(This information culled from techinfo.mit.edu -- just telnet to it. A very spiffy service, I must say. -- dwallach) ============================================================================ After this message was sent out, I started having quite severe problems with my right wrist, and having seen this message, began to worry that it might be carpal tunnel. I went to the med center and the doctor confirmed that it was in fact an early case of carpal tunnel. He gave me a wrist brace to wear, and told me to take ibuprofen when I had problems. Ibuprofen helps a lot. If any of you have questions about this, please talk to me, as I've learned quite a bit about it (not by choice, though). -MESSAGE FROM CHRIS VANHAREN. ====================================================================== The following message was sent out by a 6.170 student. She makes some points that are generally valuable for all of us to know about. This message has very little to do with 6.170, but since you will all be doing intense ammounts of typing this term and probably in the future, you should know about Carpal Tunnel Syndrome. I apologize to all those who already know about this. Carpal Tunnel Syndrome is an advanced form of Forearm Overuse Syndrome and tendonitis in the wrists. Basically, the bones in your wrist form a 3-sided tunnel (called the Carpal Tunnel). Your tendons, blood vessels and nerves pass through this tunnel. If your tendons swell up too much, it can pinch your blood vessels and nerves, causing numbness in the fingers. If it is ignored, permanent damage can occur. Even if it doesn't advance to the numbness stage, it is extremely painful and can render your hands prettyuseless. In the past, mostly factory workers were the victims of this type of injury, which is caused by repetitive motion (aka Reptitive Motion Syndrome.) However, most cases now are related to computer use. I developed this infliction last year when i was taking 6.170. I developed pain in my wrists, that sometimes ran from my fingers all the way to my elbow. I was stupid and ignored it,thinking it would go away as soon as the class was over and i got to take a rest from typing. I rested it 3 weeks and it seemed fine until i started typing again at my job. The pain got worse and worse until i could barely write, or even tie my shoes. Then one day i woke up and i couldn't feel the tips of my fingers. I ran to the med center. I had both my hands in casts, and then splints for the remainder of the summer. Even though I've taken almost 6 mos. of rest from typing, i still experience severe pain whenever i type. (Not good news for a 6-3). Almost a year later, I am taking strong anti-inflamatory medication and pain killers (equal to 7 Advil) everyday. I am in physical therapy 3 times a week getting ultrasound treatment, and i ice my wrists all the time. My orthropedic doctor has diagnosed it as chronic, although we are trying everything to correct it, possibly even surgery. Basically, I'm trying to say that this is VERY SERIOUS.It can really interfere with your career... And it CAN HAPPEN TO YOU!!!My doctor says he currently has 15 cases of students with chronic variations of Forearm Overuse Syndrome. I probably got this because I typed wrong. Do the following to avoid developing CTS/Tendonitis: 1) Keep your wrists UP while typing. DO NOT PUT YOUR WRISTS ON THE TABLE!!! It might seem uncomfortable at first, but you'll get used to it. KEEP YOUR WRISTS UP! KEEP YOUR WRISTS UP! This is VERY important. 2) If you feel your wrists might need support in the "up" position, put a pillow under them or something. 3) Make sure you are using the Shift Keys properly. Do not hit the shift key with the same hand you hit the other key. 4) Try switching your mouse to the left side now and then if you are a righty,and viceversa for lefties. There are lefty configured workstations in 38-344. 5) Make sure that the key board is low enough. It should not be too high, so that you would have the temptation to rest your forearm on the table.If the keyboard is too high (as it often is in Athena clusters) put the keyboard in your lap. Good posture while typing can make an amazing difference. 6) If you experience any pain, ice it and Go to the Med Center. 7) If it hurts too much to type, for God's sake, give your hands a rest. I worked through it last year, and I got a good grade in 6.170, but i'm not sure if that good grade was worth screwing up my hands for possibly the rest of my life (not very optimistic, i know.) I'm currently looking into Law School since I don't know what else I'd be able to do if I can't get rid of this... :) Sue ================== Date: Wed, 27 Jun 90 09:40:34 CDT From: meyering@cs.utexas.edu (Jim Meyering) Subject: info on carpal tunnel syndrome (CTS) [Submitted via werner@cs.utexas.edu (Werner Uhrig)] A friend suggested I read the following message (once posted to the sci.med newsgroup). I think it should interest anyone who types a lot. One point the author does not mention is that the "force-depression curve" of your keyboard may also play a role. It is better to have a linear relationship between force and depression. But the keys on some keyboards require greater