No announcement yet.

Xpost: long article on Carpal Tunnel Syndrome

This topic is closed.
  • Filter
  • Time
  • Show
Clear All
new posts

  • Xpost: long article on Carpal Tunnel Syndrome

    Date: Sat, 25 Jul 1992 10:02:45 EST
    From: mark sheehan
    Subject: Long article on carpal tunnel syndrome
    Sender: Health effects of computer use

    Here's a long article from TidBITS, an electronic journal for Macintosh
    users. (For more information on TidBITS send me personal e-mail: or sheehan@iugate.bitnet). It's generally informative,
    though not what I'd call authoritative. I think it could spin off
    several discussions on this list.


    From: TidBITS#134/20-Jul-92

    Copyright 1990-1992 Adam & Tonya Engst. Non-profit, non-commercial
    publications may reprint articles if full credit is given.

    Carpal Tunnel Anonymous
    Hi. My name is Adam and I have carpal tunnel syndrome. It's a bit
    hard to talk about at first, especially for us guys because carpal
    tunnel syndrome (CTS) is not a real guy injury. Guys break bones
    parachuting from hang gliders onto oil rigs and the like. Guys do
    not get pains in their hands, wrists, and arms from typing a
    little too much while sitting in a bad chair.

    Well, yes they do. So do women. Face it, if you are reading this
    on a computer then you may be at risk for CTS or some other
    repetitive strain injury. Perhaps the hardest part of dealing with
    these injuries is admitting that you have them. Tonya has a
    related problem, tendinitis, in her wrists, and after she admitted
    publicly at work that she couldn't do as much as she'd like, a
    number of colleagues came over individually and said that they too
    had occasional wrist pain. And this is from people who talk on the
    phone six hours a day (using headsets).

    The first thing to do is to immediately send this issue to anyone
    you know who might be suffering from CTS or a related injury. I
    mean it. The State of Washington Department of Labor estimates
    that symptoms of carpal tunnel syndrome will develop in 10% of all
    employed adults in Washington sometime during their employment
    careers. Surveys of doctors suggest that these sort of injuries
    are now the major occupational hazard of the Information Age.

    It's also expensive, for you or your insurance company, if you
    don't treat it immediately. A study by the American Physical
    Therapy Association claims that a mild case of CTS can cost
    between $5,000 and $10,000 in medical care and lost work time, and
    a serious case that requires surgery on both hands can cost
    $100,000. If you have bad furniture at work that hurts your
    wrists, statistics like the one above can help convince even the
    stingiest employer to replace it. After all, your employer will be
    paying the worker's compensation and a good bit of your health
    insurance premiums.

    I'm not going to explain CTS in detail because that's best
    explained by a book on the subject or an unusual doctor with time
    to talk. The basic idea is that several tendons and the median
    nerve pass through the carpal tunnel, formed by three bones and
    some tough cartilage, in the forearm and wrist. When you
    repeatedly bend the wrist at bad angles, you irritate those
    tendons and the nerve. Irritation leads to inflammation, which in
    turn leads to more irritation since the carpal tunnel doesn't have
    much extra room and the inflamed tendons rub on each other and on
    the nerve. We're talking about vicious cycles.

    CTS manifests itself in pain from the thumb and next three fingers
    (another nerve serves the little finger) all the way up to the
    elbow. We've found that overcompensation and stress can also cause
    pain in the shoulder, neck, and back, and it might even cause
    migraine headaches if you're unlucky. The pain can range from
    minor itching and stiffness (that's how bad I've got it) to
    flaming shots of white-hot pain searing up and down the fingers
    whenever you move them. Buttoning a shirt becomes impossible and
    sleep may as well. What can you do? Read on.

    Carpal Tunnel Help
    I'm not a doctor, but I've seen one and have researched this
    subject, searching for more information on ways of avoiding CTS
    and curing it once it has happened. If you believe that you have
    CTS, please go see a doctor right away, or at least after reading
    what I've written below. I concentrate on the easy things you can
    do, in part because they're cheap and easy, and in part because I
    feel that they are in the long run more effective than the drastic
    invasive measures that a doctor may recommend as a last ditch
    effort. Do note that the measures listed below are not in any
    specific order because I think they're all important, and none
    conflict with each other, unless you go under the knife.

