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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." "
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'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
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.
Shoot...I had to reply to this thread, but I wanted to exercise my moderator power. No problem (that "revoke those who reveal their access" thing is now gone, right?)
Anyways, let me just say that I've been typing almost every day for the last 8 years with no problems at all. First bbsing (in high school), then email (first couple yrs of uni) then programming (last couple yrs of uni), then now I'm finally working. I used to think I was totally immune--I know I have good posture. I even got a split, adjustable keyboard 2 years ago.
I'm fairly healthy...do sports regularly...i'm not a couch potato. I thought I could beat it. I paid attention to my posture, to my wrists, my fingers, and even my mousing.
Just one month ago, I started having pain in my fingers from typing. My wrists were sore from just moving the mouse around. My pinkie finger's knuckle is quite sensitive, such that I now hit backspaces and enters with my fourth finger instead. Now, I don't even email or type unless totally unecessary. Heck, I'm slowly reverting back to windows from linux becuase it requires less typing! My typing habits are just the same...the only difference is that I'm typing at work now too.
A long time friend of mine just told me that his hands started acting up a couple of months ago too. We're both worried because we've just started our careers, and here we are worrying about not being able to type anymore.
Don't be so quick to say that it won't affect you...if you use a conventional keyboard, you will one day come down with some kind of pain. Start now to practice good posture and get good ergonomic equipment.
<tim><
Agreed. I don't even think it was a hoax; just that the author was blowing a little bit of smoke. I can't for the life of me see running at 115kbps on a PIC (I've tried it with a 4MHz 16C84 long ago, and could crank out no more than 19.2kbps without drops, and that's with writing the data directly to an external eeprom), and I surely doubt that it can do all of RFC1122 (what about 1123? huh? Those are supposed to be implemented in tandem). However, SLIP is very simple (could take 10 words of code) and 512 words on a PIC goes very far.
I'll believe it when I see code....
...but I digress. Shame on you, moderators! You'd post two articles hawking X10 giveaways but something of at least some technical merit you remove without a trace even if it is a joke?
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.
...some is just a good old-fashioned justice system, depending on where you live...
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
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...
Also, there are motion-related problems that aren't CTS. I got checked out at after my hands started hurting at the beginning of a semester instead of the end (added paper writing always seemed to cause pain, but when my hands started hurting before any papers got written, I knew there was a problem). I didn't have CTS (which is a good thing) because my pinky fingers hurt (if your pinkies hurt, you don't have CTS).
Anyway, to make a long story short, I got an ergonomic keyboard, some wrist braces, some ibuprofen and I don't type when my hands start hurting. I believe I have tendonitis in my hands, so I just started taking care of them. They still hurt sometimes, though, which I guess is my long-
winded point.
Think like a person of action, act like a person of thought. --H. Bergson
"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
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.
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