy that doesn't help much. Other people announce they have "cured" themselves of the problem using methods that may or may not be snake oil.
This is partially from experience. I have a "trendy" medical disorder, in a fairly mild form. (Seasonal Affective Disorder, aka winter depression, if you must know.) Because of the aforementioned idiocy of my school's counseling center, I didn't follow through with their idea of treatment -- paying attention to what I ate (I'm also hypoglycemic, and the two problems reinforce each other) and occasionally sleeping with the light on are enough to keep me functioning, though it is still not easy.
"Somebody exploded a letter-bomb today
Interesting, too, how some people agree with me that mousing is much harder on the wrists/hands than typing.
I wonder how much thought was given to this issue in that "Designing Linux for the Masses" article posted earlier today? Probably none. The author was too busy condemning the CLI to death while praising the GUI as the One Truth Path.
I think I've discovered a new argument in defense of the command line: "GUIs are bad for your wrists!" Yeah!
DFL
Never send a human to do a machine's job.
Coolest looking keyboard ever. Funny stuff on the website:
"HOLLYWOOD CONNECTIONS More Kinesis keyboards keep showing up in Tinsel Town...1999: Netforce, the high tech mini-series with Kinesis keyboards:
"The Internet a few years in the future as the backbone of both commerce and crime...
" The good guys use Kinesis contoured keyboards...
" The bad guy ("Will Styles") uses a Microsoft Natural keyboard... "
-- This
my mom was a typist, she typed all day on manual typewriters. The hammer hits the paper from the force the key is hit.. no electric power or anything. Those things take at least 5 times more force then a computer keyboard but nobody she knew ever was diagnosed with CTS...
In my absolutly non-professional medical opinion, if your hands hurt when you type, there is something wrong with your posture/position or keyboard. I type all day on this "Honneywell KeyPoint 101+" keyboard (very durable because it is really membrane-type technology inside) and don't experience any discomfort. The other day, I hooked up this old Compaq keyboard on another box and after 5 minutes, my hands were really sore! That keyboard is obviously one to avoid.
Masturbation generally eases arm pain, not exacerbates it. Entirely different set of muscles and connective tissues, with a different set of strains, and it enhances lymphatic and vascular flow to your arms (more so in men than women just given the respective anatomical conditions), which can assist in delivery of your body's proteolytic enzymes, which break down the scar tissue which generally causes the pain of RSI.
And for the other commentator, don't just get a g/f; find one who types and has RSI about as badly as you do. Mutual therapy.
I at one time feared I might have CTS; my writs were aching slightly after spending 6+ hours almost consistently a day for 7 months straight on a bad badly setup desktop (it should be no surprise it was a community college's laboratory setup). Once the aching started, I went to a physician and asked him if there was anything wrong. He said that unless the pain very discomforting (it wasn't at the time), I shouldn't have to worry. To be fair, he did do some minimal testing to see if my wrists reacted to various pressures, but it was all minimal.
Now I'm in a different desktop setup, one where I can use an ergonomic keyboard in my lap (it's very comfortable, but I'm not entirely sure if it's 'correct'). I have configured my window manager to make maximal use of not using the mouse. I use the mouse as little as possible now, as this seems to be an aggravating factor in any aching. Any discomfort I get now is minimal, and if it does arise, I make sure I change my current typing position.
However, I'm always worried. Will this sneak up on me again? Was what I had before an early symptom of CTS? How close was I to going over the edge? Can I get a test to indicate early warning signs of this disease before it occurs? I would glady pay for such a test if it occured. I wouldn't mind if the test was conducted yearly.
This is my life we're talking about here when it comes to CTS. UNIX is my lifeblood, as it is for so many others.. I need to type always. I can't have my life endangered because I wasn't careful enough. A early-warning test would make me a very, very happy person.
Not only do I pound on a cheap, poorly designed keyboard for too many hours a day, I also play guitar quite heavily. By the end of a day my left wrist, in particular (from my poorly tuned power chording) can really hurt.
I bought a nice gel wristpad (It helps reduce muscle strain if you keep your wrists elevated) and bought a lefty wrist brace as well, which I wear at night. That, and I began to make sure I had my monitor high enough that I wasn't slouching to see it. All these measures seem to help.
Can't sleep, the clowns will eat me...
http://thecraftstudio.com/bcboy/keybo ard.html
The caption from cruel.com: "Build your own under-the-ass keyboard."
While I am following all the good tips for avoiding RSI, one of the best ones is to cut down on computer usage!
I went looking for alternate activities to do while on my days off, and I came up with reading science fiction books (great one right now -- Virtual Light by Gibson) and chillin' out to my music. Another good thing is to get some good computer books and magazines so you can still keep up with the industry but not kill your hands.
Also, get a little kitchen timer or a watch and take small breaks every 10 - 15 minutes -- walk around and stretch on your breaks, it really helps!
-Adrec
(P.S. e-mail me at aaronshaver@yahoo.com if you want more advanced tips)
I wanna see a Dvorak-HowTo for linux, for how to configure X and console to use the Dvorak keyboard
..i dont remember :)
btw: do you know how to change the typematic rate in linux (like with DOS KEYBOARD.SYS or KEYB.SYS
I've noticed that holding down a mouse button and moving the mouse around at the same time cause the most discomfort. This becomes a problem mainly in games. This type of movement is almost constant while playing Quake or Ultima Online. After I Quit Playing Ultima Online all my wrist probelms cleared up.