force to depress the first few millimeters than the last few. This gives what is sometimes hyped as "positive-touch" or something similar. The net result is that you have to press (relatively) hard to get over the "hump," then with the low resistance beyond it, your fingers bang into the base with more force than with "linear" keyboards. People have suggested that this sort of dynamic may aggravate or even induce CTS. Many of our HPs have this "nonlinear" keyboards. The keys on some Sun3 keyboards have become so sticky that they give the same effect. Jim Meyering meyering@cs.utexas.edu uunet!cs.utexas.edu!meyering ========= From: Andrea Frankel Carpal Tunnel Syndrome: This is a slightly edited reposting; apologies if you've seen it before, but many people who read this on an internal HP notes group have found it useful and asked for it to be more widely distributed. Disclaimer: I am not a doctor (but I sometimes play one on the Net ;@). This is from my own personal experience with the malady, supplemented by a little research and lots of talking to doctors and such. Carpal Tunnel Syndrome is being seen more and more frequently among the computer set (my neurologist jokingly refers to it as "hacker's hand"); when caught early, conservative treatment can completely cure it. However, if you let it go on long enough you can cause irreversible damage. If you have any question at all, PLEASE SEE A DOCTOR! Better safe than sorry. 1. The setup The bones in your wrist form a 3-sided tunnel, with the fourth side closed off by a very tough piece of cartilage. In this carpal tunnel run the tendons of the muscles which flex your fingers, as well as the very important median nerve which ennervates the thumb and the first two fingers. If something happens to cause the contents of the tunnel to swell, or to cause the tunnel itself to get smaller, the pressure exerted on the median nerve results in carpal tunnel syndrome. Pregnancy, sudden weight gain, drugs which cause water retention, and repetitive overuse (or abuse) which causes tendinitis in those flexor tendons, can all cause carpal tunnel syndrome. (I recently learned that hypothyroid condition can also cause CTS.) Positions where the wrist is bent back while being used really exacerbate the problem (e.g. bicycling with drop handlebars, if you are not careful about hand positioning). Other things can contribute as well - if you are doing carpentry in your spare time and twisting many screws by hand, for example. When you become aware of the problem, start becoming aware of both the wrist position and the stresses on it in various activities. The median nerve runs up the heel of the hand onto the palm, along the "life line". Direct repeated blows to this area can mimic or add to the carpal tunnel syndrome, and are often lumped in with it. Our HP keyboards are awful in this respect. Kayaking, bicycling, gardening without heavy gloves, all sorts of things can bang on this exposed nerve. 2. The symptoms and diagnosis Any or all of the following: pain, numbness, tingling, or sensations of fullness in the fingers, hands, or shooting up or down the arms. Quick test #1: make an "O" with thumb and forefinger, insert the thumb and forefinger of the other hand, and resist while trying to force the "O" apart with the other hand. The "O" should not come apart! Quick test #2 (Tinnel sign): place the backs of your hands together, bend each hand 90 degrees towards the inner wrist, fingers pointing down (forearms parallel to the floor, held out in front of you). =======oo========= key: === forearms || o wrists .. | metacarpals .. . fingers Press the backs of the hands together and hold for 30-60 seconds. If you start getting some numbness or tingling or pain, this is suspicious. Loss of grip strength is a sign that you may have a more advanced case. (I finally sought help when I was unable to open a can of tuna fish with a standard Swingline manual can opener.) I believe the best specialist for diagnosis is a neurologist. A neurologist will do nerve conduction studies, comparing rates of conduction above and below the wrist, and between hands. A good one will also do electromyography, to see if the muscles enervated by the nerve are firing properly or not. (As a techie, I was fascinated to watch the 'scopes while he poked me!) 3. The treatment Standard treatment is to start with the most conservative, least invasive approaches, and move up only if they don't help. The old RICE formula - rest, ice, compression, and elevation - is the place to start, but omit the compression as this is not a muscle strain. A wrist splint (basically a velcro-and-ace-bandage type of thing with a bent metal strip in it to hold the wrist in the right position) is worn at night for a month to see if it helps; it can also be worn during the day for stretches. (Do not make it tight - it is for positioning only.) In many cases, that plus correcting one's work habits is sufficient. Some people find that a month is all it takes; others use the splint at night for the rest of their lives, or off and on as needed. I still use mine occasionally when I've been overdoing it. It's also a good idea to wear it in situations