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Carpal Tunnel Surgery?
Kyrrin asks a question all of might have to face if we aren't careful: "I always thought that carpal tunnel syndrome was mostly invented by doctors -- until I started showing symptoms myself. I'm almost convinced of the need for surgery -- is there anyone else out there who has had this done? If so, what sort of recovery time did you have before you were reasonably self-sufficient again? "
I take mine with me. I do contract jobs and I make sure that they know that I am bringing in my own keyboard and that if they take it or someone else does, they are buying a new one. I have never had a problem.
After 15 years of bad keyboard practices My wrist were so bad by the end of the day driving home was hard. I ended up (2 surgerys) of having both wrist done. Each wrist had a different type of surgy. Due to one wrist being so tight the micro surgery couldnt be done they had to split the wrist open. Make a few slices and the doctor was done. Stich me up and I walk out of the surgery. 2nd surgery they were able to do a micro surgery and it took just a few minutes and I was on my way home. Both times I was able to get abck to the keyboard in a couple of days. with complete healing in a few weeks Big problem with CTS or RSS is that the problem comes back. Its been 10 years since my last surgery and I can tell the wrist are getting tight again and most likley will have to go back in a few years for a new cut and nip. Overall it was well worth it.
Glucosamine Sulphate is a suppliment that you can get at any health store. It helps your body repair its own cartilage. I have used it with great success with everything from a jammed finger to a twisted ankle to carpal tunnel pain. My best success has been with 3 grams total per day in 2 or 3 divided doses. It's cheaper than surgery at around $10 per bottle and speaking as someone who has had joint surgery (not wrist) it's never quite 100% again and the recovery is a bitch, unless you have a thing for pain medications. By the way, I'm no anonymous coward, I'm just too lazy to log in.
The Typing Injury FAQ is an excellent place to start: http://www.tifaq.com/ Personally, I recommend Handeze gloves, which I get at Walgreen's. Why? they keep my thin-boned hands warm and tend to keep my wrists straighter while I type. Another thing to watch out for -- don't do too much 'chording' while you code, especially if you use Emacs. C-d is a killer! Even if it feels inefficient, use one hand for the control key and another for the alphanumeric.
I took a typing course on manual typewriters and it definitely taught me posture that contributed to my CTS symptoms. Although a busted bar code reader and typing in 9 digit numbers all day really did me in.
I thought I had CTS because Doctor #1 thought it might be it, but in fact I learned from Doctor # 2 that I have tendinitis in both wrists. Which apprently will be a chronic condition for me until I retire from software engineering in 25 years or more.
Anyway, get your condition correctly diagnosed, take the correct ergonomic actions and hopefully you won't need surgery.
The thing that scared me the most was when half of my left hand went numb for a week. I could still move it but it didn't stop feeling funky, almost like pins and needles but not painful, for a week. other than that, the joints in my index and middle fingers on both hands ache and have sharp pains quite frequently. carpal tunnel has to do with your wrists though, right? I'm 19, and have been a fierce typer since i was 13. I also play several musical instruments that depend mainly on finger dexterity: guitar, keybord, and bass. i usually experience it a day after band practice, or when the atmospheric pressure changes. I also take kung fu. Some styles, such as mantis very much depend on finger strength, for spot hitting or pressure points. basically, i'm counting on a better treatment of arthritis by the time mine get's full blown. I don't think there's going to be any way to avoid it with my current job and extracurricular activities. has anyone tried acupuncture? I'm too young to be jacked up already. I can't be 30 with fingers swollen like a limp cock. I don't want to get the fat person's phone with the big buttons.
At first glance this guy appears to be a nutcase. Magnets help CTS? I don't think it was the magnets that helped him. It could have been psychological from thinking it would help him or physical from taking breaks from typing to play with his bracelet or the stretch from nervously touching his bracelet. My mother and sister have bad CTS. My sister discovered that when she often plays with her watch (open an closing the clasp or rotating the watch around her wrist) on her left hand with her right hand, her CTS disappears. That's because the movement of pushing her fingers together to touch the watch (rather than holding them open like when typing) was the stretch she needed. My mother says her CTS is better now when she wears her large new diamond ring. My mother is not a nutcase, but the new ring makes her feel better and it made the pain seem much less. As with any constant pain, how you feel can make a difference in how the constant pain affects you. So yes, having a new copper bracelet can make the pain seem to go away. Whatever works for you.
I have replied to a couple of messages, but I thought I would just make one broad comment. Everyone has a bundle of nerves running down their wrist in a "tunnel" of sorts.
CTS is caused when these nerves swell because of repetitive action, and press against the inner wall of this tunnel. Major symptoms are numbness in your fingers, and intense pain in your wrist. Surgery to correct this problem involves a doctor cutting open the tunnel, to relieve the pressure. This is never a 100% fix, unless you didn't have it that bad to begin with.
Many have commented about different keyboards and mouses. The most important thing is that whatever you use, your hands are in a very relaxed state. That means that your hands are in the same "plane" as the rest of your arm, not bent up or down for too long. I myself have a mild case of it (due to music and the instruments I play, not the computer), and I have found several things that work well.
First, a wrist rest. If you want to spend money on a Natural keyboard, cool, but a wrist rest works just as well for those of you who have gotten used to how big your backspace is. There are also a number of stretching exercises which I am going to do my best to try to explain.
Step one, squeeze your hands into fists for a count of five. Squeeze them tight. When you get to five, open your fingers as wide as they will go for the count of five. After that, with your fingers still stretching out, make full wrist turns (hands going in a vague circle) for the count of ten. Repeat this a few times. This loosens a lot of the muscles and will make your hands about 100x more relaxed.
That is most of the things I can think of.
Yeah! Being an aikidoka for several years now, I've noticed that a lot of my colleagues have been having wrist pains as opposed to me. I showed them the various wrist stretches and they've shown vast amounts of improvement
Well, I am an IBM slut, and I have had to have a few fixed. They send it to a former Lexmark plant owned by, yup, PC Keyboard (as in www.pckeyboard.com). They will clean the Dr. Pepper out and make it good as new.
Of course, I keep stuff around. I still have two Selectrics and a lot of balls;)
Like I said above, I suspect that it is accupressure, but I DO believe you. I have seen those motion sickness wrist straps work like a charm -- I suspect that this is similar.
An excuse that JFK used to get women into bed was that if he didn't have sex he had terrible headaches and that could be damaging to national security. Whatever gets you through the night.
Instead of going to one of these go to a specialist that actually has a real degree.
A physical therapist...
I also got into the "natural keyboard land" too late as well. I was not able to find one in the stores. I did how ever find some on the internet. www.dealdeal.com has some occasionally up for auction. They always have the "elite" one. A few weeks ago they had a "Microsoft Natural Keyboard".
I never took typing, have been tested at 65+ WPM using my own "hunt and peck" method, and have been typing and mousing nearly twenty years now - typing a LOT, I mean. I single-handedly (pardon the pun!) ran a large ISP with over 3,000 customers for three years, let me tell you about typing!
No carpal tunnel or RSI symptoms of any kind in all that time. I personally do think that it's in large part due to the fact that I never learned to touch-type.
I can also adjust to unfamiliar keyboards almost instantly, unlike others who took classes.
I recently ran across a big pile of "junk" heading out to the dumpster at the local HS and to my suprise I found 10 of those "clicky" IBM keyboards I love so much. The pain of typing on those "Quiet-key" things is gone. The drawback is that at college here all they have are those lousy "make my wrists bleed inside" keyboards. I would second the earlier post to find one of these keyboards.
--Evan
My wife is recovering from a severe bout of carpal tunnel.
We tried three approaches.
- She saw an MD who said, eat some vicodin. When you can't feel your hands any longer we will try surgery.
- Acupuncture provided significant short term relief and some recovery of sensation, but did not make much improvement over the long term.
- We went to a physical therapist (Manfred Anliker) who has been doing a lot of research on CTS, he did a few manipulations of her shoulders and arms, prescribed some exercises, and pushed on many of the same pressure points the accupuncturist was using (not that he does not believe in accupuncture and scoffed at the similarity in the treatments). His techniques have worked to an amazing degree. My wife's CTS is so diminished, that her hands are in better shape than they have been in in two years.
Manfred's son invented a device that is marketed under the name Flextend. It is a key pert of the prescribed excercise regimen and has been a great success in my wife's case. So I'd have to recommend it.A few years ago I worked as an electronics assembler and managed to develop a rather sever case of Carpal Tunnel Syndrome in my right wrist. At first there was the Tendonitis, then a pain that radiated from my forearm up to my neck and some odd feeling numbness in my right thumb and a couple a fingers, sleepless nights and utter discomfort all the time... I too wanted to avoid the surgery but there was really no doubt that I needed it, so after weeks of trying different therapies, pills and so on I went under the knife. I went home the same day and felt better almost right away but the Doc kept me out of work for six weeks to heal. I do not know if there is any medical proof of this but suspect that if you have tendonitis, you are probably doing the kind of motions that contribute to CTS and you may want to think of some preventitive measures (like wearing wrist braces). CTS is not something I want back!
Guelph is a smallish town so it shouldn't be that difficult to find such a person.
good luck,
evg@innovation.siemens.ca
There is a simple test to see if you need surgery or not. Stop using the computer for a week. If the pain goes away, you don't need surgery. Sounds trite, but that's what the doctors told me. If the pain goes away, surgery simply can't help you. Sounds like there's a lot of advice here on possible non-surgical remedies. Good luck!
I started having symptoms last week and soon as I reported them to my company, so I got sent off to therapy due to the fear of Worker Comp. 1. Get your workstation done right. Keyboard if your elbows are at a 90% should be 1" beneath your fingers. The mouse should be at the same level as your keyboard. 2. All mice are not equal. Their are actually med. and lg. mice for those of use with bigger hands (the ms mouse would be a small). 3. Therapy helps. If you can't go to some, do the 15 minutes hot, 15 cold treatment to increase blood circulation and reduce swelling and scar tissue. 4. Ibuprofen helps reduce swelling. 5. Get the right type of chair. 6. Don't do the asdf jkll thing, your fingers are supposed to glide above the keyboard. 7. Every 20 minutes take a break and do hand exercises (there is software for this). 8. Don't rest your hand on anything. Hold the mouse like a tiny bird. 9. Stress can also aggravate it (like having 3 blgs shut down...).
guaranteed to make nervouse tissue stop hurting.
Rest != immobility. If you take time off, you should not abstain the use of your hands, but rather do light exercise. (Han-Wen, www.cs.uu.nl/~hanwen)
Yeah, as a rememdy for lower back pain. Anything else is pure Chiro bs, designed to lure money out of your pocketbook.
There are only two kinds of medicine: That which works and that which doesn't. The whole idea of 'alternative' medicine is just more new-agey mumbo-jumbo designed to smokescreen people from the hard facts. Combine worthless terminology with 'testamonial evidence' and you've got the best money maker around: one that can promise no results and leaves people satisfied when they get just that.
Furthermore, 'alternative' medicine is just proof of concept for natural selection. Idiot medicine men who prescribe harmful treatments lose their clientele through death and the treatments die out. Ineffectual treatments like 'holistic' medicine, chiro, and TT thrive in these environments. This is not the same as showing effectiveness.
'Course it's impossible to sway a true believer. They have to have their pockets emptied a few times before they start to think for themselves again...
Here are my suggestions:
1. If your keepboard is just sitting on your desk, get one of those swiveling underdesk drawers.
2. Adjust your keyboard position once a day.
3. Sit up straight.
4. Learn to use your middle mouse button with your middle finger. Otherwise you have poor circulation, especially to your little finger.
5. If you ignore all advice above and otherwise, learn to use a mouse with your left hand.
6. Learn to bunny hop trashcans with your mountain bike. This will strengthen your wrists. Don't hurt yourself.
7. Learn to play guitar with your left hand. I'll be impressed.
8. Use Linux!
Perhaps you are masterbating too frequently.
This is sort of off-topic, but it is completely possible to type quickly and not use anything like the touch-typing that is taught. I can do 120wpm+ and my hands drift all over, not using any position as ``home.'' I've been typing for 16 years (since I was 10) and it seems that over time (and effortlessly) the brain has figured out some form of absolute positioning.
Loved that game... but I can't play it anymore. My body reacts as if alergic to the specific combination of mouse- and keyboard actions that game requires. Other than that, I manage
Are these safer than normal tunnels?
http://www.solgar.com/nutrition_library/articles/c arpal_tunnel.html
Assuming "More Man" = Man+x*Man, where x > 0: Man + Beer = More Man Man + Beer = Man + x*Man Beer = x*Man So Beer ~= Man ?
It can be secondary to fracture, it can occur with pregnancy due to swelling of the tunnel sheath, is associated with inflammatory conditions like rheumatoid arthritis. In about 50% of people there's no predisposing cause that can be identified.
Because the median nerve supplies sensation and motor function to skin/muscles around the thumb, index and middle fingers that's where most patients will notice things going on.
typical case is an aching wrist, sometimes worse at night when the arm is warm, together with variable numbness/pins and needles in the fingers I've already mentioned. Prolonged disuse of the affected muscles will lead to wasting in the muscles at the base of the thumb (palm-side) - the thenar muscles.
Disclaimer: Very little in medicine is 'typical' :)
You can also have a feeling of clumsiness or loss of control associated with fine motor movements (eg, sewing, buttoning a shirt) in the affected hand.
It doesn't normally involve the ring or little fingers (which are innervated for sensation mostly by the unaffected ulnar nerve) and it generally doesn't involve sensation on the back of the hand (provided largely by the radial nerve). I can't recall seeing anyone with visible swelling of tendons in association with CTS but that doesn't mean it doesn't happen.
It's diagnosed by nerve conduction studies, which are electro-mechanical tests. Basically, a small electrical impulse is applied to the median nerve at set points on its course down your arm and the time it takes to evoke a response at standard intervals is measured. As someone said, it can be a little uncomfortable but most people who have actually suffered from CTS will tolerate it pretty well.
Phalen's test is supposed to be a reliable (if not 100% certain) clinical test for CTS. You hold your forearm vertically and let the hand flex forward, palm down. It's positive for suspected CTS if it reproduces the typical symptoms within 1-2 minutes.
CTS is a diagnosis made by exclusion of all other diagnoses which can cause a similar clinical picture - it's the last cab off the rank, so to speak.
There's a few different methods of treatment/management. General approach is to begin with conservative management (decrease use of hand/repetitive stresses that might be aggravating it, wrist splint esp. worn at night) progressing to therapy with anti-inflammatory drugs. If that fails, or if the CTS is severe then carpal tunnel decompression might be suggested.
Surgery can be done through open incision or endoscopically (key-hole surgery). Complications can include damage to nerves supplying some motor function to the thumb and some sensory function to parts of the hand and/or a feeling of 'weakness' of grip that can last several months. Even with the surgery option you can get recurrence of CTS, although I'm not sure how prevalent that repeat episode is.
you might want to take a look at www.medscape.com or any number of offline references on orthopaedics for more information.
IMO, Kinesis makes some of the most comfortable keyboards out there. They take some getting used to, and they're expensive, but well worth the money. I have had virtually no pain from typing since I started using my Kinesis Contoured Pro keyboard.
Kinesis Contoured Keyboards
Don't forget, almost all employers will do an 'ergonomic evaluation' of your workstation.. don't let them give you a Microsoft keyboard! They've got the money and generally are pretty receptive to buying things for 'ergonomic' reasons.
I got one of the new Microsoft Intellimouse Explorer Mice. It is the one the has no moveingparts :). The reason I got it is because it is quite a bit bigger than most mice and it fits my hand alot better. Bad news is it is going to set you about 75 to 90 usd. But if it helps and lasts a long time it is worth it.
If they are over worked, why stimulate them? Other than to increase the bill.
Not-so-recently, I started developing symptoms of cts... this was over a year ago. It started with some pain in my writst, and has since escalated into moderate to severe pain from about the middle of my forarms to the inside of each palm. Within the past couple months, I have found everything from typing to driving relatively painful... and writing anything with a pen or pencil is completely out now. So I went to see my doctor about this (yeah, I should have gone months ago). He asked me about the pain I was feeling, where it was, and what type of pain it was - typical doctor stuff - and narrowed it down to (probably) one of two things. To figure out which of the two it is, I'm suppost to get a EMG/Nerve Conduction Velocity test (outpatient at a hospital). If this test does not rule out cts, then I'll start getting treatment. I know a couple people who went through it... the first step are steriod pills, the second step are injections, and the third (and final step) is surgery. I'd recommend anyone who is experiencing bilateral wrist pain to seek out their doctor - even if it isn't cts, there's something that can be done to help. Much better to see a doctor now then find out you have permanent damage later.
-Lightwarrior
Indiscrete utterances of undisciplined lips will be met with cold steel.
Xwrits is a great utility to enforce typing breaks. I take 5 mins every 35 minutes. I also use a DataHand keyboard, do various stretching exercises and try to eat healthy and I'm doing much better than I did a year ago!
If you're considering surgeory, take a look at the front page on one of our customers web sites who happens to make surgical instruments...when I saw this I started taking more frequent breaks: http://www.microaire.com/ *shiver*
The surgeon listened to my symptoms, which were (are) numbness in the pinky and ring fingers, especially after waking up. The good doctor didn't think it was CTS, but to make sure he sent me to a neurologist. (Ain't socialized Canadian medicine grand?)
The neurologist zapped my nerves a few times, and told me there was no nerve damage. What was the problem then?
Bottom line is this: if your pinky and maybe ring fingers go numb, it's most likely not carpal. In my case it is simple irritation of the ulnar nerve, the one that runs behind the elbow. The solution is to sleep with my elbows on pillows, and to not lean my elbows on tables (mom was right after all!) Apparently, with CTS, the thumb and first 3 fingers are most likely to be effected. So, no, surgery isn't always necessary. Best wishes.
I am a CTS surgery survivor. Kept me out of action for a week for each hand plus another couple of weeks of some impairement (caused mainly by the huge bandage they put over my hand to keep it from getting infected--a major no-no). Biggest problem I had was wiping my butt with my off hand. Try it sometime! So far, after 5+ years, no major recurrence of problems. As they say, surgery is no guarantee, but it's working for me. I'm not sure that keyboarding caused my problem, but it did aggravate it. I'm only a moderate keyboard user anyway. The symptoms that I experienced were not wrist pain until the bitter end, at which point mousing was the most aggravating whichever hand I used. Instead, I experienced arms "falling asleep" while sleeping at night and being quite painful. I kept thinking I must be laying on my right arm funny. Then one night I woke up with both arms asleep, completely immobile, and in terrible pain. Realizing the improbability of sleeping on both arms simultaneously. I went to the doctor and eventually underwent the surgery on both wrists. The purpose of the surgery is to sever the tendon that crosses the heel of your hand. When it grows back together, the tendon will be longer than before because of (hopefully just the right amount of) scar tissue. Bottom line is for whatever reason, I ended up with CTS, had the surgery, and eveything's OK now. If you do have the surgery, you will go through a little anxiety right before they take you into the operating room. You WILL ask yourself if the pain really that bad?
If you have a family tendency towards arthritis, it can be put off a lot by regular, large doeses of calcium/magnesium pills -- the BIG ones. I take them three times a day and I have no soreness. Stop for a few days, and it starts again. Oh well. My 63 year old mother is exactly the same way, as is her 91 year old father, and my 72 year old father reports that his father had aches that went away with calcium pills in the mid-70s. I expect that I will be dealing with this for another seventy years, so I cope.
This might sound like a wierd one, but I have been advise that caffeine can contribute to CTS. I have suffered from CTS for 3 years now, having been working with computers since I was 12. The actual amount of time that I spend typing is quite low, but the amount of CocaCola that I consume is excessive. The caffeine in Coke (and coffee too) causes headaches and wrist pain. My finger go numb, and my hands close up. Doctors have advised me that the caffeine causes the tissues behind my left eye to swell, cutting blood supply and causing the headache. It also causes the tissues in my wrist to swell. As a very easy step, try staying away from caffeine products for a week or two, and see if it helps. For the sake of reference, chocolate, coffee, tea, and cola drinks all contain lots of caffeine (the chocolate and coke are the tough ones to give up, I found).
What exactly does the surgury entail?
What do they do to you?
I have had symtoms of CTS, and it is painful. I was mostly able to correct it by changing the way I type so that I wasn't constantly holding my hands in a position that caused pain. I simply analized where exactly I was hurting, and didn't put my hands in a position to stress that bone/joint/muscle.
mrcl
Ah. I have been both a secretary and (now) a programmer; I can speak to this. I learned to touch-key -- but not at a computer, at a piano. There is a very different physical technique. I was very shocked to learn what constitutes "good" touch-typing technique, but it instantly clarified to me why trained touch-typists get wrist injuries.
Traditional touch-typing technique presupposes a 1950s era keyboard. To this end, you are supposed to keep your hands poised over the "home row", and rotate your hand from the wrist to hit the keys on the outer edge of the keyboard. A 1950s keyboard is about 1 foot wide. Compare that to an "extended keyboard" on a modern computer. It was no big deal to rotate your hand a few degrees left or right to nail that question mark, that tab key on a typewriter. But a computer keyboard is wider, has more keys to cover, and a completely different usage pattern than a 1950s typewriter. You're no longer rotating your hands a few degrees, you're all but trying to snap them off at the wrist.
Today, our keyboarding is vastly more modal than it used to, with several zillion meta keys (Escape Shift Control Alt Delete! Option Apple Windows!). The existence of these keys means both that the width of the keyboard is greater (more distance needs to be covered by the typist) and power typists (i.e. programmers) regularly must do multi-key presses with weird multi-finger combinations.
So you'll get wrist injuries -- if you try to keep to the home row, the way classical touch-typing instructs.
In this strange way, using a computer keyboard is much more like using a piano keyboard than a typewriter. The technique of playing at the piano makes more sense. Pianists have to cover a much wider keyboard. So they move their entire arms. They play from the shoulder.
Which is not to say that pianists don't get repetitive strain injuries. They do. But they are quite different, and (evidently) not as crippling. I have found using this technique, that mousing causes me shoulder problems -- related to forward and back motion and trying to have fine control of a clunky device -- but typing is little to no problem.
A couple of random pieces of advice: Splint your hands if you try to rotate from the wrist to hit outlying keys. Take ergonomics very seriously and do what is necessary to make your workspace comfortable. The alignment of your back and thighs (i.e. your entire posture) have weird non-obvious effects on your arms while typing, so pay attention to these things. And if you find your work environment too cool, and your hands getting cold, put on "wrist warmers" -- something to keep your arms comfortably warm.
It is sad that it is so hard to find the IBM built-like-a-tank clicking keyboards anymore. The only place I have seen them available new in the last couple of years is the IBM Employee Sales Program. ($60.00! yikes!) I got mine three years ago from Tiger Software(motto: Five catalogs a week is not enough!) for $20.00. They are still pretty easy to find on eBay. I use mine with one of those keyboard skins, and since crap can't fall into the switches, I suspect that it will last longer than I do.
The simple test for carpel tunnel syndrome is to bend the wrist on the affected arm so the palm is as close to the forearm as possible (about 90 degrees) then to firmly tap the upper part of the back of the hand (in a direct line from the radius/ulna) tapping toward the elbow. Those with carpel tunnel syndrome will feel pain when this is done. The rest of us will feel nothing.
Now wouldn't you be even faster if you didn't have to move your whole hand over the keyboard? Sure, you would have to practice and practice. I never learned touch typing but after a similar amount of years of typing experience I just developed a style that my brain just knows where the keys are and the closest finger always hits it. I'm pretty amazed that I can even type the alphabet with one finger and my eyes closed. Normally though I can plant my palms on the desk or pad and with only rotating my hands slightly, I hit every key.
As a half computer nerd/half musician, I never paid much attention to the ergonomics of the daily movements I made. It wasn't until I started music school that my instructor explained some of the philosophies behind good technique and how to avoid 'injury' from playing. Basically, aside from the technique aspect, you must give your hands a break from the activity from time to time. Stretching and easy flexion will quickly alleviate most stress obtained from lengthy misuse of the body parts. All things in moderation as they say. While I was in music school, I sometimes practiced up to five hours a day. However, never during those times did I have more than a 30-minute span without stopping, relaxing and stretching my hands, and my body. I've been playing and coding/hacking for probably 15 years now. In the past four years I've not had one slight bit of trouble with my hands/wrists/arms/etc...except maybe for those marathon quake2 deathmatch sessions. :-)
Unfamiliar keyboards? The only thing you would have to adjust to would be Alt, Ctrl, Meta, maybe a couple others like Escape. Now after that much typing I doubt you still hunt and peck. Do you look at the keyboard when you type? If not, well that would be called touch typing.
Absolutely. Ikkyo, Nikkyo, and Kote Gaeshi stretching seems VERY good for the wrists. I do them all the time. The looks you get are worth it alone :-)
I love those old IBM keyboards - "clicktronics" is the name I think - too much. I start to stim on the bounciness of the keys, then I type faster for the fun of it, and the problem gets worse.