    The first thing you should do to prevent or treat CTS is to make
    sure that your computer environment is well-set up, ergonomically
    speaking. The basic principle involves right angles. Your feet
    should rest flat on the floor, your calves should be perpendicular
    to the floor and to your thighs, which should be parallel to the
    floor, and the angle between your thighs and back should be at
    least 90 degrees. Your arms should hang relaxed at your sides, and
    your forearms should project out straight in front of you, forming
    another 90 degree angle. Your wrists should be straight, not
    arched upward. You might adjust your keyboard for this, or you
    might have to adjust your chair and desk height. Standard typing
    height is supposedly 27 inches, but that will vary with your
    height. I had to saw an inch or so off my desk and buy an
    adjustable chair, both of which helped a great deal.

    You should be between 18 and 28 inches from your screen, and it
    should be adjusted so that it is between 15 and 30 degrees below
    your straight-ahead line of sight. If the screen is much lower
    than that, you'll probably end up slouching.

    Wrist Pads
    By now you've probably seen the neoprene wrist pads that many
    people put in front of their keyboards. I highly recommend you buy
    one (about $10) because they help in two important ways. First,
    when you type, you shouldn't rest your hand on the desk, but many
    people do. The wrist pad is designed to remind you to lift up
    slightly so your hands don't rest on any surface as you type,
    because that angle can compress the carpal tunnel. Secondly, when
    you stop typing to think, you probably put your hands down, and
    it's better to rest them on a soft pad than on the hard corner of
    a desk, which can cut off circulation and compress the carpal

    I'm convinced that these pads, simple as they are, help a great
    deal. Microsoft gives a wrist pad to every employee. Microsoft's
    wrist pads are unimpressive compared with the one I've been using
    from Silicon Sports. Generic wrist pads consist of a piece of
    neoprene or similar rubber padding, whereas Silicon Sports has a
    better design with two layers of padding under the colorful top
    covering. The lower layer is the standard dense foam rubber, but
    the thinner layer on top is a softer foam than the generic pads
    use, and I found it noticeably more comfortable. Silicon Sports
    also has a pad for the PowerBooks coming out soon and a clever
    wrist pad/mouse pad combination that fits together like puzzle
    pieces and keeps everything compact. Get one of these wrist pads
    and use it. Depending on your office-mates, it might also be good
    for whacking them on occasion. (Kids! Don't try this at home!)

    Silicon Sports -- 800/243-2972 -- 415/327-7900

    Chill Out I
    Take a break and relax. I suspect you work too hard and put in too
    many consecutive hours at the keyboard. You should take a break
    every 45 minutes or so, and by a break I mean that you should
    actually do something different, like go hang around the water
    cooler or hassle a coworker (Dan Quayle's Council on
    Competitiveness will have me shot for that statement.). You can do
    some simple exercises as well, the easiest of which are (a) gently
    squeezing a rubber or foam ball in your upward-facing palm and (b)
    extending your fingers completely until you feel a stretch, then
    relaxing your fingers and curling them in toward your palms.

    Visionary Software has a useful little DA called LifeGuard that
    can nag you into actually taking these breaks. It monitors how
    long you're typing or mousing, and then tells you to take a break.
    You set the length of both the work time and the break time, and
    it will give you either an audible reminder or a dialog reminder
    that suggests something else (which you can set) to do. LifeGuard
    also has a useful section on exercises (including the ones
    mentioned above) and another one on ergonomics. Lifeguard has a
    number of limitations, and I'd far prefer it if you could pick a
    set of sounds for it to choose from randomly and if it had an
    option to literally lock the screen to kick you off, but it's cute
    and useful.

    Visionary Software -- 503/246-6200

    One of the easiest things you can do that a doctor will also
    recommend is to get wrist splints and wear them in bed, if not
    also during the day. Most drugstores should have them in different
    sizes and shapes, although all the ones I've seen are a vague tan
    color. I'd like to see them in black, bright blue, and even
    perhaps some fluorescent colors. There's no reason they have to be
    ugly, and it would be nice if their velcro wasn't quite so
    exposed. I hate sticking to everything!