where you might be tempted to do something silly (like lugging suitcases or lifting weights), both as protection and as a reminder to be careful. Non-steroidal anti-inflammatories (e.g. Motrin) are used, if it looks like inflammation is a major cause of the problem. Icing the wrist helps alot, both for the pain and the swelling. (Be aware that over-icing has a rebound effect as the body attempts to warm the area by increasing circulation. Best is to ice for 10-20 minutes max each time, leaving at least an hour between icings.) I keep a couple of the soft gel-type blue ice packs in a little fridge near my desk, so that I can ice several times a day if I need to. Bags of frozen peas work great (hit 'em a couple whacks on the counter to loosen them up, then pat the bag around your wrist so it conforms to the curves). For obvious reasons, jacuzzis (especially if you leave your arms in) will tend to make things worse. If water retention is a problem, you might try a mild OTC diuretic. (Women: it isn't uncommon for CTS symptoms to be worse during PMS time.) Also, simply elevating the wrist (for example, resting it on the back of a padded chair or car seat, or sleeping with your splinted wrist wresting next to your head on the pillow) can help relieve some of the discomfort at least temporarily by reducing the swelling. As a long-time fan of vitamins, minerals, and Prevention magazine, I of course asked my doctors about B6 as a treatment for CTS. Unfortunately, the original article reporting success from B6 treatment was not reproducible by other experiments. What's more, excessive doses of B6 (over 50 mg/day supplement to a normal diet) can actually cause peripheral neuropathy, mimicking some of the symptoms of CTS. My doctor said it wouldn't hurt if I wanted to take up to 50 mg/day, but since I had been taking that amount for quite some time for other reasons, he advised against increasing it. Some doctors go for cortisone injections, although mine cautioned that the carrier substance is not well absorbed, and can actually make the problem worse by increasing the fluid pressure in the tunnel. Your doctor will decide based on the type of CTS and how it is responding to other treatment (or not). The final stage is surgery. I had mine a few years ago; if you're facing it, I'd be glad to chat with you about it. The surgery itself was a piece of cake, taking maybe 10 minutes once I was fully prepped - very simply, they slit that piece of cartilage along the "life line" and onto the wrist, and it spreads apart before it heals up, making the tunnel larger. Instant relief, although the recovery and rehab takes a couple months. For those interested in such things, I talked them into skipping general anaesthesia in favor of a Bier Block, which worked splendidly - I was out of there and wolfing down antipasto and garlic bread an hour after surgery. A friend notes that not everybody who has had the surgery finds it a piece of cake. His advice would be to make sure you have absolutely the best doctors when it come to surgery on one's hands, with which I heartily concur! Hands are incredibly complex, considering all the different types of finely coordinated movement they are capable of (and all the muscles and nerves that requires). I would strongly recommend that you look for an orthopedic surgeon who is board certified in Hand Reconstruction Surgery - my scar is almost invisible, compared to some pretty horrific looking ones I've seen. (I asked the neurologist, who was really top-notch, to look through my CCN [preferred provider] booklet and recommend someone to me.) An orthopedic surgeon who handles a little bit of everything - shoulder tears, knee arthroscopy, back problems - probably won't be as good at carpal tunnel surgery as someone who spends their entire professional life specializing in the elbow down. For example, my surgeon stopped the surface cut at the first wrist fold, lifted the skin, and continued the surgery under the skin to minimize the scarring; other surgeons (who don't specialize in hand reconstruction surgery) often don't think to do that. It doesn't affect how effective the surgery is, but it sure makes a difference in how pretty your hand looks afterwards! 4. The progression The symptoms may come and go with heavy bouts of typing, bicycling, etc. When it gets really bad, it can hurt all the time or start aching spontaneously. In the early stages, relieving the pressure on the median nerve will quickly reverse the symptoms (in a matter of days to weeks). Untreated, the pressure on the nerve will eventually cause it to die back to the point of constriction. When this happens, the muscles atrophy. (The large adductor which forms the mound at the base of my thumb had shrunk to half its size by the time I was operated on.) If you don't catch it quickly at that point, the nerve sheaths (which the nerve had been inside before it died back) start to fray. This is bad news. If you have surgery while the sheaths are still intact, the nerve will grow back along the sheath (around 2 mm/day - you can actually track it!) and pretty much recover all of its connections and functions. I have a tiny patch less than 1/4" diameter