Use a pen tablet device instead of a mouse.
It helped me A LOT. I use the Wacom Pen Partner, and I use it at least 8 hours a
day.
Hear Hear!. I had severe trouble with one hand; numb fingers being the main symptom, and for sure the MS keyboard fixed the problem - and some appalling typing habits. It takes about a week to get used to the darn thing and, if you can, try and pick up one of the original models before they 'improved' it with the smaller function keys and stupid cursor arrow placement (I think this was done to reduce the footprint - it is a fairly large beast!).
The carpal tunnel is a narrow channel which runs runs through the inner side of the wrist. It is formed by carpal bones on three sides and a carpal ligament on the fourth. Tendons inside that tunnel run parallel to the extremely fragile median nerve. This nerve passes from the shoulder and forearm to the hand Repetitive finger movements, pinching and squeezing with fingertips, hand exertions with bent wrist, excessive use of the index finger, twisting of wrists, overly tight grip and uneven work movement can lead to a painful condition called carpal tunnel syndrome. Simple CTS occurs when the presence of fluid or the thickening of tissues squeezes the median nerve. The more serious condition of Secondary CTS occurs when inflamed tendon sheaths in the carpal tunnel (tenosynovitis) cause increased pressure on the median nerve. Tendonitis on the other hand is an irritation of a muscle tendon. Tendonitis can occur if a tendon is subject to a forceful strain or a period of small repetitive srains. Both conditions can result from the same type of repetitive movements.
It might be your keyboard. I've heard that the Happy Hacking keyboard does wonders. I haven't tried it myzelf but I'm worried about this as well. --Michael Bacarella
- best
money-maker around. Further,'mainstream' medicine is just proof of concept for natural selection. Doctors prescribe ineffective and unneeded treatments and keep the money rolling in. 'Modern' medicine thrives in this positive feedback cycle. This is not the same thing as showing effectiveness. And our pockets are routinely emptied by insurance payments on the threat of needing these services. (Scary, I could almost convince myself, but I guess I'm gullible that way. As a proper safeguard , it is best to believe in nothing.)I had the same problem. I solved this problem by rotating pointing devices. I use a mouse, a rollerball, and a touchpad. when one hurts, i simply choose the device that doesn't hurt that day. after a while you will feel much better.
I had carpal bad enough I was beginning to wonder about other careers (I'm a programmer). My wife (a public health researcher) did a search of medical research relating to carpal tunnel and found some research had been done suggesting that Vitamin B6 (200-300mgs a day) can reduce or eliminate symptoms. I'm a cynical bastard but I was desperate so I tried it. After about a three weeks or a month of 200mg a day my symptoms were almost completely gone. Look it up on your search engine of choice to find more info and details...
Playing Tetris is the worst thing you can do. I think I had the symptoms due to Tetris. I don't play it anymore and feel much better.
I have a Cirque touchpad that I've loved since I got it. It's not a problem for me, being right-handed, but most(maybe all) cirque touchads are fully symetrical/ambidextrous. Unfortunately, Cirque seems totally uninterested in either giving out the requisite info or in providing Linux drivers, so the thing is vastly more useful in Windows than Linux. (Grrr....) Then again, I rely WAY less on the mouse in Linux anyway. Custom keyboard shortcuts just rule, yah know? Under Windows though, I can surf for 10 hours straight or more and not really notice any fatigue. Windows really isn't too bad once you replace the desktop shell(I use litestep ) and Explorer.exe(with a file manager and/or separate "find" utility. It's actually almost stable now. Also get those crappy Netscape and IE browsers off there (Opera rules!) and you're starting to get something usable that works with you instead of against you.
Insight also carries them. Ask for IBM spare parts. If you do some research, you can get lucky. Some of their keyboards are Yes, IBM still makes them. I just got a new batch of machines where I spec'd "no keys between the alt and cntrl keys."
Take B6 and B12 vitamins to aid in the recovery from carpal tunnel syndrome.
It seems to be everybody is discussing symptoms and not the cause. Which is the use of the computer. I don't just mean the general use of the computer but the specific use of certain programs. For my job this last summer i was using a program where i _had_ to use the mouse and and keyboard simutaneously. Needless to say my right hand that was constantly switching got sore..
//semi off topic rant.
My point is that the design of programs should be such that you aren't forced to use more then one device at the same time.
Or in other words programs need to take the time to make programs that require minimum input that is intuitive to whomever is using it. Not an easy task I realize.
it seams ironic to me that:
Mac started out with using mouse exclusivly for menu use. Over time users demanded the ability for keyboard shortcuts, so that they didn't have to keep switching input devices.
Whereas Windows started out with the ability to run exclusivly with the keyboard. Now there are many tasks that require a mouse. This means that you now have to switch between devices.
Galt Drakor
First of all, a doctor will try to find out if you really have carpal tunnel syndrome. A classic symptom is where your thumb, pointer, middle, and ring fingers get numb, but not your pinky. The pinky's nerve is not routed through the tunnel. Secondly, waking up with numb hands (except for the pinky) is another sign. Finally, doing other activities that require repetitive motions with a tight grip will also bring on the numbness. For me, any kind of painting around the house will cause numbness. Using a screwdriver on my bike will cause numbness. This is what worked for me: 1. Set your keyboard as flat as possible 2. Move the keyboard toward the back of your desk, and sit with your forearms completely resting on the desk. For me, this results in perfectly straight alignment from elbow to hand, and I never get numb working this way. 3. If your mouse causes your hand to get numb, try a trackball, and vice versa. Right now, my trackball makes my hand numb, and a mouse feels find. This tends to switch back and forth, though. Your mileage may vary, but I've had carpal tunnel for years now, and the above steps help me manage it so I almost don't know I have it.
Your typing teachers were anal for a reason! Back Straight, hands NOT resting on ANYTHING, Make sure you are about arms length from your monitor get in that rigid pose and get used to it and its second nature. dont slouch. If you plan on doing computers for a long time... get used to it. Carpal tunnel is completely preventable from computer use ( some stuff like wrench turning maybe not ) butt Its not hard I had wrist pains and all from typing a lot. I just stretched my hands about every 15 minutes! ( I have the coolest little cofee cup on my monitors OSD stuff ) I just stop stretch for like 15-30 seconds sit there for another 15-30 and go back to work. Pain went away after like a month it was great. Oh and learn to write perl scripts that get progressively smaller and smaller! heh
Surgery is the _last_ resort. You should try different ergonomic keyboards and trackballs instead of mice first. A trackball made a big difference for me. Switching to dvorak keymapping did the rest. If it hadn't, I would have gone to a physical therapist. If that hadn't worked, I would have gone to an accupuncturist. I know several people who have had carpal tunnel fixed by accupuncture.
My suggestion would be to explore all alternatives to surgery, which should be your *last* option. It is my understanding that it is a painful surgery with a long recovery period and gives no promise that the condition will not return. Please do see a good doctor. But I would also take a look at physical therapy (a good therapist will not only treat the problem but will also show ways to keep it from returning), massage therapy (not the 'feel good' kind but the deep, sports medicine type), and accupuncture (Western medicine is just beginning to appreciate this form of treatment). Keep in mind that healthcare professionals (like anyone) tend to see things from their own perspective and deal with them in the methods they understand. It is up to you as the patient to control your treatment and to explore all reasonable avenues for treatment. Be sure to check with your insurance carrier to find out ahead of time what is and isn't covered. And, finally, do not hesitate to get a second or even third opion. Any good healthcare professional will respect your right to control your treatment.
I started playing with computers at a young age and was never taught to type correctly. As a result, I'm wondering about the possibilities of having this problem. I type such that both hands are over the keyboard and my arms themselfs move back and forth over their respective section of the keyboard. My fingers "know" where the keys are in relation to where my arm is at that point. So, for example, I can hit the "W" key with all my left fingers without thinking about it.
Any Ideas?
There is a device ( I don't remember what it is called ) that uses an internal gyroscope powered by torque provided by your wrist that resists your wrist's attempt to provide more torque.
t ml
Dynabee!! These gadgets rock! I had one as a kid, then found it again years later in a Sharper Image store. It's the kind of thing you pull out of a box every few years and play with all over again!
Here's a google-random picture and source to order one for $15.
http://www.prolithic.com/hpages/trn_acc/dynabee.h
Note that the string is just the starter cord and is pulled out in the process of starting it. But you don't need the starter cord. Just make repeated karate chops at the wheel to speed it up...
When I moved to my present position, I was given a Compaq. Hmmm, I thought -- that is an awfully expensive VT220. It was slow, too, but that's NT for you. After a few weeks, my wrists started hurting. This bothered me, so I changed my typing position, had the HR ergo person come by to see if I was doing anything wrong, and paid attention to posture. No dice -- my wrists were hurting more and more and I was really concerned. My mother (!) suggested that I get an old IBM keyboard and noted that she had had not problems typing 120 wpm on Selectrics and later AT keyboards, but when she was moved to a Dell with a crappy keyboard, she started to have wrist pain right away. off I went to the junk pile and I found myself a big old IBM keyboard -- the 8 pound kind. Then I gave my wrists a break and spent the weekend reading. At the end of the next week, my wrist pain was gone. It has been several months. I really wonder whether the key travel or the weight of an IBM keyboard is just better for you. I know that it helped me a lot. You can get them used lots of places, or new at www.pckeyboard.com (look at the closeout section -- you want a "buckling spring" keyboard).
Could it be the fact that they type about 4x faster than us "non pro" typists?
My mother used to be a "pro", and she wore the full regalia (gloves, keyboard tray etc...) and has managed to stay relatively healthy despite years of continuous high-speed typing.
I have had back surgery (27 yrs old). I definetely thought CTS was doctor invented. But, like yourself, something happened. For about a month my hands and arms up to my shoulders would go numb everytime I laid down for even a few minutes. I went to the doc and she told me it was most likely CTS. I couldn't believe it. I went out and bought some heavy duty braces ($20 each). When I put them on I can't even move my wrists. I only wear them when I sleep. And within a couple of weeks, my symptoms stopped getting worse, and even got a little better. Admittedly, I had a "beginning" case, so I was able to pursue this type of therapy. As to surgery, unless you feel like you are going to die, DO NOT DO IT. I've heard that it takes 6 months to heal, and during that time you CANNOT type. Surgery is always bad.
I happen to be a doctor. Some years ago I did some research into carpal tunnel syndrome. Symptoms usually consist of pain/numbness/tingling in the region of the median nerve (middle finger), although hot flushing and coldness have been described as well. Some diagnostic signs (such as Tinel's: tapping on the median nerve elicits tingling) may be used by your doctor, but my patient sample suggested that these are useless. AS far as therapy is concerned, conservative treatment is OK. Usually this means using a brace and reorganizing your ergonomics (mouse, keyboard, bike(!)). Surgery is something of a last resort and is not always as effective as one would like. Use PubMed to read up on this. Maurice
You're not a nutbag, just a little off -- what is helping you is accupressure, not the "energy." I tell people with wrist pain to loosen their watch and a day later their wrist pain is gone. How many of you out there have pain in your watch hand?
Practice Aikido! I'm not kidding. I had troubles with my wrists so I started to stretch my wrists with various Aikido maneuvers; kote-gaeshi, gaichi-gi. No kiddin', it worked!
take it with every meal... it'll shock you!
1) Take frequent breaks 2) Arms OFF the table. 3) Stretch your hands OUT against resistance. 4) Ergonomics. 5) those bizarre hand things that force your wrists into an odd position. This is the most controversial... Vitamin B12 injection. Not take pills, not snort it, INJECTION. Subcutaneously/Intramuscular INJECTION of B12. Ask at your friendly neighbourhood drug store. You'll need a hefty gague syringe too, tell them it's for IM injection of cyanocobalamin (B12). Illegal in the US, LEGAL in Canada, total godsend. DISPOSE OF YOUR SHARPS PROPERLY.
I never took any sort of typing class, and have been at computers since I was 10 or so.. (19 now) Never had any sort of pain, execpt after those 6 hour Quake marathons. (which I chalk up to just getting plain tired of moving my fingers around) I usually type with my wrists flat, sometimes hovering over the keyboard. I know it isn't the "correct" way to type, but I can go fairly fast when I want to.
:)
I started out with a mouse, and now moved to a trackball with seemed to be much more comfortable, not to mention more accurate..
If it's not too late, do the following: 1) Get yourself an ergonomic trackball. Preferably a Logitech trackman marble of some sort, unless you enjoy cleaning the insides of your pointer an awful lot. 2) Get yourself a decent keyboard. The curves, angles, and keypress mechanisms of many keyboards vary wildly, but a nice, expensive Microsoft, Keytronic, or other $60-$150 keyboard almost always will relieve wrist strain relative to the cheap, mushy, badly angled $5.00 keyboards out there right now. 3) Make sure that your work surface is low enough so that your elbows are at 90 degrees when you are sitting and typing or using your trackball. For most people, these changes seem to do wonders for computer use-related strain.
I've experienced several problems ranging from back problems to tendonitis. One thing I've found is to get into a training program. A "back extension" machine helps me with my lower back problems, while wrist curls and wrist extensions help me with my tendonitis. I'm no doctor, so take this with a grain of salt, but it seems to work for me. Cheers.
CTS has nothing to do with your tendons. You have a bundle of nerves running down a "tunnel" in your wrist. Repeated action can agrivate this bundle, and it will start to swell. When it presses against the wall of the tunnel, THAT is CTS. Symptoms include numbness in your fingers, and incredible pain in your wrist.
Surgery should be the last resort. There are many alternatives, acupuncture, laser, cortisone, rest. Even if you have surgery, it may come back.
Patient: "Doctor, it hurts when I go like this."
Doctor: "So don't go like that."
RSI injured software engineer wins against Mattel!
This may seem off topic but as many of us are avid quake fans it seems a bit important. I have never understood why suggested movement key combiniations for quake always revolved around something like wsdx or something similiar. I use asdf. It's perfectly natural instead of the cramped position the previous combination forces you into. A = Slide left S = Slide right D = Backpedal F = Forward Space = Jump(Thumb rests on space anyway) I use E for crouch in quake II With this combination ever finger is naturally resting on a movement key already and but place alternate keys for other actions above these home row keys you don't have to do any odd stretches or cramped moves to hit those action keys such as q w e r or t.
Is anyone else getting pains in there hands and wrist while reading this post.... hmm....
Hi, I have been living with CTS for over 12 years. It flairs up every twice in a while, but over that time, I have seen too many friends go thruogh the procedure at Mayo Clinic, Rochester MN with poor results to take the plunge myself. Instead, I have gone to the Chiropractor and Phisical Therapy at the local hospital for help. The people who have had the surgery have had mixed results. Some have had fair success, with reduced pain, increased mobility, etc., while others have results which have been far worse than the CTS itself. Now when I was young, and stupid, I got the CTS up in AK. when I was on the slime crew at a salmon freezing plant, long hours (16-18 a day all summer) gripping slipery fish and gutting them led to my problem. When I returned to the lower 48 that fall, I went to the Doc, who said that CTS was fiction. I decided for myself that the pain was real, so he was mis-informed. I went to P.T. at the hospital, which was helpful, but by far the best care I got was by going to the Chiropractor. I had never gone to a Chiropractor before, so I was skeptical. Sure, it took 4 months for the pain to subside completly, but it was worth it compaired to the mixed results of the surgery. For the last few years, I have needed only a few visits to maintain the proper alignment in my arms to keep from getting flair ups of pain again.
In just about any drug store you can get those wrist support thingamabobs that looks like an elastic glove w/ a metal bar over the wrist/palm area. Wear these things every night when you sleep and within a week or so I bet your symptoms will pass.
I've only gotten arm/wrist/hand pains once (over a period of a month it kept getting worse), and wearing these things fixed it. I've been using computers almost daily since 1987 and have not had any problems except for that one month.
Learning how to type correctly (i.e. no two finger crap; learn home-row and proper typing techniques) is probably 90% of the reason I've been okay. People who wing it tend to have tons of trouble with repetitive stress injuries.
A friend of mine had CTS. She's an eastern European who had a knack for matching up tubes of exotic metals in preparation for welding which required her to bash the hardened tubes with a hammer all day long. She developed CTS in both wrists and ultimatly required surgery in both wrists. I HIGHLY recommend you avoid surgery if you can. The surgery proceedure in medical terms is called AMPUTAION of the middle meta carpal. This is of course permanent, and my friend collected permanent disability from the state, had to change careers, etc. Good Luck!
Microsoft mouse and Miscrosoft keyboard ??? I have a friend who can distroy his wrist (for several days) by clicking only half an hour with a ms mouse. And everyone knows the best keyboard is the one I've got hooked up to my PC. The original IBM PS/2 keyboard (or was it from the AT, i don't remember that well). It's not shape that makes a difference with keyboards, but the way the keys "click". That IBM keyboard has this fantastic touch-response. I actually swear when I'm forced to type on a different keyboard. And best of all, if a burglar breaks in to your house, you can knock him out cold with your keyboard, as it weighs a _lot_.
Go to your local library and find a book called `Pain Free' by Pete Egoscue. Its helped many of my friends get over CTS and Tendonitis, and it's helping me with a series of back problems that I have. It's about $40cdn [Or $2 US, I sure considering the exchange rate ;)]
www.egoscue.com
Before you have surgery, try some acupuncture.
My mom was told by a specialist that she needed surgery for CTS. I referred her to my acupuncturist, and she tells me that within a few hours she noticed a considerable decrease in pain and improvement in flexibility. She's talking to him about other ailments now, ones she thought were things she'd just have to live with as a result of 'getting old'.
If anyone wants an address / phone# for my acupuncturist, send me an email. He's in Dallas, TX.
It is difficult to find a good computer desk that gives you enough room to wrest your forarms and elbows. Nearly 100% of the Wal*Mart special computer desks do not give you any room in front of the monitor/keyboard. I gave up looking for something offically labeled as "computer desk", and I'm using a good sized kitchen table. It gives me enough room to push the monitor waaaay back, keep the keyboard way back, and have plenty of space to rest my forarms and elbows. The desk that I have at the office is not quite as good; unfortunately, that is the best you can get in cubeville.
Why the HELL is this moderated to 0?! I don't suffer from CTS, but I am a big fan of 'old' mice and keyboards for exactly the same reasons as this Anonymous Coward has. They make me work much faster and more relaxed. I DO by the way find the lay-out of MS Natural keyboards very natural, but their keys don't click like I want them to click.
0x or or snor perron?!
A couple years a ago I had very bad CTS symtops my wrists and fingers hurt like crazy. I had to use an Ice pack to ease the pain every two or three hours. Here's how I solved the problem.
... etc). The constant gripping and relaxing of the hands as you do forms with weapons did mircales for me. Just a year into the Kung-Fu training my score on the grip test went to 75 pounds/per square inch on both hands(About 70% of maximum value on the grip strength testing machine). I have not done the grip test in a while so I do not know if my hand strength has improved even more.
Deal with the symptoms right away
-----------------------------------
- I decreased my computer usage by 90% for about 4 month only ( I am now back normal usage 14 hours a day)
- Went to physio therpahy sessions, those session were amazingly good ( tryout physio therapy before getting surgery)
- Bought a split keyboard and a good mouse
- Bough a good adjustable chair from costco $100
- Visited a bunch of websites learned how to ergonomicaly setup my computing environment
Solve the problem forever
---------------------------
During the physio therapy sessions I did a grip strength test. My left hand registerd 30 pounds/per square inch my right 8 pounds/per square inch (the score of 30 was about 35% of the maxium value on the device). So I decided that solving the CTS problem requires strengthing my hands forever. I did this with two steps building the hand strength back to average person then increasing the strength of the hands to twice the strength of an average person.
To Regain the strength I used a bunch of medical putty (sort of like silly putty) which you sequeeze in your hand and builds up the strength of your wrists. The putty came in different colors each color offers a different level of resitance I think green was easy and blue was hard.
To increase the strength beyond the average person I joined a kung-fu class (Hung-Gar Style). The kung-fu class involved doing a lot of finger pushups and playing with weaponry( bow staff, nunchaku, tongfa, knife, spear
Anway it has been a few years and I have not had any problems with my hands, they are in excellent shape. I hope sharing my experiences can help you. Go for the natural apporach don't go for surgery.
If you're going to buy an ergonomic keyboard (and don't faint when you face having to spend BIG MONEY) then buy a Maltron (or perhaps Kinesis) keyboard. (I think it's patents that stop other companies adopting the same shape.) If you care more about your hands rather than your aching brain, learn to use the native maltron layout as well (though this won't be as beneficial when coding as typing english text.) Unfortunately Maltron keyboards cost approx 500 pounds sterling,but it has helped me. But don't treat it as a miracle; you've also got to heavily cut down on your keyboard use (no more games!): it's not palatable but it's also vitally important
Dave Tweed (AC only because I almost never post)
[I am NOT a doctor, but some doctors may miss new developments (e.g. those on the RSI moderated newsgroups)]
:). I mean the docs didn't have a much better solution- not like I want to em to slash my wrists ;).
I'm currently taking B complex vitamins.
The B vitamins help the squished nerve in CTS. I'm hoping that the tunnel will meanwhile expand with time and moderate exercise.
The main vitamin that helps is the B12, but you need the rest- if you just take one B vitamin alone it can mask deficiencies in the rest.
B12 is quite nontoxic. And it really helps. In fact when I finally went to a hospital to check it out, the GP prescribed neurobion (which is like 500mcg B12!). Then she referred me to a ortho specialist who prescribed methycobalamin, something even more potent(better absorbed) apparently! (methylated B12, not the usual cyano B12 you get in supplements). Heh after finishing their pills, I went and bought a bottle of B complex supplements- works and much cheaper
However do NOT take more than 100mg of B6 - some studies have shown that taking lots of B6 for a long time is bad for your nerves (neuropathy).
In my case I find that about 40microgrammes of B12 (NOT milligrammes!) help. For some reason most supplements provide 1:1000 ratio between B12 and the other B vitamins. e.g.
15mcg B12 vs 15mg of B6, B2, B1 and so on.
It does take away most of the pain. However it is not a cure - it just helps the squished nerve. Use the breathing space to fix things- get a better position - elbows and wrists should be minimally bent. Get some exercise too- take some walks, swing your arms. Virtually everyone says that taking walks is a good thing for most people.
Apparently there was some research on B vitamins and CTS/nerve problems in Japan. So maybe a lot of US doctors didn't see that. Whereas in Malaysia we're a small country which doesn't do as much R&D so we probably have to be more aware of developments in other nations.
Cheerio,
Link.
To all of you out there who's wrist hurt all the time, as mine do, try glucosimine. It is a vitamin that helps in the rebuilding of tissue and stuff in your joints. It got rid of tennis elbow in my friend, and its helped TONS on my carpel tunnel. I guarantee after a month or so you won't be unhappy. You can buy it at GNC, and other herb/vitamin stores, and its not that expensive either. And I'n not anonymous, just left username and password at home, but my email is joecamel@netcom.com if anyone wants anymore info from me.
I had similar problems. By lunchtime I couldn't type anymore, couldn't open a door, couldn't brush my teeth. After exploring different keyboards, mice, desks, chairs, and taking regular breaks I'm back to normal, providing I don't overdo it. CTS surgery has horrid horrid success rates. Something like less than 10% of surgeries are successful. Often you're worse off than before. Not worth it. There are some very good books on the subject.
Try an egonomic keyboard. That is much cheaper than doctors. Also make sure your working position is ergonomically correct. If your symptoms do not improve you can try a chiropractor. The chiropractor can mobilize your neck and, I suppose, your wrist, but in my opinion the benefits are temporary.
The best suggestion I can make: if a better keyboard and better sitting and working position do not solve the problem, see Dr. Milne Ongley, who is considered by some to be the best Doctor of Orthopedic Medicine in the world. He is a pioneer in the area of using proliferant injections to strengthen ligaments for the purpose of stabilizing joints. You can look up his web site at www.drongley.com.
Hi, I've suffered Tendonitis due to RSI for about 3 years. It started after I got a new job and had a really bad keyboard setup. I've tried ice, ibuprofen, and simply resting. Living with pain is a total drag. This year I started working out at the gym. My pain has become much much better; it never really goes totally away. Now, I rarely get the numbness, and working upperbody exercises like Lat pulls, curls and anything that strengthens the upper body gets rid of the pain and makes me feel much much better. I would recommend you try going to the gym, explaining to the instructors your problems and asking for exercises which focus on the upper shoulders, upper back, abdomen, forearms, triceps and biceps. This year has been a real eye opener for me, and I am now enjoying a lot of the activities I thought I would have to give up, like motorcycling, video games (carefully), and using the web again. It's much more time commitment, but I would say it's a better alternative than surgery, which I hear actually leaves you much weaker and more suceptible to the condition returning. Anything which can improve your grip strength and the ability to support your wrists independent of wrist support should be good for you. Good luck and in the mean time use ice packs to reduce the swelling, careful not to get frost bite though. yanfali@best.com
Here is what worked for me:
Stopped all unneccesary wrist stuff for a while.
