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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 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.
Perhaps the best thing any of us could do is to switch pointer devices frequently....that would at least alleviate one wrist...
For me though, the pain is mainly typing-related.
Werd.
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?
Fingers hurting all the time is more likely arthritis than CTS. Stop cracking your knuckles.
Sore wrists, however, are most likely carpal tunnel related, though there can be other causes as well. See a doctor, man.
---
"'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
----
I had the same thing, I'm also 23. Its kinda scary not being able to type. I bought some cheap ergo-split keyboard, and it started to help. Then at work I got another one that was similar. It seems to have helped tremendously. That and doing wrist excercises has definitely helped.
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!
I had the problem also and it corrected itself when I started using a ergonomic keyboard. If you get an ergonomic be sure to read the instructions since it's not intuitive how they are best used.
Dyslexics Untie!
I have one little suggestion on where to aquire a Dvorak keyboard. There is a company called Unicomp, who purchased the old-buckling spring keyboard technology from Lexmark ( spun off from IBM ). Anyone who remembers the IBM buckling-spring keyboards knows what I'm talking about when I say that they have the best feel out of just about any keyboard. Anyway, I just purchased one of the original classic IBM 101 key keyboards from Unicomp ( $69 ). Aside from the great tactile feel, they also have an easy way to change the position of the characters to convert the layout to Dvorak.
Most keys on these keyboards consist of two parts. The top part is like an outer shell on top of the real key underneath, and all the top shells have exactly the same size and shape. This makes it very easy to pop off the shell and rearrange the letters. I converted mine to Dvorak in a couple of minutes. It's actually very easy. Of course, you still have to remap the keys via software, but at least the characters on the keyboard will match what you type.
Unicomp seemed like a very friendly and efficient bunch, so you might give them a try. I ended up paying a hefty price for DHL shipping to South Africa ( $99! ), but if you live in the US it should be pretty cheap. If you don't want to spend this amount on a new keyboard, then look around for an old second-hand original PS/2 IBM 101 key keyboard. It's the only keyboard I've ever owned which could be converted to Dvorak layout easily.
Regards,
Peter K.
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
Tip when using a thumb trackball: don't use your thumb. At least not all the time. You should be able to sorta glide all your fingers over it if you don't mash your hand down on it, which is worse to your wrists than using a mouse, which at least gives you lateral movement. Move the trackball close to you so you don't feel like you're reaching out to use it. It should feel like your hand just drops on the trackball, you should neither have to reach out for it nor mash your hand down on it.
As for your mouse, similar advice. Keep the heel of your hand off the thing and control it with your thumb and little finger. A light mouse with a slim profile helps, which pretty much rules out a MS Mouse. Of course I have huge hands so this is easy for me to do. But a light touch is the key. Now i just need to make better keymaps to rid myself of emacs pinky (no i will not use vi)
I've finally had it: until slashdot gets article moderation, I am not coming back.
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