    The splints are generally called "cock-up splints" or something
    similar because the metal splint cocks your wrist at a 20 to 30
    degree angle. This position is neutral, so in theory you aren't
    compressing the carpal tunnel while wearing them. I also find that
    certain life activities, like driving a car without power steering
    or pushing a shopping cart, are extremely hard on damaged wrists.
    The wrists splints provide welcome support in those cases, but I
    do wish they didn't look so stupid.

    My doctor recommended that I take vitamin B6. Apparently the
    omniscient "they" have done studies showing that vitamin B6, in
    doses of 100 mg daily, can help cure CTS. Apparently B6 plays a
    role in producing neurochemical transmitters, and that can help.
    You can find B6 naturally in brewer's yeast, wheat germ, and
    blackstrap molasses, but if you're like me, your diet doesn't
    include those three items regularly. Supplements are probably in

    Another vitamin that _may_ help is vitamin E, in 400 IU doses
    before bed. My doctor mentioned it as well, and my father had
    excellent luck with it clearing up his arthritis in his mid-
    thirties. I've taken it on and off when I'm running competitively
    because I find that I tend to get shin splints otherwise. Medical
    science is still undecided about vitamin E, and the only things
    they've proven, I believe, are that it reduces free radicals (a
    laudable goal) and it prevents impotence in rats (an equally
    laudable goal).

    Chill Out II
    This time I mean it literally. Current medical thought believes
    cold is much better than heat for aiding healing. The basic idea
    is that cold reduces inflammation, whereas heat may reinforce it.
    Also, since nerves are extremely sensitive to heat, heating aching
    hands may feel good, but it's deceptive because all that's
    happening is that the nerves that were transmitting pain impulses
    are now sending heat signals.

    Probably the best way of applying cold to your arms is via ice
    massage. If you freeze water in paper cups, you can then rub your
    arms with the frozen cup, gradually tearing the cup away as the
    ice melts. It's messy and not terribly ecologically-conscious, but
    it works and lots of athletes use it to reduce pain and swelling
    after exercise.

    A tidier method is to go to a sports store and pick up four or
    five of those ice bags that have some sort of blue gel in them.
    They're cheap and they work well. Don't overdo the cold. Frostbite
    isn't fun.

    Gentle massage on the hands, wrists, arms, and shoulders (which
    may often be tight and sore too), may feel good, especially if
    someone else does it, and you can also use a hand lotion that has
    vitamin E in it, just in case some vitamin E is absorbed through
    the skin. No clue if that's true, but I've had good luck with
    using it in massage.

    When I first admitted that I had CTS, I thought a bit about what I
    could do that doesn't involve my hands. Other than being a couch
    potato, which I don't approve of, all I could think of is running.
    It was an excellent excuse to get out on the trails regularly. My
    doctor agreed that exercise was excellent, in part because it
    doesn't use the hands, and in part because it helps relax both the
    body and the mind. I'm not going to recommend that you all
    immediately become distance runners, but exercise-induced
    endorphins are good stuff (now I'll have a drug czar on my case).

    Standard warnings about overdoing it apply here too. You may not
    think about it normally, but if you're having trouble with your
    hands and wrists, be careful not to clench your fists when you
    run, and avoid shaking your hands at the wrist. Of course, walking
    is good, and swimming may be, although I find that it tends to put
    a bit too much pressure on my wrists, depending on which stroke I
    use. Bowling is right out.

    Alternative input devices
    Definitely look into alternative input methods that will reduce
    strain on your hands and wrists. The most common of these devices
    is the trackball, and next week we'll look at two well-designed
    trackballs, the CoStar Stingray and the Curtis MVP Mouse and
    Footswitch. Trackballs are often more comfortable because the
    mouse click & drag action requires a significant downward
    pressure, and that pressure requires additional force to move the
    mouse horizontally. Also, moving the mouse with your wrist and arm
    is more likely to compress the carpal tunnel than similar
    movements with a trackball, which requires only the use of the

    More esoteric input devices include chord keyboards and voice
    controllers. Chord keyboards may help reduce CTS problems because
    you don't have to move your hand at the wrist to reach all the
    keys. A chord keyboard arrays its small number of keys so your
    fingers are always on the correct keys, and all you have to do is
    press the proper combinations. It may sound awkward, but I'll bet
    it took you more than an hour to learn to touch type on a standard
    QWERTY keyboard. We'll have more on Infogrip's BAT chord keyboard
    in a future issue, and you can get more information from the files
    stored on our fileserver.