This included playing the piano, tennis, READING.
Learned to stear the car with my knees. Stopped
fiddling with my home PC.
Took lots of NSAIDs for a couple of months.
Concentrated on good posture. My neck and shoulders have always been very tight and I could feel the lack of circulation in my arms as a result. Started lifting weights. This can be a strain on the wrists, but at least in my case seems to have been beneficial.
As many people have mentioned, take LOTS of breaks
from typing/mousing.
Good luck!
WARNING
Some experts believe that use of any keyboard may cause serious injury to hands, wrists, arms, neck or back.
To reduce the risk of such injuries, follow these precautions:
[] Take frequent short pauses (at least 3 minutes per hour, or more if you feel this is appropriate for you) to let your body rest.
[] Vary your tasks throughout the day.
[] Keep your body neutral and try to stand up periodically throughout the day.
[] Align your keyboard and your monitor to keep your back and neck straight.
[] Make sure that your shoulders are relaxed and that your elbows are at your sides.
[] Adjust your chair or workstation height to ensure that there is a 90 (degree sign) between your upper arm and lower arm and that your wrists are straight.
[] When typing use a light touch to strike the keys and avoid resting your wrists on sharp edges or hard surfaces.
[] Avoid arching or bending your wrists when you type; and
[] if you use a wrist wrest make sure that you use it only between keying tasks.
I never realized how many of these things I did wrong untill I saw them all in one place. Thank you NMB Keyboards!!!! (btw, NMB makes the best keyboard known to man kind. Nice and clicky!) For best effect, combine all of these precautions into one large melodramatic step: Once an hour, stand up and sit down for three minutes straight while wresting your wrists on a wristpad with your lower arms bent at a 90 degree angle to your upper arms, making sure that your back and neck are perfectly aligned and strait throught out the entire exercise.
something clever
Posted by polar_bear:
Only try to get surgery if it's a last option - do not go there first! I used to work in a car seat factory and started having CT symptoms. I went to a therapist and modified my work routines - that helped tremendously! I was having pain that was enough to keep me from sleeping, within a month I was feeling much better.
I now work on a computer about 12 hours a day. I have invested in an ergonomic keyboard and I still do exercises to keep from relapsing. If I use a "straight" keyboard too long, I'll start getting pain and numbness...you never get entirely over it, but it's much better.
I've talked to many people who have had surgery and the consensus that I have run across is that you never have full function again or the same level of strength. I imagine that the surgery has come a long way since 1994, but I still would heavily advise against CT surgery unless it's a last resort.
Werd.
--
?
That's how you're supposed to play the piano. One thing I've been curious about is why nobody ever considers is how concert pianists -- the really good ones who can play into their 70's -- hold their hands. It's the same principle with computer keyboards: keep your wrists elevated, don't rest them on any surface; there's also an optimal arching of the hands for minimal strain.
Note that I've been told by people who know that it can be difficult to find a piano teacher who knows proper posture, especially in Canada.
--
Change is inevitable.
Progress is not.
Imagine this. Just flop your hand in a relaxed position on the desk. If you're at all like me, your hand is slightly bulged, and there's a bit of an open space between your index finger and thumb. The pad is there, just move your index finger around. To click, tap your index finger, or you can use the buttons, which just so happen to be right underneath your thumb and pinky. And your ring finger is over on the edge, which acts as a scroll wheel (actually, all 4 edges act as different scroll wheels).
I think the "just flop your hand on it" description is good for a comfortable pointing device: you should be as relaxed as possible when using your keyboard and pointer. My trackball (Logitech Marble, with the little ball on the left for your thumb) fits very nicely for me; I can relax my whole hand and arm, except my thumb when I'm moving the ball or my fingers while clicking. The buttons are right where I expect from my years of 3-button mouse experience, and the ball moves easily (unless it needs cleaning) and doesn't mis-track even when the rollers are cruddy.
But if I put it or my desktop in a bad spot, I have to hold my arm up funny; that bugs me enough that I can eventually notice it and stop...
My biggest gripe with the usual split keyboards is that they assume you exactly cover the left 50% of the keyboard with your left hand, and thus give you no duplicate keys. The way I type looks a bit funny from a classical typing class style, but my left hand is definitely dominant, putting some of that "2% twist" into my typing as I turn my wrist to cover more area...and making me stub my finger against hard plastic any time I try to type a "Y" on a split keyboard.
By the way. I originally preferred the famous Microsoft mouse because it fit in my hand but being out of the work force now I've been using the original 3 button Logitech bear paw for about 2 years. Originally the Logitech seemed too big and that was probably what made them discontinue it, but that big feel was probably more ergonomically correct. A few hours of the Microsoft mouse now causes excruciating pain in the wrist while the Logitech does not.
Professional programmers seem accustomed tobending their wrists for the Microsoft mouse and they wear splints to sleep. I'm accustomed to a bigger Logitech and don't wear a split to sleep.
It sounds like you haven't even seen a doctor about it yet. There's a lot you can do before surgery becomes necessary so you need to try those options.
When my dad had carpel tunnel surgery in the early 90's, the surgery costed a two week sick leave, and pretty much cost him the use of his hands. The purpose of surgery was pain reduction, not recovery of the use of your hands.
Who knows how it is nowadays, but you need to get it treated quickly. If you can't take time off and get it done now you won't recover from the disease. Unfortunately in CS you can't afford to have surgeryat every whim and take sick leave so the mere acquisition of the disease itself can be considered lethal.
It's from Oreilly. Worth every penny!
Doing streaches helps a lot.
Erlang Developer and podcaster
1. My wife had CTS, while she was pregnant, both with our son, then our daughter. Doctor said it was due to water retention, swelling, closing the tunnel, pinching the nerve.
2. My wife has had minor relapses since being pregnant, but taking B6 vitamin supplements seem to help. She's not really a big-time computer user.
3. I have chronic tendenitis in my right wrist, (towards the outer side of the joint) - mousing aggrivates it. I tried several of the mice laying around our lab, it's the strangest thing, but the MS mouse was the worst, and an old squarish HP mouse was the best, though I had to swap out the mouse ball in the HP mouse because it was too lightweight to be useful. I took a heavier mouse-ball from an MS mouse and put it in the HP mouse. The wrist still hurts, but it's no longer as bad as it was a few years ago, when I had to actually limit my work to an hour or two per day (then use keyboards only - back then, it was feasible, Windows 3.11 was more consistent in allowing keyboard-only use). I never saw a doctor about my wrist.
4. My REAL problem is my back, and I've tried all kinds of things - I've found that my upper back problems go away if I keep my shoulders and neck covered when I sleep, otherwise, cold drafts cause the muscles to knot up, and one "knotting incident" can cause me severe pain for up to a week. If I sleep on my back, it causes my lower back to really hurt. Otherwise, no other thing I do seems to affect it in any way, work posture, special chairs, special cusions for my chairs. I know I have a pinched nerve, because when I sit, I have a sharp pain in my abdomen. I've had that checked by a doctor, and there's nothing viscerally wrong. I've seen chiropractors, and they all seem more interested in getting me to endlessly come in 3 times a week for life. I don't have the time, and manipulations just don't seem to help long-term. The only thing that HAS helped is accupuncture. The lower-back problems have improved from intense pain, preventing me from working several years ago, to what it is now, medium discomfort, but not debilitating (unless I sleep on my back).
"The number of suckers born each minute doubles every 18 months."
These are my friends, See how they glisten. See this one shine, how he smiles in the light.
I was having severe wrist cramps from using a mouse. I switched to a nice big trackball (Kensington Expert Mouse) and I don't get the cramps in my wrist anymore. Just my experience.
He had surgery on both hands... The recovery time for him was about 2 weeks per hand.
He said it was painless... So... Something I get to look forward to in the future..
About a month after his surgery he was able to do everything he had before. (Machine Labor)..
Chief Archer
Both had the exact same surgery. It entailed a reliatively quick operation (1 hour). The hand was slit down the centerline from about the middle of your palm to just below where your pulse is read. They tighten up the tendons in some funky doctor way and then sew you up. If your lucky you get to watch the whole thing.. :) Surgery in this area has gotten quite advanced in a short period of time (with my father the procedure had changed drastically over the year or so between hands)... the days of the 3-4 month recovery and full arm incisions is definately over. Another procedure is to make a small incision in the center of the palm and one in the wrist to tighten what they need to tighten. I guess its all a matter of how bad things are.
Full recovery was about 2-3 weeks.. they both got 6 weeks comp for good measure (ahh.. to have a union job). The first 2 days are the worst. The pain in most cases is quite unbarable unless your doctor is nice and gives you something stronger then codine. My Dad who always plays Mr. Tough guy was a complete baby for a couple days (no doubt for good reason)... For the next week after that expect a gradually disapating soarness and then they will start getting you to do simple tasks with your hands such as writing... get a stress ball, they tell you to play with them a lot to loosen up the muscles... All in all its not major surgery in anyway. Another thing to expect is to use wrist bandages if you are factory or repetitively using your hands..
For some reason I haven't encountered this problem yet.. and after 14-15 hour days on regular keyboards, lousy posture and using a regular cheapo mouse you would think I would be showing symptoms by now... oh well, no complaints here... oh wait.. my fingertips just went numb...
Another thing to keep in mind is that every medical system is different. I happen to live in one of the medical epicentres for Canada and we are lucky enough to have a lot of higher profile physicians. Things may be quite different if you live in bartfark nowhere...
Good luck!
- Xabbu
- Jimbob
I find trackballs much more comfortable than standard mice. I use the command line and keyboard shortcuts too much to have any real RSI problems with any pointing device, but a trackball just feels better. I prefer trackballs with the large finger-operated ball, such as those made by Logitech and Kensington. I currently use a Logitech Trackman Marble FX. It's for right-hand use only, so if you want to use your left hand, go with a Kensington. I don't recall the model name, but they have one that is a large square base with a button in each corner and a large ball in the middle.
Is there somewhere on the web from where I can order one of these? I can't find any mention of IBM making them any more. I swear I saw a place on the web that sold keyboards like them (they also had one with a pencil eraser in the middle of it), but I can't find it at all.
Does anyone know if these are still available?
OK, here is what I would recomend and what has worked for me and several of my co-workers/friends. Connect-All is a natural suplement that contains condritin, bromolin and calcium. What is does is reduce the inflamation around the damaged area and gives your body the materials it needs to rebuild the tissues. I swear by it and there are several others with similar stories.
awalker@ou.edu
I dropped down from 90wpm to a about 70wpm and got a pair of Kinesis Classic keyboards (one for home and one for work). It took about a week to get to grips with it but all numbness and soreness went away. They're a few hundred bucks a pop but that's much cheaper than surgery!
Good luck.
A few years ago, I started feeling pains in my wrists. I then started practicing Tai Chi, and they went away and didn't return.
I think another poster suggested those Chinese massage balls; they're another good idea. Buy a pair and roll them in each hand for a good few minutes a day, and they will help.
If your left wrist and arm continue to hurt even while away from the computer, you might consider the following:
An acquaintance of mine had complaints of shooting pains in his left hand and wrist, extending sometimes up the arm, and was diagnosed as suffering from CTS. After trying all the noninvasive treatments and solutions available, he decided to get another opinion from a different doctor, as a last-ditch alternative before surgery. The second doctor determined that he was experiencing low-grade heart attacks, treated *that* problem, and the pains vanished.
If you have a family history of heart disorders, don't overlook this possibility!
Does anyone know anything about the ergonomic properties of logitech trackman marble fx. It looks all sleek and ergonomic but i know this doesn't mean anything.
I switched to this trackball from a normal mouse several months ago and started getting sore hands but i changed my typiung position for the worse and started typing more so i don't know if it was the trackman....should i keep using it? (BTW cut dow o posting to slashdot and other typing and pain went away.
Marriage is the "pseudo-ethics" that cloaks the messy truth of sexuality in the raiment of propriety -- it's "Don't Ask,
I have also experienced some repetitive stress injury problems in my hands in the past. Although I was not terribly happy with my attempts to get advise from doctors, I think my problem was tendinitis that had not yet progressed to CTS. Either way, there are similar things to look at.
As a number of other posters have written, you should REALLY consider theraputic approaches before trying to have surgical treatment. The surgery won't prevent recurrence if you continue the same repetitive actions afterwards, just delay it. And even if you have some injury currently, you can often alleviate it over time with theraputic approaches.
Different posters have posted somewhat contradictory advice in terms of what equipment is likely to help. I think different people just have different bodies and different habits, and so the same equipment might not work equally well for everyone. The key is to TRY different keyboards, pointing-devices, chairs, and desks, UNTIL you find ones that cause less damage to YOU. Of course, that's not to say you should not pay attention to postural and activity recommendations that you can find in resources about RSIs. Take pauses, stretch, shift positions, do all that. If you are able to, it might help to alternate use of your pointing device between hands every once in a while (I am ambidextrous enough to do this, but some other people have difficulty with this).
But also be willing to invest some in your health. Try a new keyboard. If you don't like that one, get rid of it and try another. Whatever you might have spent isn't worth as much as your hands are. Same with a new chair, pointer, etc. When I had problems, I went through a few peices of equipment that turned out just not to be for me. But after finding a good setup, my problems went away within a couple months. I've since had to work in some other spaces... but in each case I try to be conscious of the ergonomics of my work environment, and CHANGE what I'm not happy with.
And DEMAND of your employer that they change anything causing you injury, if this is applicable. Whatever job you have is also not worth as much as your health. Although it should, hopefully, not have to come to this, you should be willing to quit a job that isn't willing to provide an ergonomic workspace suitable to you.
Buy Text Processing in Python
Trak is right. You might be able to avoid dropping any of your favoite activities by proper wrist elevation, and stretches (every hour if you can).
Stretching will prevent other problems as well, mental and physical. Get a few good books and ask your Doctor for better advice.
I took up indoor and outdoor rock climbing a while back, and found I had no more wrist pain! It was fun too!
--Fac Iustum Nec Time-- --Veritas Prevalibit--
I started showing symtoms about a year and a half ago...the pain in my wrists and the sudden numbness of a couple fingers. I don't have a bad case as of yet but I'm only 23 and have used the computer heavily for years. I just can't seem to find the best position for typing that doesn't cause discomfort anymore. I don't think the mouse has much to do with it...I think it is mostly the keyboard.
======== In the future, everything will be artificial. ========
First, My RSI seems to be mouse related, not keyboard. Long hours of Doom and then Warcraft II took their toll.
My symptoms manifest themselves as pain in my right thumb, wrist and elbow. I looked around on the web when I first started feeling it and found info on my seating position. Mine was about as bad as it got. My desk was way too high and my typing / mouse position put my arm in a pretzel. So first thing I did was get a chair that sat higher. That worked great for a while, but the symptoms came back.
I moved the chair even higher, going so far as to put a phone book (ouch, my butt didn't like that) in there. It helped, but only temporarily. So I had to reduce the computing time. I should have done that in the first place.
My girlfriend bought me one of those Marble FX Trackballs. That also helped immensely, especially because I still had the old mouse at work and a completely different one at home.
So, the important factors for me are:
Bleh!
The human wrist simply wasn't designed to be cocked upward like most typewriters and keyboards want it to go. Ideally, you would want a keyboard that lets your hands drape naturally over it. I, personally think that this would be a keyboard build into the desk, that drops down and away from you. This way, your arms can rest on the desk and your hands can be placed comfortably on the keys.
Until that comes along, I guess I'm stuck with my first edition MS natural, which is the best keyboard I've found so far...
Hope this has been helpful,
Malachi
"Life is all about strategy, mathematics and psychological perceptiveness."
I have also started experiencing discomfort in the wrists lately, despite my attempts to work more ergonomically. So I've sought out the Health Services department where I work. They've been a huge help: suggesting ways that I can work even better, teaching me exercises, things like that. I'm not going to say exactly what, because they've tailored my treatment for me and everyone's different.
So that's the best piece of advice that I can give: see a doctor, nurse or physical therepist. A doctor is probably want to explore those less invasive routes before performing surgery anyway. If you are gainfully employeed, your employer should pay for it. If they hesitate for even one second, just say, "Workman's Comp". If they don't flinch at that, get a lawyer. If you're a student, see the health services at your school. They probably suck, but it's better than listening to a bunch of /.ers (myself included). Otherwise, you're probably on your own, but it'll be worth it anyway.
Best of luck in your recovery.
-"Zow"
I had a brief scare a year or so ago. My left wrist had started to hurt, and while sleeping with a wrist brace helped, I was still worried.
After a brief interview, my doctor told me that I didn't have CTS, and that the wrist pain was some sort of sprain/strain.
After a brief survey of my habits, I discovered that my keyboard/trackball technique was ok. However, during the two hours a day I spent commuting through heavy, big-city, rush-hour traffic, I held the wheel only with my left hand. At the top of the wheel. Bent backwards at about 90 degrees. In addition, while biking, I discovered a similar bend in both wrists, which bore a good portion of my 180 lb bulk.
I spend a night or two every few months wearing the brace on my left wrist, but for the most part, noticing those habits was the biggest step towards keeping the wrists healthy.
Hope you find something that works, surgical, behavioral or otherwise.
Wil Langford - opinionated bastard - Linux rules
For all I know this could be a placebo, but it's worked very well for me and a number of my friends. I don't know what to tell you.
I came. I saw. I coded.
Okay, everyone might consider me a nutbag for this one, but I've had run-ins with carpel tunnel and have tried differient remidies with good results. First off, get yourself a chiropractor. In my experience chiropractors can do wonders for carpel. Also, and this is the weirdest of all, go get yourself a pair of those energy bracelets. The copper kind with the embedded magnets. I've loaned mine to several of my geek friends for just a few hours and they always end up ordering a pair. I got into them before the TV adds were around, as my mother is a chiropractor (suprise!) and she got me one for my birthday. I thought she was a total nutbag, but I wore it anyway just to humor her, and just a few hours later it felt like my wrists had been greased. Movement was painless and easier than it had been in recent memory, so I ordered anther one for my other wrist. Anyway, I suggest you at least get a pair of these copper bracelets, because it is well worth it. I'm not totally sure where you can buy a pair, but I can get them for something like $27.00 each. I'm not trying to make a sale here, I'd much rather not have to deal with it, but if you're unable to find them anywhere else let me know and I'll hook you up.
I came. I saw. I coded.
Buy a Kinesis Keyboard!! I was showing some major CT signs, then I bought a Kinesis ClassicQD Keyboard. Since then, I can work on the computer for twice as long at a sitting without any pain whatsoever.
-- "Big Brother is Watching..."
It's informative, interesting, and highly relevant.
I play Nerd-Folk!
1. *Don't* get surgery. Because of formation of scar tissue, your problem may get worse, especially if you keep on typing the way you do. And remember: cutting in tissue can not be undone, so always use surgery as a last resort
.rsi.moderated newsgroup
2. *Do* take all the advice given here about ergonomics, input devices, stretching, breaks etc.
3. Carpal Tunnel Syndrome is a serious medical condition. If you think something is wrong, you have to see a doctor (which you did not, from what I've read). CTS is a condition which can be objectively diagnosed. If you are "convinced of the need for surgery", it doesn't mean medical science agrees with you.
SO: Go see a doctor
4. An important risk factor in RSI conditions is stress. I think you will be much better off doing some kind of therapy or practicing sports
For stress reduction and muscle relaxation, you might try sports without extreme
muscle strain (Tai-Chi, perhaps Aikido) or meditation (Yoga?)
5. An important risk factor in RSI conditions is
posture. I think you will be much better off doing posture therapy, eg. Feldenkrais, Alexander, Mensendieck, C\'esar, etc.
As a personal note, I had major complaints for years, and thought I had CTS. Only when I visited a posture therapist (Mensendieck), I discovered that my (backward) slouching made me put strain on my shoulders. My shoulder muscles would swell and put stress on my nerves and vessels, resulting in cold and tingling hands.
6. There are lots of resources on RSI on the net.
A good start is the sci.med. (?)
Han-Wen Nienhuys -- LilyPond
Hasdi said, "My advise is to use Microsoft Keyboard and/or Microsoft Mouse. They may make a lame OS but they sure know how to design good hardware."
The keyboard is ok, once you get used to the different layout. That actually doesn't take long, but it does get aggravating when you switch computers several times a day, as do I. It takes a couple seconds to remember what keyboard you are using. My only complaint is the mouse. It may sound dumb, but why are mice 'ergonomicly'(sp?) designed for right hands? Is there a mouse designed to fit the left hand comfortably?
Take glucosamine sulphate and Chondroitin complex daily for at least a month. This stuff takes a long time to kick in, but the alternative is surgery with rehabilitation time of about that long. I think the reason for the extended time before you see a result is that this type of tissue heals very slowly. In addition to this, you need to make sure that your working conditions don't aggravate the problem more than they have to. Get wrist rests, adjust your keyboard level to something sane, and get a mouse that you can use without killing your hands. It will take a combination of these things to improve your situation without surgery.
Okay, I'll try to make a very long story short:
I had all the symptoms of cts aabout 5 years ago. Numb hands, a kind of pain when typing. I'd wake up at night and my arms would be tingling - I couldn't even feel them. My arms felt like they belonged on a maniquin.
I spent several months worrying about this. My doctor couldn't tell me what was up. Had the test where they shoot electricty thru your arms to measuring the signal. Everything seemed normal.
One night I was on the couch, with my neck on the armrest. I heard a crack in my neck like one of my
vertabrae moved. One of my arms felt normal. I made an appointment the next day for a chiropractor. Turns out my back was completely out of whack and a nerve was being pinched (due to me exercising my abs but not my back). After a few sessions things started to return to normal. I haven't seen a chiropractor in several years, but if I let my back go the symptoms return.
Moral: It's not always your wrists. It may not be your back, but it could be your posture, or the way you hold your arms / shoulders when you type.
Your doctor probably won't recommend you see a chiropractor (since many thing they are quacks) but you should check out one on your own. Just avoid the ones who try to sell you a bunch of nutritional supplements.
However, if you do have cts, glucosamine sulfate and trans fatty acids (usually in the form of flax seed oil) are supposed to help the symptoms and reduce swelling.
--
:-). Never a moment of pain or numbness, except when mousing too much or too irresponsibly.
You are absolutely correct. Almost every case of CT that I've heard of has been from people who learned how to type "correctly." I was fortunate enough to have taught myself.
--
I have to second this. I taught myself to type at 8 years old (29 years old now) programming TRS-80 BASIC way back when, and though I only use three fingers and a thumb on each hand I can get 55+ WPM with fast metal playing
Rich
----- Remove the obvious from the above address to reply.
I'm a bodybuilder and hockey player so I have pretty big wrists. Does that affect my chances of getting CTS? (So far, I don't have any of the symptoms of CTS. I have an original MS Natural Keyboard and a mouse resembling an Intellimouse. I use my computer 8 hours a day at most, but usually 2 hours a day.)
I have one, and it's not for sale. :-)
Please keep in mind that AC posts start at 0.
I have been diagnosed with tendonitis in both wrists as well as mild CTS in my right.
/neck/back position and especially feet placement! I find that if I hunch over or tense up my shoulders, or lounge without my feet placed on the floor in front of me, I end up comprimising my arm/wrist/hand position or tensing muscles that cause my tedonitis to flare up.
The difference, AFAICT is in the type an location of the pain. Tendonitis seems to me to be more of a general 'the bottom half of my forarm is in searing pain' while CTS is much more localised to the actual wrist joint area on the underside.(where the tendon and sheath is most susceptible to stress) but the pain there is supposed to be 'minor' and is usually masked by tendonitis, its the tingly 'Sprite bubbles inside my fingers' thats the sign of serious nerve damage (ive never experionced this. But this is only my experience, and I'm no Doc. The cool zappy test to check for nerve damage is pretty cool, its like sticking your finger in a light socket, but they do it for longer than any sane human would.
I have avoided surgery because even with new techniques the success rate is, well, not good. But I am able to control the pain with proper positioning of my hands/arms/body and physio and massage. (Painkillers did me no good =)
Proper posture is key. the top of your arm should be in line with the top of your hand. This is the most 'neutral' position for your wrist as AFAIK. This goes for both mousing and typing.
Another problem is shoulder
I switched to the Dvorak layout on a 'natural' style keyboard and it has helped, it keeps my hands relaxed and my fingers do the work... The keyboard is in tray that is angled down away from me slightly, and I do NOT use a wrist (crusher) rest, my hands float above where a wrist rest would be. I also use a Logitech TrackMan Marble FX with the buttons swapped (use my ring finger for normal click and thumb for secondary click).. man does THAT help. I've tried touchpads, but nothing beats the Marble FX.
Lots of breaks and massage has helped tons, and my Physiotherapist gave me lots of stretches.