One other thing I've tried that seems to help the pain(but slows me down quite a bit) is to use a track ball with two hands one for the ball the other for the buttons.
Put your elbows out, and the tops of your hands together at the wrist. Relax your hands; let your fingers hang down. In this position, your thumbs should be facing you, and your palms facing out.
Got it?
Hold that position.
Still holding?
Keep it up for 40 seconds.
If you have any numbness or tingling, go talk to your doctor some more.
Can't sleep, the clowns will eat me...
I tried the week vacation, no typing. Got back to work, and was pain free for all of 15 minutes. Which isn't to say the rest wasn't good, only that it didn't help me.
I had bad arm pains for about a year. I really didn't know what it was and doctors didn't know it either. But when I typed, my arms started aching and cramping.
After visiting many doctors, one checked me well and said that he didn't find anything wrong with me. So if resting didn't help, start exercising and doing heavy work.
It sounded horrible but I did what he said. I continued typing even when it hurted. I started playing volley ball, throwing shot put and working heavily at my parents farm. As a miracle, all symptoms vanished and I was healthy. I continued to work out and I have never been healthier.
In the end I was afraid of my arms starting to ache and was tense when I tried to do everything right according to all CTS and RSI advice.
All cases are unique though. So talk with your doctor and don't risk your health by trying anything. But if your arms can take for example weight training, then do it.
And you, yes, you healthy geek with the coke and the pizza slice. Get off your butt and work out before you get arm problems ;-)
CTS came early for me...I will be a secior in high school next year and have been on the computer since I was 2. The past two years I have been working with a company that does coding work for NASA as well as some other government agencies and companies. I jsut say this to show that I have done a lot of typing... The specialist I just saw was showing me some new writings on Vitamin B6 and its effect on CTS. I had been doing the proper things till he told me that.. taking breaks,wearng braces, using an ergonomic keyboard (in dvorak mode even), as well as the exercises, but as soon as I started taking B6 I noticed an improvement. I could type longer before numbness and pain, and when the pain and numbness did come it did not last as long or hurt as much. Also if you think you have been misdiagnosed either positively or negatively.. get a EMG.. it detected my propblems right away. Finally has anyone heard anyhgin about the new surgery using Radio or RF waves? I have not been able to find any literature on it. Thanks
I thought I was being afflicted with CTS a few weeks back. I couldn't type anymore, my hands were in such pain from moving them. Rather than spend tons of $$$ on a doctor who was going to want to cut open my wrists, I fell back on an old remedy, chiropractic. My chirotpractor took some xrays, check my reflexes and came to the conclusion that my spine was the cause of my pain. 1 hour (and a minimum of fuss) later, my hands had almost returned to normal! Remeber, your body has a network too. How many times have you cursed a shoddy machines' network access, only to find out it was the cable???
makes ya think, don't it.
Most cases of CTS are still mis-diagnosed anyway. Doctors aren't educated enough on CTS or RSI's to really know the difference between one RSI and another. The symptoms are very similar for a lot of these RSI's, and most often, CTS is the suspected culprit.
My advice if you have wrist problems is:
1. Do some reading up on it. You'll be able to learn a lot and 'diagnose' yourself.
2. Buy a new mouse. Buy a trackball or touchpad. Most RSI's develop from mouse use.
3. Take Advil before you type. This won't solve the problem, but it will lessen the pain.
4. Never prop up your keyboard. Always leave it down. I've found that natural keyboards are very comfortable and are easy to adjust to. Another easy-fix is a foam pad: I'd reccomend the gel-filled ones.
5. If your wrists really hurt, go to the pharmacy and buy wrist braces. Wear them while you sleep at night (but no more than that). This will keep your wrists still at night and avoid inflammation from sleeping positions.
That is what your doctor will tell you when you first go in to see him. Of course, one of the best remedies is a couple of months off!
jp hackworth hackworth@newstrolls.com http://www.newstrolls.com
Who cares if it is CTS or "just" RSI. Don't matter. Pain is pain, and must be dealt with. The article implies that only the small percentage have a real problem.
Variety is Key. If your mouse hurts your hand, get a trackball. If your trackball hurts your hand, get a touchpad. If your touchpad hurts your hand, start using your mouse again. The different hand motions Repeatedly Stress different parts of the hand, giving the other parts a rest.
If your keyboard hurts your wrists, there are alternatives. I like www.datahand.com's products a lot though they are expensive. For a week you will be at 70% productivity, but then you'll be fast, and your wrists will stop hurting.
Good luck!
> My pinkie finger's knuckle is quite sensitive,
> such that I now hit backspaces and enters with
> my fourth finger instead.
The Kinesys has both enter and backspace on the
thumb pads - a huge improvement for pinky stress.
Changes aren't permanent, but change is.
I had some pain in my left wrist for a while a few months ago. It was something that came and went and I'd basically gotten used to it, but the last time it was worse than usual, and didn't go away. I didn't know what it was, and I couldn't afford to have some quack look at it for me.
So anyway, after it had been getting worse for a couple of weeks, I decided to just stop using it for a while. For the next week or so, I typed one-handed (annoying) and generally tried to keep my wrist straight and relaxed as much as possible.
Surprise surprise: after that week of rest, the pain went away! It hasn't returned since. The moral: if you feel a RSI coming on, give the body part in question a little vacation. Once the inflammation clears up, it should be good as new.