    Voice controllers are definitely neat, but they must be trained,
    are sensitive to changes in your voice, and can only do the sort
    of things you can do with QuicKeys. The Voice Navigator demos are
    impressive, with the slick salesman quickly drawing their logo by
    voice. He sounds like he swallowed an auctioneer. However, the
    problem is accuracy, not speed. Apple's Casper technology promises
    to be pretty snazzy when it ships with the next generation of
    high-end Macs, but I'm not holding my breath. Finally, none of
    these systems will do dictation - for that you need a costly
    speech recognition system.

    Simple Drugs
    Doctors will recommend aspirin or ibuprofen early on. They may
    also provide a prescription for more potent stuff like Feldene,
    which is much stronger and has more side effects. Remember, drugs
    merely treat the symptoms, and unless you're in a situation where
    the symptoms prevent the body from healing itself, drugs may
    provide only temporary relief. You can't take this stuff for the
    rest of your life.

    OK, you've read all of my suggestions, but I will venture into
    left field here and claim that none of it will help unless you
    reduce your stress level. Since I've had CTS, I've talked to a
    number of people who have successfully defeated it in interesting
    ways. One swears by Tai Chi, a martial art that involves slow,
    deliberate movements and heightened consciousness of your body.
    Another had CTS so badly that they hospitalized him and gave him
    morphine for the pain. Surgery cured the CTS, but didn't reduce
    the pain. It wasn't until another doctor put him on a stress
    reduction program that he started to recover.

    Another name for CTS-type injuries is cumulative stress injuries
    because you are essentially stressing a certain part of your body
    thousands of times an hour, and the body can't handle the stress.
    Mental stress will cause physical reactions as well, and the guy I
    spoke of above who had surgery didn't experience reduced pain
    until he was able to relax and break the stressful mental pathways
    he'd built up.

    Support for this theory also comes from a study showing that early
    symptoms of CTS were twice as a common among communications
    workers who were electronically monitored than those who weren't,
    possibly because of lower stress levels in unmonitored workers.

    I suggest that you can and must reduce your stress level to allow
    your body to heal. From what I've read and heard, you have a
    variety of choices on how to go about this, be it yoga, Tai Chi,
    meditation, a non-violent martial art, or even acupuncture. I
    suspect it will be hard for many of you, being rational computer-
    types like me, to try one of these methods wholeheartedly,
    although I gather people become much more accepting when the
    alternative is the knife. I also highly recommend that you look
    for a book called "Freedom From Stress: A Holistic Approach" by
    Phil Nuernberger (ISBN 0-89389-071-5). It combines well-explained
    scientific evidence along with advice on ways to reduce stress
    using the theories of yoga as a base. Do with that advice what you
    will - I'm trying it.

    Icky things
    I don't want to talk about this much, but if you let wrist pain
    progress too far, Western medicine will almost certainly want to
    give you drugs or cut you open The first move is a cortisone
    injection into the wrist. This is painful and doesn't always work.
    Doctors generally try injecting you up to three times at intervals
    of three weeks. If you're lucky, the pain will recede by three
    days after the injection. Some people have great luck with this
    treatment. Others don't.

    If you're not lucky, you progress to surgery. The basic principle
    is that the doctor can release the pressure in the carpal tunnel
    by slitting it so that it can expand slightly. Some people do well
    after this process and return to normal work several months later.
    However, if you don't treat the causes of CTS, you can just get it
    all over again. So do yourself a favor and try the stuff I suggest
    above wholeheartedly before you submit to the needle and the
    knife. It can't hurt, and I sincerely hope it helps a great deal.