Worse still, I had to have a tendon transfer operation on my left thumb after hurting it playing football. Let me tell you, surgery on anything in the hand/wrist area is not something I would look forward too. I had a specialist do this and if you dont baby your hands for twice as long as they tell you, then you will be worse off than when you started. I had a spill on my 6th week of recovery (supposedly in the 'safe zone') and it has never been the same. Physio is helping a lot though. Breaking down the scar tissue and replacing the lost muscle (actually, over-replacing it to supplement the weak hack job that the docs did and nature didnt...) ugh.br>
take lots of breaks, do stretches, learn some Massage techniques to keep your muscles relaxed, sit properly and relax...
An old sig
a bit drops in
Sound of ascii
I've been typing behind a keyboard for 19 years, since age 11. I've been a blind typist almost right from the start, and after a few cups of coffee I can do 60 WPM.
Earlier this year I've started to get CPS. My advice is to avoid any kind of surgery at all costs, and it should be done only as a last resort.
Use your head. Pay attention to your wrists. At the first signs of any discomfort, stop. Take a break. Get a cup of coffee. Take it easy for a few minutes, then start again. Even if the pain starts coming back a few minutes later, stop. Take another break.
You may want to try taking some generic over-the-counter anti-inflammatory drugs like ibuprofen (that's Advil, but don't waste your money on the brand label, buy the drug store generic brand which is the same thing). If your usual aches and pains respond better to acetaminophen (Tylenol), try that. Don't over do it, you can only take a few pills a day, at the most.
Eventually, your wrists will adjust. It took about a month before the pain went away for me completely. I threw away my old keyboard, bought a new one - "Fellowes" keyboard which comes with a gel-filled wrist pad that is VERY comfortable. I feel absolutely no pain any more.
--
RSI is not to be taken lightly.
-- This
Start->Settings->Control Panel->Keyboard->Language->Properties->Keyboard Layout
Select, 'United States - Dvorak.'
This will require an install disk the first time.
Path may very slightly between windows versions, this is correct for Win98, and it is not much if at all different for WinNT or Win95.
Dvorak does not work in the MS-DOS window on Win9x, although it did on WinNT and hopefully will on Win2K. Theoretically a driver can be installed in the dos-window's autoexec but I've not done this yet, just use Cygnus bash instead. Some windows native utilities and some unix-alike utilities, even under bash, are disrespectful of proper calling conventions and read raw keycodes or otherwise avoid the dvorak mapping, so you have to memorize which programs want the 'real' "Y" or "N" keys and which respect the remapping.
--Parity
'Card carrying' member of the EFF.
I was having some serious trouble with my wrists and forearms between ten hours of coding and my weight workouts.
I bought the Kinesis Ergo Classic with the footpad to help ease typing pain. And it helped a lot. But my condition was pretty severe and it wasn't long before, even with the new keyboard, I was in pretty serious discomfort.
I stepped up to the Data Hand keyboard about four months ago.
This is the final solution.
The design of this animal is so outrageously different, it's only vaguely recognizable as a keyboard. But it's worked wonders for me.
I bought a "Professional II" demo unit for 1/2 off. That came to 600 USD.
Yup. That's a full order of magnitude more than most ergo keyboards. And that was at 50% off!
Here's how I rationalized the purchase... I could either hurt myself, stop typing or try out the most expensive keyboard I'd ever seen. I gave it a try and, after a week of getting used to it, never looked back.
My lifting has improved, my productivity is up and I no longer dread the workday.
when I read your question. In our results-oriented medical
establishment, surgery is the first thing that comes to mind when
someone is facing an injury as debilitating as CTS. But surgery
really should be only used as a last resort.
You didn't give much detail in your question, but since you said you,
not your doctor, are "almost convinced" of the need for
surgery, I can't help but wonder if you're putting the cart before the
horse. Have you really exhausted all other therapies?
Make no mistake--if you present yourself before a surgeon and show her
your symptoms, she will most likely perform surgery. That's
what surgeons do, and if you have a hammer, everything looks like a
nail. The phenomenon of costly, repetitive, and in the end
ineffective or even damaging surgery is well-known in the
CTS-suffering community.
But I hope you'll go to a general practicioner or family-practice
physician first (your HMO, if you have one, will probably require you
to do so) and explore other avenues of treatment.
Are you sure it's CTS? There are a number of keyboard-related
injuries under the Repetitive Strain Injury (RSI) rubric, and carpal
tunnel syndrome is actually one of the rarest. Tendinitis and various
types of extracarpal nerve damage are far more common. A
self-diagnosis is almost always wrong, so make sure you see a
physician.
When I first felt RSI symptoms earlier this year, I had the first
thoughts that it sounds like you are having: it's carpal tunnel
syndrome, and I need surgery. But then I did some reading and I
learned that surgery is rarely the correct treatment option, that CTS
was not necessarily my diagnosis, and that lifestyle changes combined
with non-invasive treatment could largely restore the use of my hands.
This is something to keep in mind: surgery, even if it is indicated in your
particular case, is never going to restore 100% of your pre-RSI
function. And repeated surgeries are sometimes necessary in order to
get full benefit. Similarly, the non-invasive treatment options and
lifestyle changes that I mention below also do not allow you to go on
nine-hour coding binges sprawled with your laptop on the floor. I
assume you must have very painful, very frightening symptoms if you
think surgery is for you. But don't go looking for some way to bring
you back to 100%: there unfortunately isn't one in the current state
of the art.
Among the less-invasive options that you should explore with your
physician (in addition to surgery; it may, in the end, be indicated in
your particular case):
therapist, not the typical "relaxation" masseuse)
or, more likely, a combination of the
above.
When I saw a physician about my symptoms, which left me unable to type
even the shortest email, I was initially diagnosed with forearm
tendinitis (basically, a combination of golfer's and tennis elbow) and
started on therapy involving aggressive physical therapy,
non-steroidal anti-inflammatory drugs (NSAIDs) and posture therapy.
During this period, I didn't even touch the keyboard
(voice-recognition helped here!). As time went on, my symptoms
improved, but in a kind of lopsided way, and I was rediagnosed, this
time with extensor tendinitis (a broader diagnoses than forearm
tendinitis including more tendons) and thoracic outlet syndrome (an
injury of the nerves in the thoracic region of the chest). With the
new diagnosis, I was started on various neurological therapies, and I
added chiropractic and neuromuscular massage to my regimen.
And eight months later, I'm no longer in regular, ongoing therapy
(though I continue the chiropractic and massage because I like it and
it's an easy "maintenance" treatment) and I can type well enough--I
typed what you've just finished reading, didn't I? I have a regular
exercise program, and I am hyperaware of my ergonomic situation
whenever I sit down to do work. I still have symptoms, of course.
Sometimes my hands will go numb for no reason at all, or I'll
experience pain when lifting a grocery bag. I still have to massage
my sore upper arms and forearms at the end of the workday.
But I no longer worry that I'll lose my livelihood, or that I'll end
up unable to even clothe, bathe, or cook for myself. I can't
say the same for some of my friends who have forgone other therapies
for surgery. Maybe surgery is right for you--but investigate all the
options.
About 4 year ago when getting my degree in computer science, my hands started to get a tingling feeling at the tips of my fingers. This was complicated by the fact that I was also playing sax in the marching band about 12 hours a week. All the typing and playing sax seems to be causing CTS. I don't play the sax as often anymore, but I have developed a "ganglionic cyst" in my left wrist (self diagnosed on http://health.yahoo.com/). The CTS symtoms have gone away. This is definitly caused by too much finger action in college.
c7five
http://www.scriptics.com /people/john.ousterhout/wrist.html
What John Ousterhout (creator of Tcl/Tk) does about his RSI. Summary: Windows PC running Dragon Systems NaturallySpeaking, plus a2x to make the Windows PC act as a keyboard for a Unix box running X.
Here is an article from Byte reviewing good mikes with NaturallySpeaking. (Formatting's terrible, but at least it's all on one Web page.)
Accuracy is reported to be 99%+.
Stupid job ads, weird spam, occasional insight at
How about a "Ask ________, the Carpal Tunnel Expert Anything." This could be quite useful. Anyone know of an expert we could harass???
I've been reading some of the responses on my earlier thread and I think I should add that my advice regarding the natural keyboard is not a medical advice. Furthermore, I was not talking about using it to cure carpal tunnel syndrome but to avoid it.
AFAIK, when you drop your forearm while typing, you cause your median nerve to be stretched in the entire duration of typing. The problem comes when the streched nerve gets squeezed back when you are not typing. So, the solution is 1) to conciously lift your forearm while typing, 2) use a keyboard rest or 3) use an egonormic keyboard. No need to bash the hardware because it has Microsoft name on it. If you insist, you can check out Datadesk Smartboard; somebody provided a link to somewhere in this thread.
Anyway, what do I know, that is what the links are for right?
There is a device called the Twiddler which looks quite worth
trying in order to avoid CTS. It's a one-handed
keyboard/pointing device that stays fixed to your hand, so you
can position your arm and wrist however you desire (that is
what makes it sound so attractive).
The (almost fanatically religious sounding) Testimonials may
be worth checking out.
The device is really intended for wearable computing applications,
however, according to the testimonials it is great for desktop use as well.
Lately I've been thinking about switching from a
mouse to a trackball, so I have two questions:
- Does using a trackball really make a difference?
- Is there any brand/model of trackball that
anyone would care to recommend?
For treatment, the only person who has been abl to help is Dennis Ettare of Biofeedback Associates of California. He is a miracle worker (though even that is not enough to completely cure me yet).
Alexium - open source software and articles for web publishers
Yeah, now that I think about it, cd'ing around directories would tire me out quick. Doesn't bother me anymore but I remember noticing that in particular :) With qwerty I leave my pinky on the slash key most of the time, but with dvorak, I have to move it all around (l and s are pretty common in pathnames).
Also, I tend to use the wrong fingers (not just my pinky) to type out parenthesis and braces. Parenthesis I use the middle two, while bracers I use the last two. Much more comfortable and faster that way, for me. Do you other programmers do the same thing? (this really applies to qwerty too)
In any case, perhaps remapping the dvorak / key somewhere else would help if this is a problem?
I noticed that too. I wouldn't say mine got numb but they definitely were strained a bit. Yes it goes away, at least in my case. My theory is that it just takes a bit to get your pinkies up to strength- the same keys under dvorak ('a;lsz) are more common that the qwerty keys (qazp;/).
In general, my fingers took a while (month or two?) to get used to the new layout. My right hand in particular would get fatigued easily. I've been typing Dvorak for about a year and a half now and I don't notice either of these symptoms any longer.
I use an Elite at home and a regular one at work, and I have to say I prefer the Elite. Once you get used to the new keys (Everyone complains about this, but come on, how often do you really use them anyway?), they're not a big deal. The biggest difference is the Elite is much easier to type on, the keys seem much easier to press down. I would think, for people with wrist/finger problems, this would be reason enough to use the Elite.
Check out the links I posted in the original comment. Key stickers would probably be a more economical idea...
Also, try just printing out a dvorak keyboard layout and keeping it near your keyboard. Almost as good as the real thing, yet still encourages good typing habits.
I switched staring at a qwerty keyboard remapped as dvorak. Funny thing is I would have a hard time telling you where a specific key is, but I can type without a problem.
I'm 19 years old, and i'm showing signs of symtoms as well. Is it possible to get it at this age?
----
eclip5e
eclip5e@ccs.neu.edu
ICQ #2567792
"I can't wait until Windows 1900 comes out!"
www.ccs.neu.edu
"Charging a man with murder in this place is like handing out speeding tickets at the Indy 500" -Apocalypse No
A couple of years ago, I started getting serious pain in my wrists and hands after long typing days. A friend of mine who happened to practice Chinese medicine did some acupuncture on my elbows, wrists and hands and it really helped. I also used some chinese sort of cataplasms (herbs, oils, etc) and within about a month, I had no pain left.
.02
Adding this to good ergonomics (MS natural keyboard helped a lot), good work position should save most ppl from this kind of pains (not CTS in most cases anyway).
In case you got heavy pains and before accepting any kind of surgery, try to see a chinese acupunctor. This stuff does wonders, really. It has also helped me a great deal after some heavy duty fractures and back pains. Hey, these guys have been practicing for over 4000 years...
Just my
-- It's always darker before it goes pitch black.
When I saw an orthopedist, he said "You don't have carpal tunnel, but you will if you keep wearing those braces." I had either extensor tendinitis (1992 diagnosis) or radial tunnel syndrome (1999). In either case, the pain is in the upper forearm, not the wrist, and treating the wrist does no good at all; in fact, it was inducing a different typing injury!
So make sure you get a diagnosis for your pain, and that the treatment is making the pain better, not worse.
If you're specifically having mouse problems, you might consider the Dr. Mouse (formerly Anir Mouse). I tried and discarded a couple of alternate pointing devices before I settled on this.
See the Typing Injury FAQ for further pointers.
I've been reasonably lucky in that I've avoided CPT --- but I had to undergo serious wrist surgery last fall after a bad wrist/arm break in a bicycle accident. It took about three months before the doctor would let the cast off, and another week or two before i had reasonable wrist mobility (with a total of two months on top of that before I had full use of my right arm).
:)
I managed to find a way to type when my arm was still in a cast, though.
I would recommend, if you elect to go with surgery, that you be careful in your selection of a surgeon --- you don't want to have to go through the system twice.
...because you have to remove the causes first. Surgery, unfortunately, causes scar tissue which has its own set of problems, including the risk of infection and adding to later irritation if the underlying causes are not addressed.
As many have noted here, the way you type and the keyboard have a large influence here so look seriously at the way you do things in this area.
From a chinese medical point of view most of the damage/inflamation in CTS is due to a lack of correct flow of energy and blood through this area. This can be caused by numerous external factors but in my experience the most common is excessive exposure to overly cold air conditioning in the working environment.
Acupuncture is known to have extremely good sucess rates in this area in quick time but if like many people you have a fear of needles, acupressure (by a trained professional not a do-it-yourself book), rubbing oils and correct stretching exercises can correct the problem in a reasonable short time.
when you're up to your arse in alligators, it is difficult to remember your original job was to drain the swamp!!!!!
So, how have any programmers here dealt with that? Have you customized your most popular keys to be better placed?
-- these are only opinions and they might not be mine.
I had Severe carpal tunnel syndrome until I started working out 3 times a week. Give it a try.
I'm not a doctor, but I think I'm anyone.
About seven years ago, I had extreme soreness in both wrists and went to see a doctor. He diagnosed me as having tendonitis in both wrists and very mild CTS in my right wrist.
If you feel a tingling or pins-and-needles sensation in your finger tips, that's because a nerve is being pinched because the carpal tunnel is swollen and is closing.
General soreness is more likely tendonitis.
Again, I'm not a doctor.
___
Cognitive Overflow
more than yo
- Wrist braces! These look like rollerblading wrist protectors and have a thin metal brace in them which bends your wrist slightly up. This position is the position that opens the tendons which form the carpal tunnel.
- Wrist braces while you sleep. Again, the braces hold your wrist in a good position while you sleep and helps rest your poor tired wrists more.
- Typing position. As many people have said, it's important to have your wrists off of the desk, but it's also bad to have your wrists arched too high. The knuckles between your palm and your fingers should be well above your wrists.
- Vitamin I, better known as ibuprofen. It's an anti-inflammatory which will lessen swelling. My doctor suggested 800 mg, three times per day -- that's 12 standard Advil per day. I am not a doctor, you are not me. Do not take my advice about drugs. Ask YOUR doctor what YOU should do for YOUR body.
- emacs. Too many mouse clicks aggravated (actually still aggravates) the tendons in my wrists. The more I can do on the keyboard, the better I feel.
Good luck.___
Cognitive Overflow
more than yo
Two things that I find help with my writs/hand pain -- note that I don't have carpal tunnel syndrome, but I get muscular pain in that area pretty easilly. 1) Raise the chair up so that when you bend your elbows 90 degrees forward your fingers should just land on the home-keys on your keyboard. (wrists should be above the desk at this point. You'd be suprised how much easier it is to type correctly if you can get the chair to set at the right level. 2) Remove any and all jewelry you might be wearing -- no kidding. I used to wear a somewhat heavy (but i was used to it) gold ring on the ring finger of my right hand. I would get really bad cramp-like pains in that hand after working for a relatively short period of time. It stoped when I wasn't wearing the ring. Needless to say, I don't wear it anymore when I'm typing.
a chiropractor is basically gives massages - don't expect them to correct a real problem like CTS.
As far as rubber bands go - whatever...
If you really have CTS, then you'll have a positive electromyelogram (EMG) - it's a test where a physical medicine doctor (MD) will insert electrode into your muscles and nerves in your have to look for nerve conduction changes. CTS produce a real decrease in neerve conduction velocity and a few other things. Usually a scrupulous surgeon (Orthopedic or plastic) will only operate if you have a positive EMG since the surgery will in this case decompress the nerve. If you have a NEG EMG, then the surgeon won't operate since you prob don't have CTS and the CTS release surgery will not provide relief.
nuff said.
look at the first anonymous coward reply under the first post for sigs and symptoms of the disease.
The surgery Usually provides erlief - but nothing is an absolute in medicine - too many variables - we only play the percentages.
..........FULL STOP.
Everyone knows that Microsoft doesn't get things "right" until the 3rd version (and often not then) so just wait for the next rev.
David Corbin Promote Freedom - American Liberty Foundation
Tendonitis is not nearly as well known as CTS, but it is MUCH more common. (Everything used to be called CTS...)
Tendonitis can be VERY VERY painful (don't know how to compare this to CTS) and can be just as permanent as CTS. A while back, I got "just tendonitis" and continued working ... for almost an entire day... After the pain was severe enough to keep me from typing, I tried to go home and found that I couldn't drive... By the end of the day, my hand was COMPLETELY useless and in SEVERE pain. I kept it mostly immobile and packed in ice for 5 days, unable to pick up anything, or even sleep well because of the pain. The doctor gave me extremely strong anti-inflammatories, but the pain lessened only slightly.
When I had to go back to work, I could barely type. I immediately rearranged my workstation and later got a Kinesis kbrd, trackball, and switched to dvorak (all at different times). Each thing helped combat my tendonitis, but I am still experiencing a (mostly mild) pain continuously (3 months later). Some days it's worse than others, but it's always present to some degree or another.
Moral of the story: If you have ANY type of RSI, do something about it IMMEDIATELY. Any delay could cost you months or years of pain free life. My doctor told me I did enough damage to last for 2+ years ... for at least one of which I would probably be in pain.
She had a pretty bad case of it. It wasn't from using a computer wrong, however she did have a hard time using the computer before she had her surgery. She said her hands would go numb and be basically useless, sometimes with a painful tingling. She saw a doctor, and he suggested surgery. She didn't want to have surgery at first and tried other ways to make it better, but to no avail. So she had the surgery. They did surgery on one hand and waited 4 to 6 weeks for it to recover before doing the other hand. Just so that she wouldn't be completely disabled for 6 weeks. She says her hands feel perfectly normal now. Email me if you would like her email address, I'm sure she'd be happy to tell you more...
This maker have a better mouse than MS. I'm just using it for 6 months and my wrech pain just leave.
I got a new keyboard when I got the new parts for this system. Fine for awhile, but it was small--I don't have petite hands. The thing also had a softer touch to it, and had a two-inch stub for a spacebar, meaning I had to reach a lot farther. To make matters worse, I started to do a lot of HTML, lots of excessive wordy typing.
Also, I began to practice guitar (electric, meaning I mash my hand all over the place to do weird sliding bar chords) and piano heavily, and that's when my wrists started to hurt.
Do you play any instruments that might do this to you? Sorry, but you'll have to cut down on practicing. At least for a little while.
I also got a wristpad to keep my wrists more level with the keyboard and not resting on the desk. I used to hammer away 100wpm with my wrists 2 inches lower than my fingers. Ow. I recommend getting a nice, gelly, contoured one and not one of those square blocks of foam rubber.
Also, the most comfortable keyboard you'll ever use is one of those old, era 1986?-1989?-type mechanical IBM keyboards. Y'know, the ones you can pop the key caps off. They make you work harder to depress the keys. Great stuff. I got one of them and it's helped immensely. I still use it just because it sounds cool.
Try wearing wrist splints at night. That's been mentioned here--I recommend a FORMfit 8" wrist splint. It's black and blue with 3 velcro straps. Find one at a pharmacy or something, about $20.00 a pop.
Now, if I could just find a way to stop writing everything in Palm Graffiti...;]
Just curious: Anyone else here ever come across CTS from extensive practicing of muscial instruments?
Can't sleep, the clowns will eat me...
I was living in Hong Kong when I had a terrible bout of Carpal Tunnel. I first went to a Western doctor who recommended surgery to relieve the pressure on the nerve. Unfortunately the surgery is not guaranteed and can take 6 weeks to heal. Just for kicks I went to an accupuncture doctor. I did not believe in it at all, but it was cheap.
Anyway the doctor was an elderly gentlemen who didn't speak much English, but he checked me out by taking my pulse in a few places, blood pressure in a few places and checked a lot of reflexes. I was pretty impressed with the thoroughness of his examination and even more impressed when he took my arm (the one with the bad wrist), made some ink dot marks, and hammered in some needles (they were from a sealed plastic envelope). Hammered means he used the reflex tool to give each needle one tap. Amazingly I could feel that he was on a key spot when he put the needles in, 5 or 6 of them from my shoulder to my thumb.
He then hooked up some sort of electrical thing to the needles, felt like a sawtooth wave building up to an unpleasant but not painful peak. When he finished he then put me into neck traction for 20 minutes. My whole arm buzzed like crazy from the needles. Again, unpleasant but not painful.
He told me to come back in three days. I ran out of there, but by the next morning my wrist felt great. I skipped the apointment, but the pain started to come back in a few weeks so I went again. After three similiar treatments I was pain free. I brought a friend to translate on the second visit and found I had an inflamed nerve. The cure was to stimulate it with electricity to cause better blood flow to cure the imflammation, and the traction was to counteract the tendency of the nerve to shrink due to the stimulation.
What can I say. I have no idea how/why it worked, but it did. Cost me $26 dollars. Better to try anything before surgery.
Streching and Exercise help a lot. I had therapy for 2 months and it really did the trick. Surgery is something to always avoid.
#1 rule is if you have ANY pain stop. Relax. Message. Strech.
Make sure you are computing ergonomically it makes all the difference.
Please listen I would give anything to have my young wrists back.
---- Now I am done ---- Shh
Soak raisens in rum. (At least overnight.)
Eat six each morning.
I don't know how/why this works, but my hands feel much better now, after 10+ hours of coding at work (as well as the hours of Quake 3 at home. => )
P.S.: This was a stretch for me, as I don't drink. But 6 raisens shouldn't "mess-up" even the lightest of programmers.
I was having a lot of pain along the top of my hands which i figured was caused by how i typed. i got one of those gel-filled wrist pads for my keyboard and mouse, and they have helped tremendously. I only get pain now when i'm away from this pc and don't have the pads anymore. it also helps that i've started making myself notice how i type and making a concerted effort to keep my hands in a good position.
this is just a placeholder till i send back my real sig from the future.
Simply the best and most comfortable keyboards you can get.
I spent alot of time researching true ergo keyboards, none of thet MS crap thank you. Kinesis wins.
The best feature? They keys are arranged in columns, not on diagonals. Takes some getting used to, but is well worth it.
And if you've got the testicular fortitude, you can get them with the Dvorak keyboard layout.
Between the Dvorak layout, and the better hand positioning, my wrist pain is gone.
Want to know one of the easiest changes you can make? Dvorak Dvorak Dvorak. Your fingers actually move something like 60% less with the Dvorak Layout. Your hands kinda feel lazy when you're typing compared to a QWERTY. Took me about 6 weeks to get fluent with it, but I've heard of people transferring over faster. Only problem is if you work on a variety of different computers every day, having to switch back and forth can get confusing.
When I was around 10 or 11 years old, I started suffering extreme pain in my wrists. Over the course of a week, it got so bad that I could no longer type and moving my wrists hurt. This certainly sucks for a computer geek.
Anyway, I gave my hands and wrists a rest for a week or two, but in order to prevent this from happening again I have to put one of those soft wristpads up against the front of the keyboard. I've never had problems since. I also keep the keyboard as flat as possible (which means keeping those pop-up stands in the bottom closed) so that my wrists and hands are in a straight line when typing.
Dave (dgr116@psu.edu) is correct about your wrists being more comfortable if they are not resting on anything, but the setup I am most comfortable with does not particularly promote this. The arm-rests of my chair are actually below the top of the desk, and my keyboard and wristpad are placed on top of the desk (I hate those pull-out drawers).
I had surgery on both wrists about 20 years ago. I have designed and knitted fishermen's sweaeters, hand-stiched quilts, and use the computer ~20/7. I have had no recurrence, at all, ever. Of course, one personal anecdote does not equal a treatment protocol! But, if there is no scarring of the bands of snipped connective tissue, the symptoms do not necessarily recur.
One plus of surgery: The scars have faded, but it was so much fun to let people assunme I had slashed my wrists!
I'm right handed but I use my mouse with my left hand. I use a cheap square mouse with 3 buttons.
I don't see why you would need a special left-hand mouse. I only ever barely touch the mouse and I pick it up between the tips of my thumb and last two fingers when I have to, so the shape seems of very little importance compared to the weight of the mouse. It seems much less stressful to me to use my longer middle finger to click the left mouse button, so I never tried to configure it backwards.
If you ask me, lefties have it pretty sweet. Most keyboards have number pads and other junk where the mouse should be, so most right-handers have to either type at an awkward angle or use the mouse at an awkward angle.
I've never liked a mouse that cost over $20 (the store paid me to take my current mouse: they sold it for under the manufacturer's rebate). They have awkward shapes you have to wrap your hand around and are often heavier than the cheaper mice. They rarely have 3 buttons and often the buttons are asymmetrical, misshapen, or oddly textured. For fine work, such as drawing or 3d modelling, a mouse is a bad choice; pen tablets are much better.
Part of my point was that, "supposed to" aside, the MS mouse's shape (along with most other ergonomic mice) is more uncomfortable whatever hand you use it with. Square edges are good, they let you nudge instead of grabbing.
Games are probably responsible for a lot of CTS and other RSI. In a work app, you can always stop and start at will, but when you play a game you can lose if you try to take a break. I'd be inclined to think that this is a much more common cause than people are willing to admit.
As far as the chiropractor, I concur; I have been seeing one since I was 5 (mother took me with her). I am 20 now, and I must say that whenever I get too bad (soccer can hurt, for instance), I find a lot is caused to back mis-alignment. You'll be amazed to find the symptoms caused by it: pain in any extremity, numbness, hot/cold spots, organ misfunction (particularly urinary tract), etc. This might actually be the best route to go as a first step; if would really suck to have surgery when your back is merely sitting wrong!
Additionally, anyone from the Texas School of Chiropractics is good, too (in addition to Palmer); both are basically the in the same class as far as methods and quality. Hope this helps.
-Grandpa_Spaz
I have worked in a large number of high-tech companies. I have worked with people who do nothing but type - 12 to 18 hours a day for months at a time. They never take breaks, never stretch their hands, etc. Meanwhile, there are other people who only type for an hour or two a day, and yet are in wrist splints after a few months.
Obviously, typing is not the problem. Then I realized that the guys who were married or in long-term relationships seemed to be fine, while the single guys got the Repetitive Strain Injury (RSI). This lead me to form the hypothesis that perhaps some other repetitive wrist action was the cause!
Recently, a co-worker was telling me that a female artist working for her was complaining about getting some RSI from using her Wacon drawing tablet. I explained to her my theory on the true cause of RSI. She said "No, I think it is the Wacom stylus, because she only has it in this one finger."
Needless to say, we both then laughed for hours.
- davevr
I am amazed that no one has mentioned acupuncture. It helped me more than drugs, more than chiropractic (though chiropractic can be a very good thing). Surgery was not an option for me (I'm also a musician). When looking for an acupuncturist, ask if they are planning to needle the carpal tunnel area itself. If the answer is yes, find another acupuncturist; needling the local area will just make you feel worse.
It helps to get ergonomic input devices (I like Datadesk, Kinesis). It helps to make sure your workstation is set up properly, too.
I think the most important thing is taking breaks every 20-30 minutes. Repetitive stress injuries only happen when you stay frozen in the same position for long periods of time. If you get up, stretch and move periodically, you are much less likely to suffer from this type of problem.
I got CTS from those crappy mice that Sun used to sell. I did two things,
1. Got a nice trackball that works with SUN's keyboards.
2. Got acupuncture. I had to go a couple of times but most of the pain went away when the thrid needle went into my hand between my thumb and index finger. After three acupuncture sessions my pain was very managable. The only time it hurts now is when I dont mind my eronomics.
I watched my girlfriend go through this. She seems to have beaten bact CT, for at least a while, by using borage oil (an anti-inflammitory), and Glucosamine Sulphate (which seems more for cartilage, but she swears by it). These along with some changes to environment worked pretty well. YMMV
:^(
I know that the vertical mouse she switched to is good even for my somewhat less used scientists hands. I can tell the difference between it and a standard MS mouse after about 20 minutes. It is held like a joy stick, but moves like a traditional mouse.
Oh and definitely do some ergonomic work to:
* remove weight from your wrists/palms
* put your keyboard/mouse/monitor so that you don't have to hold yourself in a strange position to work.
* take breaks! (You've heard this all right?)
All in all, I'm not sure why she got better. When people have this kind of problem they usually try so many things to make it better that the control of the scientific method seems to take a back seat. On the other hand, she's only been programming 15 years, and could develop problems again (probably at the highest stress crunch time... can't quit...must work... perhaps then I'll get a chance to run real experiments
Here's a review of the mouse I like:
http://www.mactoday.com/mayjun98/Anirmse.html
and the Norwegian folks who make them:
http://www.animax.no/webshop_world.html
you can buy them at Fry's or on line, I'm sure.
p.s. No I don't work with or for them or anyone else who pays me more than living expenses.
I perform this kind of surgery, but do not recommend having both hands done at the same time.
Due to the delicate nature of the surgery, the doctors usually don't give it too good of a success rate.
The surgery is actually quite simple and takes about 20-30 minutes. Not particularly delicate either. The sucess rate is quite good for patients who haven't responded to conservative measures and do not already have permanant irreversible damage to the median nerve. When numbness and weakness become significant, then it is likely that the nerve is damaged and not just irritated. In this situation, surgery mainly helps get rid of the pain and helps to prevent further loss of function.
Unfortunately. when he finally recovered from the surgery, he only had feeling in about 3 or 4 fingers between both hands.
In this case, either he had surgery too late in the course of his CTS (after damage to the nerve had become permanent), or something went wrong with his surgery (uncommon).
If you must see a chiropractor (spine manipulating health care provider) rather than a neurosurgeon or neurologist (nerve doctors) for your median nerve problem (carpal tunnel syndrome), please do not let the chiropractor pop your neck as a proposed treatment for the pinched nerve in your wrist! I've been to a chiropractor and had some manipulations. Some of them actually felt good. But they are not without risk. I've taken care of patients with dissected (torn) vertebral arteries (the arteries that run up the side of your spine and provide blood flow to your brainstem) resulting from chiropractic manipulation that suffered horrible (fatal) brainstem strokes! Chiropractic has a place, but it is not without risk - and if you have a pinched nerve in your wrist (carpal tunnel syndrome), then the risk of violent neck popping is not justified (in my opinion). Do let your chiropractor prescribe ibuprofen and wrist splints. Do ask about behavior modification.
You are correct in saying that surgery does not treat inflammation and that it only removes the pressure from the nerve. However, carpal tunnel syndrome (the symptoms and nerve damage) are caused by the pressure on the nerve in a tight carpal tunnel. Often the carpal tunnel is tight because of the inflammatory changes.
So the causative sequence is inflammation (and/or other factors) -> tight carpal tunnel -> pinched median nerve -> damaged median nerve.
Surgery relieves the pressure. If the symptoms return (they usually do not) after surgery, it is because the surgery was incomplete or because you formed excessive scar tissue over the nerve and the nerve is once again "pinched". This is why I encourage my patients to keep moving their fingers regularly after surgery so that the tendons and nerve will not get scarred into a fixed position. In difficult cases, there are substances (Adcon-L, for example) that can be placed on the nerve to prevent scarring.
Surgery should be avoided if conservative measures can control the problem. But it is not the least desireable alternative! The worst alternative is to allow permanent nerve damage to occur when CTS goes untreated too long. At that point, no treatment will reverse the damage.
I'm sorry to say this, but it sounds like you probably have significant nerve damage at this point, some of which is quite likely to be permanent. Surgery is very likely to get rid of the pain, but the numbness and weakness are likely to recover very slowly and incompletely. If allowed to progress too far without effective treatment, carpal tunnel syndrome will lead to irreversible, disabling, damage. It is a shame that this might have been prevented by earlier intervention, as unpopular and distasteful as the idea of surgery seems. I would recommend finding a good neurosurgeon that specializes in peripheral nerves (most major cities will have at least one such neurosurgeon) although most neurosurgeons do this procedure frequently. An orthopedic or plastic surgeon with specialty training in hand surgery would also be a good choice. Good luck!
A pretty cruel thing to say! Some of the contributing factors for CTS are not under your control. Who knew that you were going to develop acromegaly, rheumatoid arthritis, hypothyroidism, sarcoidis, or another medical condition that can cause carpal tunnel syndrome? Is it your fault that you developed those diseases? No!
If your carpal tunnel syndrome is due to RSI, pregnancy, or oral contraceptives then maybe your behavior is partially to blame, but this is not always the case!
I'll second that.
I bought an old style natural keyboard, and *NEVER* experienced wrist pains. But when I'm using a regular keyboard, if I use it for > 3 hours, my wrists will begin to hurt. Once I get home, and settle infront of the old style MS Natural, the pain eases.
For mouse, I use a Logitech Marble FX. Great trackball, requires very little cleaning.
BTW, IIRC, the front end (closer to spacebar) of the keyboard should be raised, not the back end. Back end is bad ergonomically. (Something about negative angle or somesuch). Mine set all the way up (flat is a bit too angled for me).
I believe you should be able to get the old style keyboards somewhere... if not, I gotta make mine last as long as possible.
You know it's a weird world when...
I use voice recognition software to chat now
Computers are just massive extensions of the brain, welcome to the 21st century.
+&x
I started showing signs of carpal tunnel a few years ago.
This is my highly dumbed-down understanding of CTS:
There is a narrow area in the rest through which tendons pass (the actual "carpal tunnel"). When the tendons start to swell through overuse, repetitive motion, or incorrect use, they pinch in the tunnel. This causes pain, numbness, etc.
I'm not against surgery per se (in fact, I had a torn pectoralis reattached 3 months ago), but it would probably be a last resort for me with an overuse/misuse injury such as CTS.
What did work for me was to seriously re-engineer my work area. I set my chair/desk height so that there is a straight line from my elbow to my fingertips -- no wrist bending at all. I use a wrist pad in front of the keyboard now.
I also make it a point to exercise the forearm/hand muscles with something other than typing. Overuse injuries happen when people focus too much on one activity -- runners get shin splints, tennis players get elbow pain, computer users get CTS. It sounds like a bunch of "total wellness" yabber, but a little weightlifting and rock climbing did me a lot of good.
Save the whales. Feed the hungry. Free the mallocs.
I had pain and numbness in my fingers, and it turned out my problem was in my shoulders, not my wrists. The tip-off is that your thumb and your little finger get numb too. With CTS they usually don't.
I went to a physical therapist but it didn't help much. Then I went to a chiropractor. Wow! big improvement.
Ergonomics-wise, don't sit too far from your keyboard. Reaching out with your shoulders is what does you in. This means if your gut is too big like mine you have to have the keyboard jambed right in there, but it helps.
My carpal tunnel problem has gone from minor paralysis to only occassional pain, without medicine or surgery.
Genocide Man -- Life is funny. Death is funnier. Mass murder can be hilarious.
You need to stop any activities that cause scar tissue to build up in your hands. Foremost among these is cracking your knuckles. If your a knuckle cracker, you have to stop. The popping sounds is nitrogen liquifying under the pressure. This is bad for your muscles and is the source of your scare tissue.
Where do you get this factoid? Seems rather improbable to me that joint cracking builds up the pressure to liquify nitrogen (quite a large pressure at room/body temperatures). According to a number of sources it is the sound of gasses (including nitrogen) coming out of solution or filling gaps. I'd be interested to know if you have research/references which refute this.
o ok..anyway, I still think the AC-comment does make sense.
0x or or snor perron?!
IANAD, and IANEAP, but:
If I spend more than just a few minutes at my machine with anything but the correct posture, my wrists and the backs of my hands start to ache. So I just settle down and assume the proper position, which for me is: Sitting up somewhat straight, elbows on the armrests of my desk chair, wrists on a beefy wristpad on the desktop (I use two rolled up bar towels), fingers on the home keys. If my wrists have to tilt up to reach the keys, pain... Typically, it feels much better within moments of adjusting my posture though.
Oddly, unlike a number of other posters, I have no problems with the mouse, except for a couple of times I was randomly surfing for several hours and my hand locked in the shape of the mouse. And the other hand - it was holding a Mountain Dew can, I swear.
--
It took me three months to get over it. From everything I've heard, I had a mild case. There was never a time I couldn't type, from spasms or whatever. I've got a (better) ergo keyboard now, and I (try to) not pound on the keys. A gentle touch seems to be best for me. YMMV, of course.
-russ
Don't piss off The Angry Economist
I would really research the surgery aspect before pursing that avenue. My father had been diagnosed with CTS quite a while ago, and ended up having to have surgery on both wrists at the same time. Due to the delicate nature of the surgery, the doctors usually don't give it too good of a success rate. Unfortunately. when he finally recovered from the surgery, he only had feeling in about 3 or 4 fingers between both hands.
Oh, BTW, I've found that a really good mouse to use is the Logitech MouseMan Wheel. The design, along with a good wrist pad, is usually extremely comfortable.
Thanks to everyone who's taken the time to respond to my question; there's some good information here. Rather than respond to each point individually, I'll recap:
-- Yes, of course, I have been seeing a doctor and changing the ergonomics of my workstation -- things are set up wonderfully at home, with one of those old Apple Adjustable keyboards propped up by a thin paperback to tilt it away from me, and a trackball rather than a mouse. The problem is my work environment. I'm not a programmer; I do customer service, which has turned into data entry while I wasn't looking, and it's for a stodgy old financial/insurance institution. I first submitted the paperwork for an ADA accomodation back in February, and have not gotten the equipment yet. Of course, they prevent you from purchasing computer equipment on your own and bringing it in, too.
-- I started showing symptoms a good five years ago, and treated it at that point with massage and physical therapy, and had very good luck with that sort of treatment. That was before I got this job, however, and about a year into the sort of demon typing I have to do here, the symptoms stopped responding to that sort of treatment.
Overall, really, I think I've exhausted my options. I've tried chiropracty, I've tried massage, I've tried the anti-inflamatory shots, I've even tried a prescription that my doctor gave me that was originally an anti-depressant and was being used for nerve damage. (Quipped I: "Well, even if it doesn't work, I won't be depressed about my hands hurting.")
As for the symptoms: Over the past year, I've lost all feeling in my thumb and middle/index fingers on both hands; I can't pick up anything more than about 2 lbs without it completely slipping through my fingers; I wake up with sharp, shooting pains through my palm and wrist; and when I tap the inside of my wrist, I can feel the numbness and tingling all throughout my palm. I've been to two doctors, and they both agree it's a pretty bad case. (The Nerve Conduction Study they do, when they hook you up to a machine and zap you to see if they can tell if there's any nerve damage, is one of the most bizarrely violating medical experiences I've ever had.)
Overall, I've pretty much decided that I've exhausted my options. I'm going to have the surgery done, to hopefully alleviate some of my symptoms, and then I'm going to find a different fscking job that won't give me a hard time about a $100 keyboard.
No one should have it.
YOU are in direct control.
Don't type for long stretches without stretching and flexing. Don't get glued to your mouse... shake out your hands, roll your shoulders!
Don't sleep on your hands. Blood flow not getting to your hands to repair daily damage while you sleep is the culprit that almost had me.
CTS is self induced and is the result of abusing yourself too much and not letting it heal.... or
CTS results from doing more damage to your system on a daily basis than your system is capable of repairing while you sleep.
In my case I had to break myself from sleeping on my hand, so that I would get enough blood flow through on a nightly basis to repair the daily wear and tear.
Again, if you have CTS, YOU are to blame.
CTS takes months and months of abuse t develop. So, like your mother said, " If it hurts, do do it!"
I don't know if it's real CTS or tendonitis, or what, but my left wrist started aching two or three years ago. Which is a pain in the @#$!, since I'm left handed.
(It's interesting that some people get it in their mouse hand, others in the keyboard hand - I got it in the keyboard hand).
Anyway, first things first - go buy a good keyboard for each machine you use - make the company pay if you can, pay for them yourself if you must.
The good keyboards have two main features: (1) the keyboard is split in half, with each half angled towards that hand. (2) The keyboard is slanted AWAY from your hands instead of towards them. These two features allow your wrists to relax while you type. It will feel odd for the first day or two, then you won't notice it at all - unless you have to use an old fashioned keyboard.
I've used the original MS Natural keyboard - very, very nice - and an Acer keyboard (I'm using right now). I forget the trade name of the Acer, but the model # on the bottom says "ERGO".
The Acer keyboard does have one big problem - it has an integrated touch pad, which I thought would help, but turns out to irritate my wrist. I turned it off.
After you've changed your keyboard, you might want to invest in a wrist splint/wrist brace. Basically, it's a molded metal bar in a glove. You put it on the aching wrist and it braces it. Personally, I discovered that if I'm having an episode of wrist pain, sleeping with the brace on helps tremendously.
I hope this helps!
--
Clear, Dark Skies
i've been working on keyboards and with mouse for over 20 years (since 1979), and it is a problem at work, because when a deadline comes, and the wrists start to hurt, what do you do? since this is a prime concert for my livelihood, i have found two solutions:
i) i have switched to a dvorak keyboard. its a pain to learn for the
first two weeks, but once you get used to it, the 70% less finger travel
off the home row starts to become significant. this works because they
did a frequency analysis of the most common consonants and vowels and
placed them on the home row. if you've got RSI, the dvorak keyboard is
worth looking into (from someone who's tried it).
ii) about a year ago when my wrists were particularly sore from over 10+
hours/day on a computer, my doctor wanted to perscribe an anti-inflamatory
to reduce tendon swelling. but i had read something (below) that got me
thinking -- when mouse clicking and keyboard typing, i'm constantly using
my muscles and adapting them to a single and automatic way of moving.
this gives the muscles fatigue for that configuration of movements. after
reading the below text, i surmised that perhaps i should retrain my muscle
reflexes with a new set of movements that are difficult to learn (as in
playing a guitar or new instrument when you've never played one), or do
something like practice fine motor control in a way.
the solution to mouse-clicking and keyboard typing pains is therefore
this: REPROGRAMME THE DEVICE DRIVERS OF YOUR MUSCLE MEMORY WITH A NEW
FINELY CONTROLLED SET OF MUSCLE MOVEMENTS SUCH AS THOSE PRODUCED WHILE
PLAYING A MUSICAL INSTRUMENT OR WITH AN ALTERED STYLE OF HANDWRITING.
THIS WORKS TO STRENGTHEN THE MUSCLES INVOLVED, and alleviates much of
the pain, because your hand is stronger, it can withstand more of what
causes the pain -- i.e. the cumulative effect of small repetitive strain.
--| repitivie strain solution from 1920's |-----
Here is another example that may also appear trivial on the surface. You know that the physical and etheric bodies are intimately connected. Now anyone with a healthy soul will be moved to compassion for clerical workers and others whose professions demand a great deal of writing. Perhaps you have noticed the strange movements they make in the air whenever they are about to write. Actually, with some of them the movements are not so extreme and they may only give a kind of jerk when they write, a jerk repeated for every up and down stroke. You can see the jerking in the writing. This condition is easily understood through spiritual science. In a healthy human being the etheric body, guided by the astral body, is always able to permeate the physical body. Thus, the physical body is normally the servant of the etheric body. When, undirected by the astral body, the physical body executes movements on its own, it is symptomatic of an unhealthy condition. These jerks represent the subordination of the etheric to the physical body, and denote that the weak etheric body is no longer fully able to direct the physical. Such a relationship between the physical and etheric bodies lies at the occult foundation of every form of cramp or convulsion. Here the physical body has become dominant and makes movements on its own, whereas in a healthy man all his movements are subordinated to the will of the astral body working through the etheric.
Again, there is a way of helping a person with such symptoms, provided the condition has not progressed too far, if one takes into account the occult facts. In this case we must recognize the existence and efficacy of the etheric body and try to strengthen it. Imagine someone so dissipated that his fingers get to shaking and jerking when he tries to write. You certainly would do well to advise him to write less and take a good vacation, but better still you might also recommend that he try to acquire a different handwriting. Tell him to stop writing automatically and try practicing for fifteen minutes a day to pay attention to the way he forms the letters he writes. Tell him to try to shape his handwriting differently and to cultivate the habit of drawing the letters. The point here is that when a man consciously changes his handwriting, he is obliged to pay attention to, and to bring the innermost core of his being into connection with what he is doing. The etheric body is strengthened in this way and the person is made healthier.
(Experpted from "Overcoming Nervousness", a lecture by:
Rudolf Steiner, Munich, January 11, 1912, GA 143)
--
I don't think anyone makes asymmetrical mice for lefties anymore. The best you can do is get a symmetrical Kingston or Logitech mouse.
Interesting...I also use Dvorak almost exclusively, and have also noticed numbness in my pinkies. I never have had any RSI, and have been using Dvorak exclusively for the last 4 years or so. I'm also a home/job keyboarder, spending the vast majority of my time typing. My problems are simply an occaisional annoyance that comes and goes (currently :), but it's very interesting to see another Dvorak user with similar problem, different from the QWERTY folks.
I've been typing like mad for almost 15 years now and never had wrist problems. In reading a lot of this stuff, I'm fairly convinced that my typing style has a lot to do with it.. i.e. I hunt & peck.
Speed really isn't an issue because after doing it for that long, I practically have the keyboard memorized. Plus, you start to see a lot of patterns to keystrokes. I have all sorts of funky finger/key combos depending on the word. So I've never really had much of an incentive to lear to type the "right" way.
Turns out that may be a good thing.
My wrists never touch because they can't. I type primarily with the middle 3 fingers (pinky every now & then -- thumb only on the spacebar) of both hands and have to move my hands around the keyboard to get to the keys I need.
This would make an interesting poll. how many type the 'right" way vs. how many hunt & peck. I'll be there are more "peckers" out there (heh heh) than you might think.
Comment removed based on user account deletion
I had trouble off and on for a while. My karate training actually helped a bit, as it increased my hand and finger strength. I've also learned some good stretches for the hands and wrists.
But, strange as it may sound, what really helped was moving the mouse to the other side of the keyboard. In the sort of text editing you do in programming, you use your right hand a lot to hit the cursor control keys (arrows, home, page up, etc.) as you move around the code; then you also use that same hand to mouse around. It puts a lot of extra strain on the right vs. the left hand. If you're having trouble primarily on the right side, try mousing left handed (it takes a while to get used to).
Tom Swiss | the infamous tms | my blog
You cannot wash away blood with blood
Well, my father got carpal tunnel a while ago. He's a winston-smoking, 10k running, eat-death-for-breakfast kind of guy. He cured it with stress balls and a hand grip exercises, with no surgery. I don't think surgery is always required.
It's 10 PM. Do you know if you're un-American?
Um...despite a long-standing prejudice of "modern" physicians against such things as chiropractice, chiropractice is and has been accepted as valid by the medical sector for quite a while.
Isn't it amazing how doctors are miraculously synthesizing chemicals which are naturally found in all sorts of places in nature and used by all sorts of cultures? Isn't it amazing how the focus is being shifted from incident-repair to lifestyle? "Natural" therapies have worked for a very long time now...the medical sector is only now wising up. Only now that modern medicine can understand HOW some of these things work, is it actually accepting that they do.
If your body was an engine, "modern" medicine would basically be tearing out broken parts and putting in new ones, using duct tape to fix holes here and their, whereas "natural" practices would attempt to keep the engine in shape in the first place. It's the difference between maintanence and repair.
Disclaimer: There are many quacks of many kinds, including "faith" and "psychic" healers, people selling panacea potions, and medical doctors either through ignorance or greed prescribing the wrong treatment...none of these are valid.
It's 10 PM. Do you know if you're un-American?
I was diagnosed with RSI in December, not Carpal Tunnel but the first step. It seemed to be directly caused by (forced) typing all day. I was doing telephone tech support where every call had to be completley logged. What helped first was quitting, but I find that the genuine Apple keyboards are altoghter the most comfortable I have used. (No joke) I will also say that the old mechanical keyboards have really reduced the pain and swelling when I have to use a PC. It seems that the greater key throw and firmer resistance force the hands into the proper typing positions. You just can't type as fast with them which is good.
I still use the method my piano teacher used for playing. Pretend that you are typing with a ball in the palm of your hand. No matter what The Man says about it, you really need to stop frequently and do something else. A stiff shot of cortisone does wonders.
I've had carpal tunnel syndrome for several years. There are several types of repetitive stress injuries that can hurt your hands and you really have to go to a doctor to get a proper diagnosis. Surgery should be a last resort, it can help or it can make things much worse.
The one keyboard I've found that really helps is the Datahand (www.datahand.com). It's the strangest of the "alternative keyboards", and takes a couple of weeks to get used to, but it greatly reduces the stretching and finger motion you have to do.
Besides the standard (and useful) response "use a better keyboard and pointing device," I found that I was sleeping on my stomach, and I had a bad habit of tucking my wrists under my body. That put extra pressure on them all night long, and once I stopped doing that, my wrists felt much better.
I used to use my mouse with my foot a lot (much to the annoyance of my roomate) as I found it to be much more comfortable to use the mouse without having to move my arms. I have a good keyboard (compaq something or other). Together I have had no wrist problems what so ever, despite friends of mine who spend less then then 10-12 hours a day i spend on the copmuter having CPT.
OFTC: By the community, for the community
As for Windows, when my boss forces me to boot into NT at work, I've found that it actually has a native Dvorak keyboard mapping somewhere in the depths of its many configuration screens, don't ask me exactly where. I had to go hunt up an admin to get an install disk when I did it, but it worked fine after that. I do not know about Win9X, thank Garp.
Oh, and nowadays, I do all my NT under vmWare, and since he uses X like a good lil camper, my xmodmap works fine for him, too. Now if they'd only make an Oracle PTE client for Linux ...
One thing that I don't think has yet been mentioned is getting a good keyboard tray. It's virtually impossible to have correct posture if your keyboard is at the wrong level, and raising/lowering your chair won't necessarily help, because that, of course, changes your posture. If it's financially possible, buy a high-end keyboard tray -- something that adjusts smoothly up and down, left and right, and tilts on a horizontal axis.
I had a pretty bad bout of RSI last year, and the keyboard tray did wonders (as did all the other suggestions above -- ergonomic keyboard, using voice-recogntion for chatting and email, more exercise, etc) Take your time with it and make lots of little adjustments -- change a habit here and there, fiddle with this and that. As most honest doctors will attest, RSIs are different in
every person, so the remedies are also maddeningly different. What works for me won't necessarily work for you. Just be patient and don't give up until you hit a combination that works; it took me nine months.
But the biggest single help is simply to take time away from the keyboard. Workaholism may be good for our careers and stimulating for our minds but it's just *murder* on our bodies, if we fly keyboards all day. Take the weekend off, and quit your job if your employers get pissed off. If they have a scrap of intelligent self-interest they'll realize it's better to have you regularly getting time away from work than to be off on a sick leave for months.
Re: surgery -- I'm a writer, with lots of friends in medical journalism who have themselves wrestled with RSIs. They told me to avoid surgery at all costs. Apparently it rarely does anything particularly good and can actually make things worse. This is not to say that physical therapy doesn't work -- acupuncture gets high marks, from what I've heard, as do various forms of excercise.
But the painful truth is that our jobs are hazardous to our health when they are practised *precisely as intended*. We gotta grapple with that or we'll all wind up in chronic pain.
I've studied repetitive stress injuries and ergonomics as a network administrator, so I'll have the right answers for users who have problems. I think the funniest thing is that the single best way to determine if someone is statistically likely to have problems with RSI is to ask them "Is your boss an idiot?". If they say yes, then they'll probably have trouble.
RSI is stress related - if you're tense and driving yourself too hard, that's when it's likely to show up.
Two things you know: Once this happens, you've got it for life, and SURGERY WILL NOT MAKE YOU WELL!!!
Surgery has a good chance of keeping further damage from occurring, PROVIDED YOU STOP DOING WHAT CAUSED THE INJURY. Surgery will NOT return you to your pre RSI condition! You will have discomfort ranging to pain for the rest of your life from the surgery.
The good thing is that if the injury has gone far enough that the nerves are being damaged even without the stimulus that caused the original injury, surgery can arrest further damage and give you some chance of normal life. It's an emergency treatment, it stops the problem from getting worse, but it's not good for you and it doesn't FIX the problem.
If there's any other therapy you can try, please do try it. What's very important is to realise that you are seriously injured, and that if you continue to work in the way you have been, you will end up crippled. Seriously. Not just unable to type, but unable to use your hands as anything but a blunt, painful club.
You may be able to get disability leave to deal with this, but one way or another you've got to change what you're doing with your hands.
Not knowing how far your problem has really gone, it might be enough just to radically change your ergonomics (how your body relates to your hardware) and your work pattern. RSI is from REPETITIVE motion - constantly doing the same stuff. If you can limit your typing to fifteen minute periods, with periods in between where you use your hands for an activity that is mechanically different, that will help. You should seek professional advice on this, and you should NOT settle for vague answers - get a specific, detailed plan of how you will change what you're doing to stop this injury.
I recently got over a bout of CTS.. yes it can and does heal itself without surgery.. and it does require relearning how to type.. personally, i found using wrist splits, those ugly, metal plates that strap to your wrists, work like charms, you CAN'T move your hands much with them on, and it totally retrains you on the kb. it's a pain in the ass to get used to them at first, but it pays off in the end. Natural kb and trackball mouse also helped.
Moral indignation is jealousy with a halo - H. G. Wells
Have a look at this
http://www.silitek.com/sk-6000.htm
It's not MS, it's great, it has a touchpad, and cost me the equivalent of $25US
There are lots of other non-ms natural keyboards out there, and most of them cost less than MS anyway.
I've been typing heavily (at least 5-7 hours out of an average day) for close to 5 or 6 years (I'm 21) and I haven't had much of a problem, except for a brief time I tried to teach myself the "home key" typing style (fingers on asdf and jkl;) my wrists hurst constantly for the month or so I tried that. When I went back to the hunt and peck (I like to call it "seek and destroy" typing, everything worked fine... no problems since... specifically, I use my left index finger, and my right forefinger, middle finger, and thumb to type, and sometimes my little finger... This gives me only like a 10% decrease in speed (I max out at 72wpm) and zero pain... anyone have any similar experiences?
We do yoga and stress management classes at my work for reducing the stress of keying all day. Once a week, an instructor comes in, and for a half hour we do some simple stretches that greatly relieve the strain.
Try these:
1. stretch your fingers out as wide as you can
2. tense them like claws
3. tuck your thumb under your fingers and make a fist
4. hold your arms out, elbows slightly bent with your hands as a halt sign and bring your fingers back as far as you comfortably can.
5. then, bring the hands down and curl the fingers under into a hook
6. shake out your fingers
the sixth step should be performed every 15 minutes as you are typing. it brings blood into the arms, wrists, and hands.
I've heard that relaxation is a conscious effort. This is making more and more sense to me. Bringing the breathing to a normal, healthy level can be tough when you're under a deadline and popping penguin mints every 5 minutes. Take hold of the unconscious process of breathing and bring some deep breaths in using your diaphram. Body parts can also be consciously relaxed.
Body awareness is something geeks as a group seem to lack development in. The time invested in it will pay off in extra hours of hacking. At least until you upload your consciousness...
I started to feel strain on my wrists when I first got a job programming, because after a full 8 hour day of typing I would then go home and keep doing it. Getting a Dvorak at home was enough to make the pain go away, even though I was still using an awful keyboard at work. (It wasn't full-blown carpal tunnel or anything, though.)
Joe
I switched to the Dvorak keyboard a few years ago when I started noticing that my hands were beginning to ache from typing. One thing I learned when I switched to Dvorak is while typing English is much easier, you have to be careful about shortcuts. Shortly after I switched my left pinky started to hurt alot, though my hands felt better otherwise. It turned out that the control-X combination in Emacs was the problem. I was used to typing control-X with one hand, but under Dvorak it is quite a stretch. I've since been careful to train myself not to press modifiers like shift and control with the same hand that is typing letters.
The other change I made was switching from a mouse to a tablet. Being left handed I had found most mice to be a pain and clumsy. It got so that I spent alot of time either fighting with the mouse or cleaning it. I found the speed and easy of tablets let me relax more at using the computer.
One word of caution with tablets though, they are addicting. I've found that once I got used to tablets, I found mice much more annoying to use.
-I also sent this as eMail to Kyrrin.
Hello Kyrrin!
About six or seven years ago, I thought I had carpal tunnel syndrome and I was considering getting surgery on my hand. My right hand was so weak I couldn't crush an egg in it and it hurt almost all the time. If I tried to do a push-up, I couldn't; it hurt _a lot_, my right wrist would buckle and I'd fall on my face. But it turned out that my problem was in my neck and upper back, not in my hand. I was working a lot of overtime doing CAD drawings and you sit funny, with your arm upraised, tensed and stretched in an unnatural way, when you use a mouse or a tablet all day.
I went to an osteopath and after a few treatments (sort of a mild form of professional wrestling; I'd lie on a mat and he'd push here, pull there, shove here, twist there, pop crunch pop, he was really skilled) I started to get my right hand back. I continued treatments for a few months and my problem disappeared and hasn't come back since.
The other thing that helped was getting one of those little gel-filled pillows you rest your wrist on when pushing a mouse; you can get them at most computer stores. The one I got comes attached to a mouse pad with a Velcro strip; I detach it and use it on my tablet. It cost about twelve dollars, which is high, but it works great.
Get your upper spine examined before you do anything as radical as letting someone cut you with a scalpel.
Yours WDK - WKiernan@concentric.net
There's no quick fix here. you need to adjust the way you sit and the way you type to avoid putting too much strain on your wrists. Raise your chair so that your elbows are higher than the keyboard. If your chair isn't adjustable get a new one, because your wrists aren't going to get any better if you have to sit in a bizarre manner. The idea here is not to stretch your wrists, or you'll cause undo burden on them. I use a UNIX workstation without the benefit of 'Natural' keyboards, but I found that sticking a small three-ring binder under the eyboard so that it leaned away from me helped alot. Other than that take some time off and let yourself heal.
-m.d.
I had/have carpal tunnel. About three years ago I went to a local doctor who spent all of about 3 minutes looking at my hands and wrists and then said, "You have carpal tunnel, you need to have surgery." Luckily, it was going to be almost a month before I could schedule the surgery, and I did not find it acceptable to wait this long to solve my problems. I then went to another who I had previously gone to. The great thing about this new Doctor, he himself had suffered from carpal tunnel, so he knew all the options having researched them personally for himself. When I went to visit him, he performed some form of standardized tests on my hands/wrists that gave him a feel for how bad my problem was. He told me that my problem was only moderate. He said surgery was definately NOT needed and would NOT solve the problem. What he did do was give me a steroid shot in my wrist (basically cortizone if i recall correctly) that brought the swelling in the tunnels down. This got rid of my symptoms within hours.
He then told me the following:
1. FIX YOUR BAD TYPING HABITS
2. Wear your wrist braces at night ( he said that wearing them during the day was far less important then wearing them while I slept. This seemed counter-intuitive to me, but nonetheless it worked.
3. When your hands/wrists feel slightly bad, do not let the problem build up, take an anti-inflammatory (such as ibuprofin) to keep the swelling of the tunnels down.
I haven't really done number one very well, although I am a little bit better than I used to be. Number two and number three used only when necessary have kept me from having any problems in almost two years.
There are a number of different solutions for carpal tunnel. One that I would suggest is to see an orthotist who can give you a wrist-hand orthoses(WHO) with a flexion stop that can reduce the amount of tension through the tendons in the carpal tunnel.
One of my friends had it recently and it put him out for like two and a half months.
They cut you open (about two inches along the wrist) and then they scrape the build-ups off of the tendons. Sound nasty enough, they only do one hand at a time so you're not completely disabled. So you have to go through it twice and wait four to six weeks for each hand to heal.
Oh, did I mention that the scars look like you tried to off yourself.
"Share your knowledge. It's a way to achieve immortality." -- Dalai Lama
I've found a few things that alleviate the problems when I've been at the keyboard for long amounts of time:
getting soft pads to rest your wrists and forearms on while you type that cushion your wrists but also prop them up so that you're wrist isn't bent at a weird angle
I own an ergonomic keyboard, but my favorite feature of it is that it has two legs under it that allows me to change the angle at which to type at. I change the position every our or so, up or down, so that my wrists aren't at the same angle all day long. You'd be suprised at how much of a difference it makes.
Sitting straight with good posture really does help. I find I put much less pressure on my wrists and fingers when I'm sitting up square and typing with a proper (albeit typewriter-style) form of posture.
Get those C-clamp looking ace-bandage/braces that they make for tennis elbow. You clamp it with it a little pressure at the top of your forearm just under your elbow and it gets rid of the pain when it does happen. They cost $10 or so... it's worth checking out.
I hope some of these ideas help...
This might be off-topic, but might we also start an "ask slashdot" for a discussion on eye-sight problems and ways of helping your eyes from monitor burn and such?
I took typing in high school, I hated it at the time.
Nowadays (25 years old) I consider it as one of the most useful classes I've taken.
How does it help to prevent CTS?
1) I can type very fast but I take frequent breaks. As soon as my fingers/wrists get the least bit tired, I stop and stretch. This is much better than typing slowly but non-stop.
2) I learned to use nearly correct posture (OK, I'm still slumped back in my chair) but my wrists are fairly relaxed when I type, and I let my fingers do the work.
I've never had a problem with typing, but I have developed some pains in my wrist from extended mouse-using. This typically happens at work, not while I'm at home playing games for some reason (must be the wrist pad I have at home).
When that happens, I put the mouse on the other side of the keyboard and go lefty for a day, which pretty much solves the problem.
-CausticPuppy "Of all the people I know, you're certainly one of them." -Somebody I don't know
You don't need to quit drumming!
I type all the time (read my response a couple posts down) and I'm also a drummer.
Actually, I double-majored in percussion (and physics).
The most important thing I learned to prevent overstressing yourself, when typing or when playing, is to stay relaxed. Playing 4-mallet marimba is torture on the tendons, but what kept me from developing any type of repetitive stress problem, even through intensive practice, is frequent breaks.
As far as drums go, if you keep loose and warm up properly (you didn't just sit down and start banging away, did you?) you'll avoid all sorts of problems. You're probably gripping the stick too tight, which wastes energy and will definitely lead to CTS, tendonitis, etc.
I'm pretty sure you can start playing again if you wanted to, but you HAVE TO WARM UP every time. I learned plenty of warm ups and finger/arm stretches from marching in drumline.
Don't give up drums, they're so much fun!
Email me if you want any more advice on that front...
-CausticPuppy "Of all the people I know, you're certainly one of them." -Somebody I don't know
I'd be curious to know who among you with and without CTS has ever taken typing in school or a course somewhere. Most of the people around me seem to fall into two catagories: Those who did take typing and now have CTS and those who didn't and don't. Seems to me that the forced positioning of the hands applies too much strain. Just my 2/5ths of a nickel...
"Imagination is the foundation of reality" - Gallagher
Wayne "Flu" Fluharty
Having the joy of suffering from both (very mild carpal, severe flare-ups of tendonitis) for many years now, here's what little I know.
1.) Tendonitis tends to hit the forearm, wrist, thumb and pinky (for me at least) with pain and numbness. When it's really bad it goes up all the way into my shoulder. Not fun. Carpal affects the middle fingers (and thumb). If it's to the outside of the hand, it's probably tendonitis. Inner fingers -- Carpal. Other things that apply to both are weakness of grip and numbness.
2.) There is no quick, easy, or sure cure. I've not had surgery and have managed to avoid it for now. Things that do help:
Find a good massage therapist, usually associated with a chiropractor. If you're lucky, your insurance (if any) will cover visits. If so, take advantage of it. Have them do deep massage work on your arms.
Vitamin E helps some people and reduces flare-ups. Some people say shark cartilage tablets are useful. I've never tried those.
Change your workspace. Get a GOOD chair, fully adjustable, back support, etc. Sit with your feet on the floor (mostly), get your arms and wrists in a natural straight line. Try to get your monitor about eye level. DON'T use those gel tube or padded wrist rests. They encourage you to put pressure on the spot you're trying to relieve pressure from. (Even soft pressure is pressure.)
Get an ergonomic keyboard. The MS one is good, but the best I've used (still use at home) is a Floating Arms keyboard and chair set-up -- splits the keyboard and mounts it on the arms of the chair.
Get up. Get out of your chair a few minutes every hour and stretch. As you sit in your chair, reach to the side and grip the bottom. Stretch to the other side. (Pull and stretch those the tendons in your arm.)
Get a mouse and a trackball. Switch between them every now and then. Both will eventually cause pain, so by switching you're giving relief to one area or another.
Once you got it, it ain't going to go away unless you quit typing. Get used to it.
D. Cook
I switched from a mouse to a thumb-operated trackball a couple of months ago and it helped
a lot.
Wired News just had an article describing DPI, a non-profit Silicon Valley agency that helps match afflicted programmers with hundreds of technology products that can let you work without destroying your wrists. They range from different keyboards to full Stephen Hawking-type setups.
_________________
Oh, INTERCOURSE the penguin! (Python tribute, not Linux knock)
My wife had the surgery and it took her about a week to recover. two days of discomfort.
It was performed by a micro-surgeon using a local. The cut was along a fold in her wrist and left no scars at all. This was about 8 years ago, so microsurgery may be the only way it's being done these days.
I was talking to my father yesterday and he happened to mention that he suffered from the condition last year. He noticed that while changing his wrist position helped the real culprit seemed to be what he ate.
He found that if he stopped eating sweet foods on a daily basis (ie/ had only a sweet or some ice cream once a week) the condition disappeared totally.
Just passing the message along.
========================================
Death will come, and will have your eyes
-- Pavese
My mother actually had Carpal Tunnel (she's a flutist, actually), and she ameliorated it with a brace that kept here wrist in the same position. As has been said before surgery is really a last resort. Make sure you see a CTS expert, so you can know all your treatment options.
-- Moondog
The weight and travel on the keys of the old IBM AT keyboards are the best I have found. You can pick them up for as little as $5 at used computer places, and they are easy enough to clean up. I have three at home and two at work, and I will use nothing else. Although I still have some severe shoulder pain (mostly from an unrelated injury) when I use the mouse for extended periods, I have no problems with my left wrist. The gel wrist rest helps, also.
Check out http://www.logitech.com/us/trackballs/index.html
The one in the middle (white with gigantic red ball in the middle and front).
This trackball rocks!
I can't say enough about it.
It costs about 40 bucks (not too bad), is all
optical so no moving gears to get clogged.
And you can use it with both your right
and left hand.
The only bad thing is no 3rd button for X-windows.
But for 100 times more comfort I'm willing
to give it up.
I had symptoms of Carpal Tunnel for almost 3 years! God it was painful! I got a Microsoft Natural Keyboard, it helped a little but not enough. I wore the wrist braces all the time. These helped a lot but I still felt pain occasionally. I would take enormous amounts of Alieve and other asprin like drugs. That reduced pain the most and would make swelling go down... but didn't solve the problem. I tried trackballs which helped my wrist but made my thumb really hurt. I tried ergonomic chairs, new postures you name it. The way I finally solved the problem was by trying another doctor!
My new doctor said I had been mis-diagnosed for CTS!!! Can you imagine the expression on my face? He said that most of the people he sees for CTS have been mis-diagonsed. He said get rid of the braces and pills and exercise instead. I went to a physial therapist who did the standard training stuff eleco-therapy,ice-packs, whirlpools of hot water. I learned new exercises that strengthened my wrists and elbows.... and slowly the pain went away. I noticed significant improvement in 3-4 weeks. I was out of the braces completely in 2 months. It took maybe 4 months of work to completely heal. Where I used to feel constant pain daily , I might feel a twinge now if I play too much Soul Caliber.
So my word to everyone out there having wrist/elbow pain is to do some research. Sometimes your doctor is wrong. Carpal Tunnel is a specific problem that many people get misdiagnosed for. Simply being in shape and strengthening muscles will solve many peoples problems.
Be insightful. If you can't be insightful, be informative.
If you can't be informative, use my name
Where can someone find good Dvorak Keyboards?
In the past I've used xmodmap to change the letters around... but the letters printed on the keyboard are still wrong. Also that doesn't work for windows.
Be insightful. If you can't be insightful, be informative.
If you can't be informative, use my name
There is a new Natural keyboard, the Pro. It looks different from the Classic and the Elite, but it has full size cursor keys (the Pro features are a set of small application launcher buttons above the function keys). I don't know whether it has the height raiser at the front or at the back. It comes out in October.
${YEAR+1} is going to be the year of Linux on the desktop!
Does anyone know whether there are left-handed versions of the ergonomic MS mice. Their site says that these mice suit left or right-handed use, but that is crap.
${YEAR+1} is going to be the year of Linux on the desktop!
it came out well, she has some nerve damage andcan not bend her wrist as much but it no longer hurts her when she types. the scars are small, less than 2 inches and is about as wide as one of the lines on my hand.
.sigs suck, thus nothing here.
I might buy that explanation, for this reason: I type 120-140wpm for 8-10 hours a day. I've done so for 10 or 15 years. And never a lick of wrist trouble. My theory as to the reason is this: I never learned to type right. I don't keep my hands in home key position, and they fly all over the keyboard. I don't always hit the keys in the middle with the same hand. Then again, maybe I'm just lucky - who knows with these things?
My mother had surgery for CTS
She got it form working with horses, But
it didn't work.
I'm starting to get it now, I wake up at night
with my hands numb, and I have to hang them over the side of the bed to try and get some blood
back into them
No surgery for me tho' just a M$ Keyboard and mouse!!
-- "I hope I Didn't Brain my Damage!"
This has done wonders for me, and I would strongly suggest that you at least try these methods before doing the extreme step of undergoing painful and costly surgery.
Sig goes here
I've been living with CTS for a few years now. It got to the point where I had numbness in my fingers and shooting pains up to my elbows. I found doctors to be useless.
Acupuncture, however, was a big help. It's almost painless, makes for good anectdotes, and seems to actually work.
Aside from that: Get an ergonomic keyboard for all of your machines. Get a gel-filled mouse wrist rest that you can drop in the freezer before use. Buy some wrist braces and wear them to bed.
Is all this a hassle? Well, it's less a hassle than losing the use of your hands.
Ruby on Rails resources and more at idolhands.com
For a little more on carpal tunnel: Ask St. Joseph's
Find an acupuncturist near you: http://acupuncture.com/Referrals/ref2.htm
Ruby on Rails resources and more at idolhands.com
Burning pain on the underside of your forearm, especially if it wakes you up at night/keeps you from sleeping is probably the most well-known "defining" symptom. Numbness in the last 2 fingers of the affected hand is another telltale sign. Your whole arm (up to and including the shoulder) may hurt, due to the way you use the affected limb to compensate for the pain. Typically, the first thing(s) they'll do for you is give you a splint and anti-inflammatories. If that doesn't work, then they'll try cortisone shots (IMNSHO, these are utterly worthless) and pain meds (Darvocet, Ultram, stuff like that). If you have 3 cortisone shots in a year, then you are a surgery candidate. I was lucky--surgery helped me. But I suspect I didn't wait too long...
She switched from her company mandated Microsoft (un)Natural Keyboard to an old IBM break-spring (the one with the nice-click) keyboard. Her doctor suggested the IBM keyboard, because you have to hit it harder than her old Microsoft (un)Natural keyboard. I tried using her old Microsoft keyboard, and it made my hands ache.
This is exactly what I did. I actually learned typing on an old IBM typewriter, and used the original ps/2's when I worked as a student lab assistant...Being used to hearing an ^CLICK^ whenever the key was pressed I actually started "mushing" the keys on my newer keyboard to make sure I had the damn thing pressed. Of course the newer IBM's aren't near as nice, so whenever I see one at a thrift shop or electronics clearing house I get it (if it's under 10$, most are around 2$). The really cool ones have a detachable cable so you can have both an AT and PS/2 style cord on it.
McRANdello
I no longer run Windows, so this is all from memory. But I used Dvorak on WinNT for over a year...
You can change your keymapping on Windows (NT at least), by going to Control Panel->Keyboard. Somewhere on there it should say Locale, Country, keymapping, something of that sort. You need the WinNT install disk, and you can then install US-Dvorak. You can choose a primary(Dvorak) and secondary(qwerty) keymaps, and toggle between them with an Alt-Shift, or using the blue EN tray icon.
-Rimfire
First, I wish you the best in your search for
painless typing. Be aware, however, that many people who experience pain while typing do not
have carpal tunnel, and most of them finally resort to fewer and shorter bouts of typing.
If it feels like your fingers are about to tie themselves in knots - take a break.
Don't rest your wrists on anything. Keep them in the air and force your forearms to do some of the work. Bigger muscle groups are much less susceptible to repetitive stress injuries.
And a last thought to those who may have severe problems. A retraining strategy that focusses on sensory retraining of the hands has a very high efficacy after diligent training for 2-3 months. Many people who thought they would never use their
hands the same way again now can. This therapy was pioneered by Nancy Byl and Mike Merzenich at UCSF.
It supposes that a large portion of the problem is
sensory reorganization during heavily attended heavily repeated motor actions, and the lack of sensory feedback wreaks havoc with motor control.
email me if you are interested in more info.
my aunt has had the surgery 3 times
need i say more?
- Rachel
First off, surgery is only as a last result. There are plenty of things that you can do. There are also a number of risk factors that many of us all share. To put this in perspective, the worst I ever got was when it hurt to walk because I could feel the vibrations in my hands. Now I'm pain free most of the time, even though I work at least 60 hours a week. 1. If you are given anti-inflammatories like ibuprofen, napersin be sure that you don't just take it with a little milk like the label implies. Consume larger snacks, the more the better. I have had stomach problems ever since I took the medication, even though I haven't been taking it anymore. Don't trade hand problems for stomach problems. Relafen is much better on your stomach, so you might want to ask for it. 2. Try not to work more than 80 hours a week. :) 3. weight, diet and exercise are contributing risk factors. There are a bunch of exercises physical therapy wise that help and I know when pain reoccurs it usually correlates with my gaining weight from a lack of exercise. Diet is a big one, as vitamin B6 has been linked to it. One of the main reasons for B6 deficiencies is cafeine. There's a good phamplet that covers this that you might be able to find in health stores, named something like how to cure Carpel Tunnel Syndrome without surgery. I was originally told in the health food store by someone working there to avoid caffeine and verbally lashed out at them. The idea of me giving up caffeine!! Later I realized that I could work an hour before pain and after an hour of rest at lunch, I could only work 15 minutes. Then I realized that at lunch I was drinking a 40 oz soda everyday. Taking B6 (although you have to be careful about dosage to avoid vitamin toxicity) and stopping caffeine made a big difference. Drinking a lot of water is supposed to help as well. 4. Ergonomics are important. I'm sure you've gotten a lot of advice on this. For me the best keyboard is the smaller MS natural keyboard, the elite. The fact the arrow keys are smaller is a real pain, but it's easier on my hands. Get desks with an adjustable tray so you can get it at the right level. For this, there are good fold up tables that you can get at staples for $50. I've tried those joystick type mice and it was cool for a couple days, but then it just caused pain in another set of muscles instead, which it used pretty heavily. 5. it returns if you don't keep doing what you can to avoid it. Once you heal a bit, taking up a hobby which strengthens these muscles helps. There is someone who started rock climbing and it never had problems again. I usually do pretty good when I'm swimming on a regular basis. Once you have a Repetitive Stress problem, you have to pay attention to avoid it coming back. Those stress balls could also help, but I haven't done it enough to have a firm opinion. Unfortunately, I've been paying less attention to it, so I've forgotten a lot of the details.
My girlfriend had a pretty bad case of CTS a while ago. Basicly, you need to keep your wrists straight and keep it inactive other than excercising it throughout the day. Namely, don't type, drive, pick things up, etc. Put your wrist in a split and keep it as straight as you can.
CTS, for those in the don't-know, is caused by inflamation of the tendons in your wrist which surround the carpeltunnel. Through which, the bulk of the nerves travelling to your hands pass through. The inflamation causes the nerves to be pinched off.
A doctor should be able to provide you with a good splint that will restrict wrist movement. They should also be able to provide you with a subscription for steroids which should keep your tendons from swelling and pinching your nevers while you recover.
Ibprofen is good to take also, if you're done with or not on the steroids. Ibprofen should keep the tendon swelling down. Soaking your wrist in warm water will also help keep the swelling down.
It took her about a month to recover. She was in alot of pain durring that time, especially in the mornings. Unforunately, tendons do not heal quickly.
She had a few relapses after her wrist got better. If you got CTS in the first place, you apperently need to change a few things so you don't get it again.
That's where erganomics come in. You need to have a verticly adjustable chair in your office so that you can situate yourself above your keyboard such that you don't have to bend your wrists more than 15 degrees. You might pay attention to how much strain you put on your wrist while driving, especially if you have a long commute. Keep them straight.
Surgery is deffinately a last resort. Most doctors seem to have no problem putting people through hell. But that's just IMHO, having had over 15 operations. Get a second opinion before you go through with any operation is my advice. You may need the operation, then again, you may not have a very good doctor.
Usually Surgery is only suggested if you've had CTS for over 3 months (I think) and it hasn't gotten better, or it's started to get worse. Normally the doctor should first suggest a splint and perscribe some steroids which can be taken orally. The next step, after not getting better after a month is usually an injection of steroids into your wrist. If that doesn't help, it's off to the OR for you.
Lastly but not least, try not to strain your other wrist while the first one is healing. My girlfriend's other wrist started hurting while she was recoving since she was making the other wrist do the work of two wrists. Most likely she already had a emerging case of CTS in her right wrist. Since it was her stronger hand, it didn't show up as fast and she didn't help it by using it more instead of less.
Hope the advice is hepful. Take care.
Do yourself a favor and see an orthopedist, preferably a hand specialist. A good one will have several Xrays taken of both hands, before he makes a diagnosis. You may, for example, be suffering from arthritis rather than carpal tunnel. Once you have a diagnosis you have confidence in, you can explore your options. I would insist on a referral to a physical therapist. You may get some relief from a custom split which you can wear while sleeping. Also, a PT may be willing to tell you (off the record) the track record for a particular procedure or a particular doc. Just remember to take everything you hear with a grain of salt.
It's always darkest just before it goes completely black.
Educate yourself about Repetitive Stress Injuries (RSI) at:
http://www.tifaq.com/
and
http://www.geocities.com/HotSprings/1702/
Change your typing ergonomics. Posture, monitor, keyboard, chair and lighting all effect how much stress you put on your wrists. Be aware of how you're typing!
From my research the two biggest risk factors are:
1. Key pressure: don't be a key banger!
2. Wrist angle: keep the wrists up in a gentle natural curve.
One other thing that can do wonders is taking 1500mg a day of glucosamine sulfate along with 2 grams a day of vitamin C. For more complete info on glucosamine, refer to my article in the June '96 issue of Muscle and Fitness magazine. Take care!
I too have been seeing a chiropractor. It started off with my back because I got so bad I could barely walk. She fixed it so well and so easily (along with suggestions on how to prevent it from happening again - Sit up straight!), I went back and had her look at my wrists and ankles, which I also had problems with. I'm doing quite well now! There are crackpots out there though, so ask around. Also, don't be limited to chiropractors. Too many manipulations can be bad for you. Talk to Phsyiotherapists as well.
Well, the point is that the MS mouse's shape is supposed to be comfortable, but if you're lefthanded, its actually more uncomfortable. I prefer to stick to symmetrical mice myself. All this is an issue when doing long mousing sessions. Some games come to mind.. well this is untopical so lets cut it right here :)
Try ditching your mouse and getting a trackball instead. Worked for me.
(unless declared an integer, God is real)
CTS *does* have to do with the tendons. It is the movement of tendons within their sheaths as fingers flex that cause this repetetive strain disorder. Friction, then irritation, then swelling of the tendons leads to the compression of the media nerve. A compressed media nerve leads to the symptoms. Everyone experiences a little bit of this, tingling and numbness, but as long as the compression is minor no permanent damage is done. If the nerve gets badly crushed, CTS can become a debilitating condition.
Complete cure and recovery if you switch to a touchpad. EZPoint pad, 30.00 Canadian. Complete cure, just get any touchpad; switch away from the rodent squeezing.
Where the only monopoly we support has a Boardwalk and a Baltic Avenue.
well after working in a safeway bakery for 5 years I too had carpal tunnel and tendenites. Well to say the least they wanted to cut both wriest to slove this problum. The reason being they wanted me back at work in three months top. Well I decided no after talking with people that had it and were not happy with the results. I found around 65% unhappy with pain comeing back after time. I chose the treatment that would change my lifestyle and job. It took two years and alot of therpy to fix this, I wore braces on both wrists 24/7 for 1.9 years, as well as two vists weekly to a chiropractor the best thing he use to do is work my arms and shoulder then apply heat with electronic shock to stimulate the the over worked tendons and wrists four pads were put on one on each shoulder and one on each forearm. then 20 mintues of zapping and I would fall asleep everytime, the thing is it works them into a relaxed state. I use to feel like jelly when I was done but It worked. With a change of jobs I'll never bake again, Now I do service work for a banking company. Point is time heals with the right help and tools and possabilty change of jobs.
Well the shock forces the arms and wrist to relax, I had it so bad the pain would keep me awake at night. The way I guess it works is the muscles are to tight or tense that the are inflamed its like walking around with a fist all the time, your forearm is in constant pain becasue the muscle is so tight, The shock forces them into a more relaxed state it works very well. I also dident just have carpal tunnel I also had tendites in both the fore arms. In those cases with both problums I would feel pain all the way up my arm into my shoulders but my forearms would lock up sometimes I couldent even open my hands, my hand would bend at the wrist and lockup. The other thing I find usefully is a homedics mouse pad with a built in massager.
what most people said (ie preventing it is important) is true, but i hate to see people telling others not to get surgery no matter what. the plain fact is that surgery does help many people WHEN IT IS INDICATED. Obviously just jumping in and doing surgery right off is foolish, but under the right circumstances it can be the most benificial treatment available. Ohh and as for the intramuscular B12 shot, what a load. Unless you have a nontraditional diet (vegan) or have a serious metabolic problem (lack of intrinsic factor required for B12 absorbtion) IM shots of B12 wont help. Ohh and another thing about the sugery, a first or second year med student could do it, as all it is making a small incision at the base of the palm and finding the transverse carpal ligament(the roof of the carpal tunnel) and cutting it (without doing the same to the median nerve beneath of course!) Any questions? C. Wise SLU school of medicine
Ditto on the Kinesis keyboard. Here's another thing to try:
Place a Kensington Orbit trackball in the blank area in the center (between the two sets of keys). That way you can can:
1) use one hand to click and the other to move the ball
2) re-map the left and right buttons whenever one hand is getting tired from clicking (which doesn't happen to me much anymore).
A lot of mouse/trackball strain comes from having to use one finger to click and the other to drag -- having to execute two movements with the same hand makes the motion more complicated and tense, contributing to CTS.
A Logitech Marble Mouse trackball works just as well (and lasts longer because it's optical rather than mechanical).
Two things have helped me: one is an Options Keyboard. It's an A-shaped split keyboard. No flat ones for me. I have small hands (being a small woman and all). So the Microsoft Keyboard sucks for small people. My Options keyboard keeps my hands in neutral (palms together) instead of prone (palms facing downward). I've got a Gold Touch keyboard at home since they don't make Option keyboards anymore.
Try http://www.keyalt.com/ for lots of good ergo stuff.The other thing is to slow down my typing and stop pounding the keys. Modern keyboards have a very soft touch which can actually make it easier to increase the impact on your fingertips. That's very bad for your hands. Exercise, water and frequent breaks are really important too.
Good luck!
More likely you are suffering from tendinitis, which is generalized pain and soreness in one or both wrists and hands. If you use emacs often, and you have left-hand numbness and tingling in your little finger and along the back of your elbow (that 'hit your funny bone' feeling, which isn't funny at all), you have ulnar neuropathy. This is from the stretching of the nerve through repeated slamming of the control key with the left pinky.
In any case, you probably do not need surgery. One of the reasons why CTS surgery fails is that most people don't have CTS. Even if you do, you can probably substantially relieve the pain reduction without surgery.
1) Like others have noted, you need to work on proper posture, keyboard position, and chair adjustment. Not exciting, but required even if you do have surgery. Also, get enough sleep so that your body can recover from the day's damage. If you have 'emacs disease,' you could switch to vi. At least make sure you have a right-hand control key mapped and that you use it as often as the left. If your right hand hurts and you are right handed, it's probably the mouse. Get a good trackball.
2) Take your Tylenol or Advil to reduce the swelling and inflammation. This is not a case of just numbing it so you can do more damage; swelling reduces blood flow and prevents healing. Use tiger balm ointment and warm soaks also. I used to apply ointment to my hands and cover them with socks when I went to bed to keep the ointment warm.
3) Check out alternative medicine, even if you have to pay out-of-pocket. I started Chinese acupuncture when I began having bad problems with ulnar neuropathy. I added regular chiropractic care later, and keep up both treatments to stay ahead of the damage. I recommend both highly.
4) Your doctor may offer cortisone shots to reduce the inflammation and help healing.
5) Once you start feeling better, begin a program of regular gentle exercies to strengthen your wrists. Learn to juggle.
Remember that even if your health plan covers surgery, it's painful, requires lots of downtime, and exposes you to evils such as hospital-borne infections and hospital food.
i use a laptop at college, and am planning on buying a new one shortly. im not worried about the type of pointer, as i can use just about anything pretty well. i have a cirque pad for my desktop at home (great device), and an eraser pointer on my laptop now. is there any difference between the devices from a RSI point of view? is one preferred over another? obviously a mouse has got to be the worst (sometimes it brings on pain within minutes), and certainly a touchpad involves more motion than the eraser pointer. besides trackball, has anyone had any long-term experience with laptop pointing devices and RSI problems? thanx --andrew
Until I read "Healing Back Pain" by John Sarno. Check it out first, don't cut yourself up.
http://www.hpl.hp.com/personal/Danny_Abramovitch/w rist/wrist.html
http://www.hpl.hp.com/personal/Danny_Abramovitch/w rist/wrist.html
thx go out 2 Danny!
i was struck hard with CT about five years back. not only was i spending all day at a keyboard, but i was spending all night behind a drum set. my wrists were taking a beating.
the first thing i did was to quit drumming, cold turkey.
the second thing (and i think the most helpful) was to move all of my mice to the LEFT side of my keyboard (or vice versa depending on your case). not only did this take a major load off of my right wrist, but it also made me ambidextrous in regards to mice (i just love beating somebody's ass at quake and then hearing them say, "why don't you switch mouse hands and give me a chance?").
third was to keep my wrists OFF of the desk. don't rest them on the desk, or even a cushy pad. keep them airborne using your forarms and elbows. this will seem awkward at first, but its very important. to help in the transition, raise the height of your chair.
fourth was to take breaks and do some stretches.
Is there a mouse designed to fit the left hand comfortably?
Yep. AFAIK, all "sculpted" Microsoft mice are available for both orientations: http://www.microsoft.com/products/ hardware/mouse
My wife recently had the sugery. We learned quite a bit during the whole ordeal.
While you're correct in that surgery is the last resort, go see a chiropractor. If you wait too long, you risk permanant muscle and nerve damage. My wife put off seeing a chiropractor and ended up with some nerve damage, but the doc said that unless it's major, the nerves will repair themselves. The muscle damage is the big problem, though, as I gathered that that was near impossible to fix without major surgery.
Anyways, go see the chiropractor. Plunk down however much it costs if your insurance won't cover it (ours did) and have a -doctor- look at it. There's all sorts of tests they can run to determine the severity.
Also, the way it generally goes is that they will see how severe the carpal tunnel is, and make treatment recomendations based upon the results. The low end treatment is physical therapy, then cortizone injections, then surgery. Surgery is a last resort, but the carpal tunnel syndrome is highly unlikely to return (my mom had the surgery 25 years ago ans has never had the pain again).
In the end, go see a doctor if you're worried, it's worth it. For a lot of us, our hands are every bit as important to our livelyhood as a doctor's.
It may be too late for you, but I made my RSI symptoms go away by altering my computer environment and habits:
* Keyboard position matters - The single best thing I did was to get out the toolbox and lower the keyboard drawer on my desk by several inches (it should be just above your knees, so that your forearms are horizontal while typing). Hacking up your desk may not be an option; if not you can also just set the keyboard on your lap.
* Keyboard shape doesn't matter as much - The main thing that the Microsoft Natural and similar keyboards are good for is compensating for poor keyboard positioning. The angled split is good for situations where you must keep the keyboard higher than the optimal position.
* Mice are bad - I can't use a standard mouse for very long at all without some pain in my wrist. I prefer finger-operated trackballs (I have a Logitech Trackman Marble FX. Kensington also has some good trackballs)
* Don't get lazy - just because you have a wrist rest in front of your keyboard doesn't mean you should keep your wrists on it while typing. Your wrists should be straight, which doesn't happen if they're resting on a pad
* Unlearn bad typing habits - (this one I'm still working on) I tend to use the left shift key for everything, whether the shifted character is typed with the left or right hand. This is not a good idea; train yourself to shift with the opposite hand. On a related note, you may want to consider remapping your keyboard - I mapped the key to the left of 'A' (normally capslock) to Control. Some people say the Dvorak keyboard layout is easier on the hands, since more of the typing is done on the home row.
HTH,
-Ben
The sorehand mailing list (web site at http://www.ucsf.edu/sorehand/) helped me through a bad bout of RSI several years ago.
There's quite a bit of RSI-type problems here at CMU. I type as much as anyone here probably, but I'm careful, and so far I haven't had any problems.
.Also, get some of those wrist-braces to immobilize your wrists while you type . . .
... very hard to find now) and Sun type-4s (also quite good, properly positioned Ctrl key :), with occasional (never extreme) use of my laptop keyboard.
... evolution will take a long time to save use :). The best possible thing you can do is take breaks and change positions. Vary between putting your keyboard on the desk and on your lap. Move around in your chair. And take breaks at least every 15 minutes for a few minutes -- don't work more than 45 minutes out of the hour.
... I must be doing something right.
There are some serious problems in the above (as well as in several other threads), and also some good advice.
The best thing you can do is take a month off from using the computer.
Abso-frikkin-lutely.
get an ultra-ergonomic keyboard . .
Actually, while the wrist braces make make everything feel okay, you can continue to damage your hands while using them. Use them if you must, but avoid it.
Gel wrist rests may feel good, but they also encourage you to move the mouse or reach the keys with the small muscles of your hand rather than the big muscles of your arm -- a very bad thing. It's better to only ever rest your wrists lightly and move your hand with the whole arm.
The truth of the matter is, anytime you feel pain, you're doing something wrong. You shouldn't try to mask it -- you should try to fix it. Several of my friends have hurt themselves (fortunately none of them permanently) by using poorly set up college dorm desks and chairs. A good desk/chair/keyboard can help a lot, but isn't magic. I like a nice high comfy task chair, the keyboard at a reasonable height on the desk or in my lap, and a good keyboard. I don't go for the fancy ergo keyboards (tho some people like them a lot) -- I use exclusively good tactile clicky boards. I switch between an old IBM PS/2 (the amazing indestructible mid-80s kind
But having a good workstation won't protect you if you strain small muscles/tendons by repeatedly using them in ways they weren't designed (and no form of typing as we know it is what any of those muscles was designed for
I'm no doctor (tho I've been exposed to a lot of material, good and bad, on the subject). But I'm a CMU CS student, I use computers constantly, and I play violin. I've also never had an instance of repetitive strain injury
But avoid surgery at all costs. It doesn't do anything regarding the inflammation of the tendons; it only removes the pressure from the nerve (read: it numbs it), and then you just start typing again and get your tendons even more inflammed but you have even less feeling in your wrists, so when the pain comes back it's even more persistent and thus the vicious cycle continues.
Again, the best thing to do is to take as much time off from the computer as possible. I know that's difficult in this day and age. So just type as slow as you can (I know it's frustrating) in short periods of time. If you get any pain, STOP NOW and take a nice long break. If your employer can't understand this, then it's time to go through the process of getting worker's compensation and/or quitting (I recently did the latter, though a flare-up in my wrists was only the most recent of several reasons I wanted to leave).
But as has been mentioned several times here, there is no quick fix. Don't delude yourself into thinking there might be one.
That said, you might want to ask your doctor about steroid injections. Apparently they do have some success in removing inflammation for a few months at a time. However, it's such a recent treatment that I wouldn't trust it for the long-term (after all, damage will still be done to the tendons when you type, particularly since you won't feel any pain telling you to stop).
---
"'Is not a quine' is not a quine" is a quine.
"'Is not a quine' is not a quine" is a quine.
Quine "quine?
Very interesting - I rarely feel pain when I type, but I often feel it when I drive. So perhaps my symptoms are more due to excessive driving than typing.
I'll be keeping your instructions in mind as I take the wheel in the future - thanks.
D
----
First off, for diagnosed and severe cases of CTS, surgery may be the only available option. These are the cases where the hands simply can not function well, and the pain prevents any sensible corrective action - these cases are rare in the extreme.
The most important thing to remember about CTS is that it is a RSI (Repetative Stress Injury). It develops over time, from unchecked, unhealthy behaviour. Keyboarding is most often the culprit, but many people in hand-use fields suffer from symptoms. Barbers, jewelers, gardeners, fine motor skill hobbyists such as model makers, people who tie their own fishing flies, people who tinker with electronics...
The key to correcting and avoiding CTS is well rounded use of your hands. Exercise and flexibility are key. You must avoid having your wrists cocked back (i.e. rested on a desk while typing). You must keep your tendons limber.
Stretching the wrists is very important - take periodic breaks (a couple per hour) to slowly and steadily bend your wrists both forward and back - use one hand to gently bend the other. Do not go to the point of pain, but try to get a good stretch. Note that your wrists should never bend by more than 90 degrees... Hold the stretch for a count of 10, relax for a minute or so and repeat. Roll your wrists through the extremes of their natural range of motion. Stretch your fingers as far as you can and hold the stretch while tilting your wrists back.
Some other posters have suggested a rubber band around your finger tips, so that you can open your fingers against the resistance.. This is excellent. Anything you can do to strengthen your forearm extensor muscles (the one's you use to bend your wrist back) is good, from rubber bands, to light weights, to just using the muscle with no resistance other than your own hand. Chinese meditation balls are great too.
What's important is to use your hands in a way OTHER than the single way that's causing the condition. Vary your hand usage, while trying to limit the repetative motions that brought CTS on in the first place. Use a wrist rest, the gel types tend to put least stress on sore wrists IMHO. If you mouse a lot, try a trackball. If you haven't already, switch to an ergonomic keyboard - a full size one is best.
Do not keep your wrists on the desk. Use a pad with both the keyboard and the mouse/trackball. Reason being that the desk tends to be cool/cold. A cold surface will cause decreased tissue flexibility, and will tend to numb pain that would remind you to take a break. If you can, try an elastic bandage sleeve on your wrists. The extra warmth and support will help.
Most importantly, stop kinking your wrists backwards as you type. Your hands should angle down slightly from your forearm. You should not have to maintain muscle tension to keep your hands in their working position. Do a little homework on ergonomics to see if maybe your chair or desk are not of the correct height.
And on a related topic, it's quite a good idea to go outside and focus on far away objects every one in a while. Focusing at a monitor 3 feet away all day is bad for the eyes.
-- What you do today will cost you a day of your life.
My mother was in a similar situation. She had a regular old push-the-key-down-a-long-ways key board, but because she doesn't have large hands, the micros~1 rounded mice were what gave her CTS. The big bulge ended up resting not in her palm, but below it. She has not had surgery to the best of my knowledge, but what she did to aleviate it, in addition to wearing a brace for a while, was to replace the mouse with a touchpad.
Yes, the touchpad does take a little while to get used to (I ended up getting one too), I actually found it a better pointing device, in addition to being more comfortable.
Imagine this. Just flop your hand in a relaxed position on the desk. If you're at all like me, your hand is slightly bulged, and there's a bit of an open space between your index finger and thumb. The pad is there, just move your index finger around. To click, tap your index finger, or you can use the buttons, which just so happen to be right underneath your thumb and pinky. And your ring finger is over on the edge, which acts as a scroll wheel (actually, all 4 edges act as different scroll wheels).
Some of the scroll features are exclusive to the Cirque pads, but the general feel is common to all good trackpads. I paid $40 for my touchpad, which is a bit more than most mice, but you don't have to go through the yucky cleaning like a mouse (just wipe it off with a tissue), and the thing takes much less desk space, and is more durable. Also, I can pick it up and put it on my lap or whatever and not worry about having the ball roll on the pad.
-Cheetah
Is there a doctor out there (or anyone, for that matter) who can describe the symptoms of CTS? My left wrist has been hurting for a while, but my doc says it's just tendonitis...What are the differences?
Juiced? Or Not?
Two alternatives:
1) Chinese medicine.
My wife had tried everything *except* surgery and steroids, and was at the point of retiring at the ripe old age of 23, when I prodded her into going to see a well-known OMD here in Atlanta. The night before the appointment, she could barely hold a fork. When I got home the next day, she looked at me with a smile, demonstrated a full range of motion, and said "Look, they work!" This after about 40 needles worth of acupuncture and a prescription for what we jokingly called "nuclear swamp in a cup" (foul-tasting but effective Chinese herbs). The Chinese have been practicing holistic medicine for 6,000 years, they know what they're up to.
2) Cat's Paw
The previous poster mentioned using a rubber band to create resistance in the opposite direction and thus create balancing exercise for your hands. There is a product designed for just that, it's called the Cat's Paw. It's this little piece of neoprene rubber with holes in it, and you stick your fingers in it and make a motion like a cat kneading its paws, only you're pushing out instead of in. I never could get into the bloody thing myself, but the dude that invented it has references from a plethora of Big Corporations (like Lockheed and Mariott) that swear by the thing. For fifteen bucks it's worth a try, lots cheaper than surgery. http://www.catspaw.com for details.
But yeah, please, leave the knife guys to stuff they really understand, like knees and appendices.
"one thing I really *would* like is a completely split keyboard, *completely* so I can put one hand somewhere, and the other completely somewhere else..."
:-)
I recently had symptoms of some kind of RSI: numbness and tingling in my forearm and upper arm, shooting pain along nerves, etc. I had an industrial safety technician take a look at my workspace. He suggested all sorts of changes (including getting the cool black chair
One of the changes that he said would be good to do is get a new keyboard. I splurged and got myself an Interfaces Keyboard by Cramer. This thing is wonderful! It's one of those completely split keyboards, where each half sits at the end of your chair arms. It's completely adjustable in terms of placement, tilt, etc. There's a glidepoint built into one of the sides, so my mouse comes with me, too. I currently have the keyboard hooked up to my SGI O2, and I'm never going back.
The story has a happy ending, too. With all of the changes I've made, my symptoms have gone away. It took several weeks, but rather than getting progressively worse, they got progressively better. Until now, I'm typing without pain or numbness at all, at the speeds that I'm used to typing at.
Bear in mind, I am not a doctor, so take this as uninformed advice. I looked into this once (my wrists are beginning to get to me too) and came to an interesting conclusion.
The surgery is really only a temporary solution. It will help, but will bring permanent relief only if you change your habits to remove whatever caused your CTS in the first place. For this group, this generally means give up computers, or at least cut _way_ back on using them. (Or finding a fully-functional voice recognition package, good luck.)
I doubt you like this answer any more than I did.
Tim
This is my sig. There are many like it but this one is... Oops. Frank, I've got your sig again! Where's mine?
I won't post links because they'll change too fast for archival purposes and we all have favorite search engines. And if you really want one you'll start searching in your favorite online shopping sites, and those URLs are useless for posting here.
Yes! As a neurosurgeon, I see a fair number of patients who suffer from carpal tunnel syndrome, some of which eventually have surgery.
The simplest way to conceptualize carpal tunnel syndrome is to think about it as a problem of proportions: The median nerve must pass through the carpal tunnel in order to reach the hand. If the carpal tunnel is too small (for any number of reasons) or the median nerve is swollen or enlarged (again, many possible causes), then you may develop the symptoms of carpal tunnel syndrome, since the median nerve is essentially being "pinched" as it passes through the carpal tunnel. Nerves really do not like to be pinched!
There are many possible contributing factors which can lead to such a situation, some of which can be improved with medications or behavior modification, and other which cannot.
Some Contributing Factors
Symptoms
- Pain
- Numbness
- Weakness
- Clumsy Hand
Since it is the median nerve that is affected, the pain and numbness will follow the course of the median nerve. Although there is variability, this usually means the "thumb side" of the hand - the thumb, index, and middle finger - and to a variable degree the ring finger. The pain and numbness are usually exacerbated (made worse) by certain activities. If the median nerve is sufficiently irritated, you may also have pain in your forearm. Sometimes the pain and numbness are constant. Often, patients will wake up in the middle of the night with pain when their unsupervised wrist gets into a bad position. Weakness in the grip or thumb may occur, especially the abductor pollicus brevis (a thumb muscle). When weakness and numbness are combined, your hand's feedback and execution are off, and you may experience clumsiness. You might find yourself dropping things that you thought you had a good grip on. In advanced cases, the muscles of the hand become atrophied, which can be disabling. Atrophy of the thenar eminence (the "mound" of muscle between the base of your thumb and your wrist) is characteristic of advanced disease. You do not want to let it get to that point, since a full recorvery is unlikely despite any treatment when atrophy exists.Diagnosis
- Examine for weakness, numbness, atrophy
- Tinel's sign - tap the middle of your wrist a few times. Did you reproduce your pain or get a painful shock in your fingers?
- Phalen's sign - push the back of your hands together so that your wrists are forcibly flexed. Hold that position for a minute or two. If your pain is reproduced, the sign is positive.
- EMG/NCV - electrical tests of nerve and muslce. Prolonged motor or sensory latencies are suggestive (delayed transmission due to abnormally slow conduction though the pinched portion of the nerve). In advanced cases, you may see "dennervation potentials".
Not all of these findings are present in every case of CTS - and no one single finding is sufficient to make the diagnosis.Treatments
What does surgery do?
Surgery entails an incision over your wrist and a portion of the palm of your hand. The transverse ligament, which is the "roof" of the carpal tunnel, is then cut so that the median nerve is no longer trapped inside a tunnel. The tunnel becomes a ditch. The nerve breathes a sigh of relief. The degree of tightness is often quite impressive, and often the nerve is visibly swollen or even discolored. In those unfortunate enough to have waited too long, the nerve is visibly atrophied.
If pain and intermittant numbness were the only symptoms, then there is a very good chance for an excellent recovery after surgery. If, on the other hand, there is 'round-the-clock numbness or weakness prior to treatment, then this suggests that the nerve may be permanently damaged, and a complete recover is less likely. In these cases, the pain will usually resolve fairly quickly postoperatively, but the numbness and weakness may take months to recover, and may not recover completely. Recovery in these cases is slow because the median nerve has actually lost some of its fibers (axons), and they must regrow. The axons begin in the spinal cord or a ganglion in the neck and extend all the way down the arm into your fingers. When there has been prolonged CTS and associated inflammation of the median nerve where it was pinched, there may exist scar tissue within the nerve which prevents the axons from crossing that segment as they try to regrow though the wrist to the hand. So the moral of the story is: try conservative measures if you are having pain or intermittant numbness. If the conservative measures do not work, and the CTS is interfering with your life, or if you develop 'round-the-clock numbess or signs of weakness then you should consider surgery. Most cases will not require surgery, but it is a sad thing to see when CTS is allowed to progress to the point at which damage to the nerve is permanent.
There seems to be a lot of talk on the internet lately about carpal tunnel syndrome as a mysterious entity that only a select group of doctors that treat famous musicians understand. Simply untrue. Family physicians see CTS all the time. Any neurosurgeon and most orthopedic surgeons (and some plastic surgeons) will be intimately familiar with CTS, as it is really quite common and is treated by a relatively minor procedure when conservative measures fail. The risks of surgery are small, but they include
- damage to the median nerve leading to further numbness or weakness
- infection
- failure to completely free the nerve from compression (i.e. compression of the nerve beyond the extent of the incision).
In my own personal biased opinion, I favor the "open" approach with an incision over part of the palm of the hand and wrist over the "endoscopic" approach which allows a smaller incision. I believe that the traditional larger incision provides superior visualization of the nerve, and thus more control over what is and isn't being cut.The other popular take on CTS these days on the net is that RSI is somehow being misdiagnosed as CTS. This is actually becoming a very popular misconception. The critical thing to keep in mind is that RSI (repetitive strain injury) is one of many mechanisms that can contribute to carpal tunnel syndrome. We don't tell patients that they have Repetitive Smoking Injury (another RSI!) when they have a stroke, heart attack, or lung cancer, even though smoking can certainly be a cause of those problems. It would be silly to say "You don't have lung cancer, you've got repetitive smoking injury". Similarly for RSI and CTS. If you have the signs and symptoms of carpal tunnel syndrome, then you have carpal tunnel syndrome. Repetitive strain injury may have been an important contributing factor and you may be able to help your symptoms by taking altering your behavior. The increased public awareness of repetitive strain injury (RSI) is, IMHO, a good thing because it can lead to changes in behavior that help to avoid CTS and other problems - just like increased public awareness of the dangers of smoking can lead some people to quit. But let's try not to confuse our terms! RSI is a general mechanism of injury to tissues that contributes to problems thoughout the body. CTS is a specific problem with your wrist in which RSI may or may not be a contributing factor. I hope this has helped to explain RSI and CTS!
Surgery should be a last resort, it will cause a bunch of scar tissue to form and it doesn't always solve the problem. Try looking for a Chiropractor, not a wussie one, the kind that actually adjusts his patients. I used to go to one, and he had a couple machines specifically for carpal tunnel. Also, try to look for a doctor that graduated from Palmer, it's like the Harvard/Yale for Chiropractic. Oh yeah, an excercise you can do, is put a rubber band around your hand (kind of like on your fingernails) and keep opening and closing your hand. It counteracts the motion that normally causes carpal tunnel (the tightening down of the hand). By the way, I'm no doctor, so talk to a doctor and talk to a chiropracter, then decide which is best...
-- My neighbors dog has a four inch clit.
I urge you strongly to consider alternatives.
I was suffering from this up until about a year ago when I thought "there must be some other way."
I never did use a wrist brace, nor an ergonomic keyboard (still don't). You may want to look into those if you are not already using them. I was to the point of numbness from fingers to past the elbow in my right hand and partially in my left. The numbness comes after the pain stage. Even at this point I was able to test at over 60 WPM.
I now take frequent breaks from typing and staring at the screen -- either by reading a magazine, book or something related to work, but not typing. It will also help the eyes from watching a flickering screen all day and help to stop your eyes from strain. It's helped on all counts over the past two years. No sore hands, wrists, arms and no more frequent "eye-aches."
Watching my mom go through the surgery kind of left me adamant about not having the surgery. Her doctor fouled up somehow and the strength she has now is a mere fraction (10% one "specialist said) of what she used to have. Not being able to lift a gallon of milk, a pot of water, or even go back to work, or even still sleep on that arm because it still hurts.
I didn't have the time to read all the comments here, so I may be redundant. Let my possible redundancy be a reinforcement though as to the alternatives.
-m
1) I switched from a mouse to trackball, this helped a lot.
2) I ordered a pair of lycra gloves (at the time it was from Mega-Tex, but now you have go to Handware. They seemed to help a lot.
3) Position your mouse/trackball and keyboard to minimize stress.
4) Stop chatting, or change your chatting habits. My wrists hurt the most when I chat the most, so I use voice recognition software to chat now, though it does get embarassing in those intimate chats.
George
http://alumnus.caltech.edu/~dank/rsi.htm
This is the place to look.
They're putting dimes in the hole in my head to see the change in me.
But alas, a couple months ago I started a new job, and I wanted a Natural Keyboard, and the only ones that you can buy anymore are the Elite models, which are the new ones with the slightly (very slightly) smaller footprint, but with a bunch of keys cut in half. No longer are the function keys actually usable. Escape, heck, they certainly didn't have emacs in mind when designing this keyboard. Not only that, but they actually rearranged the home/end/delete/page up/page down/insert keys. They rotated them 90 degrees, too! Certainly not a gaming keyboard, they cut the arrow keys in half and arranged them in a plus sign format instead of the standard T shape.
All of these things could be overlooked. This is at work, so I'm not gaming, and I've adjusted to the size and placement of the keys anyway. The thing that is absolutely intolerable about this keyboard is that there is no bar in the front anymore. They actually put props on the back of the keyboard instead! Now it's just like any other keyboard on the market. Don't waste your money on this piece of shit. I actually have a 2 inch book underneath it, propping it up off the desk.
So the one good thing that has ever come out of MS was corrupted on the second iteration.
There's probably an underground market for the old style keyboards, I don't know anyone who has liked the new one once they have switched.
They're putting dimes in the hole in my head to see the change in me.
They're putting dimes in the hole in my head to see the change in me.
My neighbor was a mechanic for probably 20+ years, and he got CTS from wrenching all day long. When they did the CTS surgery on him he said that it was mostly fairly painless, the only things about it he didn't like was that:
A) He couldn't use his hands very much for almost 3 weeks afterwards - his doctor recommended an extended healing time in his case.
B) During the surgery they actually sliced open his lower arms and used a scalpel to dig out all of what he called the "Carpal Tunnel Junk" that collects in your arms.
All I know is that it sounds like a great operation, and since I have recently started showing signs myself, I got a trackball and a Microsoft Natural Keyboard (Hey - they're actually really nice if you can find an older style one with the full size arrow keys) I have been feeling a lot better.
A friend of mine had surgery done to help alleviate the problems causte by CTS. They had two separate operations, one for each wrist. I believe that his wrist was in a brace for about 2 months before he went in for a check-up and to verify the surgery was a success. He then had the surgery performed upon the other wrist.
I am not my friend so I cannot truly say how much of a recovery to normalcy he gained through the operation but he was very happy with it and apparently so was his wife after the brace was removed. >;)
-vel
Sorry, I cannot really give you a recovery time. However, I think you might be able to avoid surgery. I don't know the details and circumstances of your condition (and I am not a doctor); but I think that while carpal tunnel syndrome is not an invention of doctors, your need for surgery might be. Is that the case, or is surgery your idea? Have you gotten second, third opinions?
I know a number of people who do have carpal tunnel to varying degrees, one of whom is my mother. I am fairly certain that my mom's doctor never suggested surgery as a cure. Rather, he suggested a regimen of exercises designed to strengthen and condition the muscles, tendons and ligaments in the hand, wrist and forearms.
I have been coding for a couple years now and am fairly young, so maybe I am not yet displaying symptoms of CTS. However, I like to think that my chances of getting it are greatly decreased because of my activities as a rock climber.
From what I understand, CTS is caused by constant, repetitive stress on the bones and muscles of your hand, wrist and forearm. Your body does not like constant repetitive stress. However, the human body, being the incredible machine that it is, does like a variety of stresses. Ever notice how runners tend to have crappy knees after a number of years of running? Same thing. People who cross train tend to have stronger, healtier bodies on the whole. Frankly, cross training and weight training bore the hell out of me, so I like to mountain bike and rock climb.
Anyway, the idea is to help your body by cross-training your hands, wrist and forearms. Get some Chinese excercise balls. Or a high resistance stress ball. There is a device ( I don't remember what it is called ) that uses an internal gyroscope powered by torque provided by your wrist that resists your wrist's attempt to provide more torque. It's a great lower arm workout. The faster you torque it, the harder it gets to hold on to.
So that's my suggestion. Look into it. Consult other physicians. I think spending the time and a few dollars on conditioning your arms would be a lot better than a couple thousand dollars on surgery.
Nothing can possiblai go wrong. Er...possibly go wrong.
Strange, that's the first thing that's ever gone wrong.
Tyler's words coming out of my mouth.
http://www.datadesktech.com
I was diagnosed with CTS a LONG time before it was fashionable, and even before I got into a keyboard-centric career. It was in high school, and periodically I would experience numbness in my fingers and that sensation of my hands falling asleep. My doctor (back in the late '70's) gave me a list of things to try before falling back on surgury...
1. While keyboard work can complicate CTS, it's not *neccessarily* a direct cause. I've lived with CTS a LONG time, asymptomatic, by being careful. I use those geeky pads that sit at the bottom of your keyboard to help boost my hands up a bit, and that seems to do the trick for me.
2. Driving (a lot of driving) is actually harder on your carpal tunnel than keyboard work. Resting your wrists on the steering wheel is very bad for CTS. Again, I know it sounds stupid, but use the old "10 O'Clock and 2 O'Clock" steering wheel holding method, and you'll reduce the stress on your wrists. This is a technique where one actually HOLDS the steering wheel (yes, with your hands!) at a comfortable distance. When you sit down in your car and grab the steering wheel, note how close you are to the wheel and how "bent" your wrists are in order to hold the wheel. Try to straiten your wrists as much as possible.
3. Develop good habits where you keep your wrists as strait as possible, when writing typing or driving. Extreme and extended bending of the wrists aggravates CTS.
4. Finally, try getting wrists splints and sleep with them on. I did this for about six months, it's not something you have to do the rest of your life -- just until your symptoms go away.
For me, the CTS got worse when I was a Domino's Pizza driver (back in the early '80's) than anytime later when I actually worked at a keyboard. Changing my driving habits and using the wrist splints at night virtually eliminated my CTS symptoms. I still have to be careful, but I don't have to live with the symptoms every day.
My mother is a data control type person (operator) who had it much worse and ended up getting the surgury. She could barely drive for six months and it took years for her to recover her full wrist strength. She had the surgury in the heydays of the '80s "fix it with drugs or surgury" phenominon. She later confessed that she wished her doctor had recommended other threatments first rather than just going strait under the knife.
Standard Disclaimer: I'm not a doctor, and this is not medical advice. Before persuing a treatment plan, you should consult with your physician. Etc. Etc.
-- "In order to have power, I must be taken seriously." -Mojo Jojo
I heard all kinds of good things about it so I made the switch about a year ago. I don't have CTS or any other disorder despite my heavy use of computers since about 2nd grade, and I decided I'd like to stave it off as long as possible. I also bought myself a MS Natural Keyboard Elite. I recommend it over the regular one, the keys are MUCH easier to press. And the 6 is on the right instead of the left side. ;)
:)
:)
Once I made the switch, I definitely noticed much less hand fatigure after a full day of typing. Somewhere (check out the dvorak links) I remember reading on an average typists' day, using the QWERTY keyboard, your fingers will travel about 7 miles as compared to DVORAK which measures in around 2. Enough to make me switch. Besides I type 20-30 wpm faster (average) now too, and I can easily measure over 100wpm if I try
Introducing the Dvorak Keyboard
A Basic Course in Dvorak
I switched in approximately a month, though I had a tough time because I couldn't completely wean myself from QWERTY (had to use other computers, etc). I hear if you switch cold turkey it goes much faster.
Finally, I only used resources I found on the web. Didn't cost me a penny
It seems Microsoft wants to "standarize" on right-handers by simply forgetting about the existence of us left-handers. Hence Microsoft mice are useless and more painful for me. Or has anyone seen a lefty microsoft mouse? Logitech on the other hand used to make a lefty version of the MouseMan.
My wife had horrible CTS, and surgery didn't help. It kept her from work for almost a month, and it cost us a fortune (no health insurance, I'm an engineer). She has gotten much better by doing three main things different.
"I always thought that carpal tunnel syndrome was mostly invented by doctors -- until I started showing symptoms myself. I'm almost convinced of the need for surgery -- is there anyone else out there who has had this done? If so, what sort of recovery time did you have before you were reasonably self-sufficient again?"
Have you thought of changing the way you do your work. Most likely it caused yoour pain in the first place. any solution for it will have to include changing that. If you don't it is likely your wrists will get worse and that they will be permanently dammaged.
From what you wrote I gather that you are looking for an easy fix in the form of an operation in order to continue working the way you have always done. As far as I know there are no easy fixes. If you go to a doctor he will only do the obvious, that is try to prevent you from further damage your wrists rather than cutting them open rearrange some stuff and declaring you cured.
If you are a programmer (what i suspect) and are planning to spend the rest of your life programming, you might want to start considering that your wrists won't go all the way. I.e. start thinking about ways of reducing the amount of typing you have to do for your work.
Jilles
Not a doctor, but knows CTS all too well:
:)
Okay, here's how it goes. About a year ago I was experiencing the classic symptoms of carpal tunnel.
I'd wake up in the middle of the night with my hands asleep.
My wrists would be in incredible pain most of the time, *especially* when typing.
I lacked the coordination to pick up a coke, or a cup of coffee (what else is there to drink?)
and more pain, pain, and pain.
I looked into many solutions, surgery of course, being an option, here's some information about the surgery of which everyone should be aware:
Surgery to rectify Carpal Tunnel Syndrome has a *very* high fail rate.
I'm aware of a few individuals who went for surgery and now longer have feeling in one hand, the other, or both.
I could go on, but with that said, let's look at our other options....
What i did: surveyed my area.... and learned about what i was looking at, there are many resources on the web, as well as many doctors/people who have experienced CTS (sign language interpreters, writers, teachers, crack addicts...) you'd be amazed how many people have dealt with it. Talk to them about what they did, or don't.
The first thing i did, was cut back on my computer usage, from about 10-12 hours a day (seriously) to 2. That in itself made a world of difference.
Second thing: new chair, one of those really big cool black ones, with arm rests, and a small puppy to stroke so whenever anyone entered my room i could turn around and say "WELCOME TO MY HELL."
Third: new desk, with a keyboard tray, and a mouse tray, the key is having your keyboard level, and your mouse low.... not too low... but just to the point where everything's happy... i've also heard it was bad to have your mouse above your heart. But i don't know about that one.
Fourth: Wrist braces. No, you don't have to wear them when you go out (when do you go out?) or to school, just to sleep. Your hands might get a bit sweaty, but they actually do help. NOTE: on the braces, you can go to some "CTS" site, and spend a hundred dollars on wrist braces, or you can go to walgreens, and spend 20. Same thing, much bigger price.
Fifth: Keyboards. Didn't even change mine... have no "natural" no anything, i just have a nice clickity clackity PS2 keyboard... and i love the thing. Some people will say "having a 2 degree twist in your keyboard will prevent CTS.." i don't believe it. Some people swear by them.... *shrug* one thing i really *would* like is a completely split keyboard, *completely* so i can put one hand somewhere, and the other completely somewhere else...
so, cutting time down (fairly essential) for a while... (now i'm back up to about anywhere from 4-8 hours a day) and changing your environment work really well.
make sure you stretch
Carpal Tunnel Syndrome Home Page
A Patient's Guide to Carpal Tunnel Syndrome
My advise is to use Microsoft Keyboard and/or Microsoft Mouse. They may make a lame OS but they sure know how to design good hardware.
Hasdi
Now, unfortunately, I have noticeable numbness in the outer pair of fingers on both hands. It started soon after I started using the Dvorak layout full-time, and intensified steadily over the next couple of months.
However! Do not run away yet. My wrist pain has stopped almost entirely, and the numbness has now begun to decrease slowly but steadily. Why the strangeness? Well, as near as I can tell, because I had been typing for so long on the QWERTY layout, I didn't have to keep my fingers on the home row--my hands sorta "floated" over the keyboard, and my motion was loose and easy. But in the time it took me to become really proficient with the Dvorak layout (and I am still not quite back to my original speed yet, but close) I kept my fingers glued to the home row like attentive schoolchildren. And my hands were tense, as were my forearms.
But now I'm loosening up, and it appears that I'll wind up better off than I was before. So yes, by all means try the Dvorak layout. Just know that it works better (and faster) for some people than for others. Be aware, not scared.
And please, do what these other folks are telling you--get away from the keyboard and do something totally unlike typing for a while each day. Like masturbating. Or rock climbing. Or whatever.
You do not want to get surgery first. Surgery is a last resort for stuff like this. The reason that you are having a problem is because you are building up scar tissue and/or straining the muscles in your hands and wrist. Surgery can alleviate some of this pain, but it will ultimately make things worse if you wish to continue with the stressful activity (i.e. Typing). The end result of any surgery is the creation of scar tissue and possibly the cutting of muscles. This results in less flexible muscle that can be damage more easily than the pre-surgery muscles. Surgery now is asking to not be able to type 10-15 years (possibly with additional surgery along the way).
You need to stop any activities that cause scar tissue to build up in your hands. Foremost among these is cracking your knuckles. If your a knuckle cracker, you have to stop. The popping sounds is nitrogen liquifying under the pressure. This is bad for your muscles and is the source of your scare tissue.
Another problem with typing is, shall we say, improper technique. Most people assume that the presence of a wrist pad/mouse pad means that they should rest their wrist on it while typing/using their mouse. This is absolutely wrong. Typing or using a mouse while your wrist is resting on any surface (even just the table) puts additional strain on your wrists. This will cause you problems. Although ergonomic keyboard are nice, you can receive great benefit from having your wrist not touch anything while you type.
Another aspect of proper technique is the height of the keyboard relative to your body. When you are typing your forearm should make a right angle (or as close as possible) with your biceps. Anything above or below this puts additional strain on your elbows and wrists. If forced to choose between a little below or a little above, I would recommend a little above because the muslces in your biceps are more able to compensate for the additional strain.
While we are on the subject, monitor placement is also an issue. Most monitor documentation is wrong. They show that "safe" monitor height to be the top of the monitor at eye level. This is absolutely wrong. It puts additional strain on your neck. The center of the monitor should be level with your eyes. Additionally, if you are forced to pick between above and bellow this, above is much better. The reason is that looking above causes your next to arch backwards, which does not degenerate the curve in your spine. Actually, short periods of over-curving the neck are beneficial for the spine (not that you will enjoy long periods of the monitor being to high). Having it lower than this is always bad. It degenerates the curve of your neck and strains the muscles.
As many of the other posters have said, I strongly recommend some form of exercise. The scar tissue in your muscles can be removed through exercise, which also has the added benefit of strengthening your muscles.
I strongly recommend you go and see a chiropractor. In addition to the concerns about school raised above, there are also concerns of technique. There are different kinds of chiropractors, and I am very in favor of biomechanics. I have been going to chiropractors for the last 15 years (and my current biomechanics chiropractor) for the last 10. Please e-mail me if you are interested in additional information (such as the location of a repeatable chiropractor in your area.)
I know several people that were told they needed surgery by docotors and who ended up not needing surgery after seeing a chiropractor. Also, I would like to take the time to dispell some of the myths about chiropractors. Medical school requires a student to put in less credit hours than does chirpratic school. Both schools require the student to have a college degree. Additionally chirporators have to pass a licensing examination to be able to practice. They are not unskilled quacks as some other post have try to portray them.
Dave
dgr116@psu.edu