on two finger tips which is numb, and otherwise have full function back. If the nerve sheaths have frayed, however, the nerve can't find its way back to make the right connections, and you're screwed. IF YOU THINK YOU MIGHT HAVE CARPAL TUNNEL SYNDROME, GET IT LOOKED AT *NOW*!!! Don't delay, or you might not make a full recovery. Workman's comp studies looking at prognosis for recovery give very low odds, based on most factory workers (who used to account for most of the CTS claims before computeritis hit) being too macho or too scared of losing their jobs to file a claim before it was too late. 5. Prevention The optimal position for your wrist is with the hand bent back just 20-30 degrees; you want the position where the front of your wrist makes a straight line with the first inch of the heel of the palm. Play with it a bit until you find the place where the wrist seems to be maximally "open", but without bending the hand back so far that you feel strain. Look down at your hands as you type - if you are dropping your wrists, you are at risk. Think about how they used to teach piano technique: an almost straight line along the back of the forearms, through the wrist, onto the back of the hand; fingers dropping down. (My sister's piano teacher used to place pennies on the back of her hands while she played, to teach keeping it level.) Practice typing that way, and instead of resting the heel of your hands on the edge of the keyboard when you're thinking or reading, rest them in your lap instead. I got a very nice padded wrist rest from a local office supply house, that allows me to rest my forearms or wrists while I type in this position; I have one under my 320 keyboard, and one for my Vectra. You can also improvise by taking a length of bubblewrap, rolling it up and securing the ends with rubber bands, then taping the roll to your desk in front of the keyboard. Warning: this padded wrist rest can actually make it worse for some people, if it distorts the normal typing motion or presses too hard against the wrist. I currently have a keyboard draw from Devoke (about $115) that has a full 6" height adjustment, slides in and out and swings to both sides. It mounts with two screws, and I have one in the "L" of my workstation table at work, and on the desk at home where I have my PC. This has made the most difference when my CTS flared up again (along with rest and splinting). Wear padded gloves for anything which might bang on your hands. Bicycling gloves with Spenco pads can be used for many things (I wear mine ice skating!). The Spenco pads are definitely superior to leather or other types when it comes to cushioning that area against shocks. (After the surgery, I was warned that the median nerve would always be a bit more exposed and sensitive, and it definitely made me a connoisseur of bicycling gloves!) Learn to back off when you realize you're about to lift or torque something heavy with your wrist bent. If you can't rethink the movement so you can keep your wrist straight, get help (person or tool)! p.s. Feel free to copy and distribute this to anyone who might be helped. I only request that you not delete anything, especially the disclaimer. Andrea Frankel, Hewlett-Packard (San Diego Division) (619) 592-4664 UUCP : {hplabs|nosc|hpfcla|ucsd}!hp-sdd!andrea USnail : 16399 W. Bernardo Drive, San Diego CA 92127-1899 USA ------------------------------ End of RISKS-FORUM Digest 10.12 ************************ Return-Path: Date: Thu, 9 May 91 13:50:44 EDT From: Karen Rosin Sollins Sender: sollins@allspice.lcs.mit.edu To: elias@theory.lcs.mit.edu Subject: carpal tunnel syndrome and tendonitis I have just gone through a bout of this. I have chronic arthritis, but over the last few weeks, something different happened - a form of tendonitis in my wrists and hands. It is much better now, but it brought home how incapacitating these problems can be. The number of things I couldn't do was astounding - open doors, eat with a fork or spoon, it gets down to real basics. As I'm sure you know from having gone through this, when it gets bad it just hurts all the time and we do a great deal with our hands. The most well-known hacker in our community who has this problem is Richard Stallman, who no longer can type at all. For at least a year or more, he has had hired typists to whom he dictates everything. I've known other people who are in the same condition. Actually, I first learned of carpal tunnel syndrome because for some reason it is more common among women, especially as they reach 40 and older. It is also common during and after pregnancy, so it is something that women should be especially aware about because they are more likely to get it later, if they don't get it as undergraduates. Date: Thu, 28 Jun 90 09:06:49 -0400 From: Mike Tanner Subject: Re: info on carpal tunnel syndrome (CTS) (RISKS-10.12) At the risk of turning this into a medical forum I wanted to add to the excellent summary on carpal tunnel syndrome that there is a related problem called ulnar nerve syndrome. As with CTS, those of us who spend lots of time using keyboards are prone to ulnar nerve syndrome, too. The main difference in the symptoms is that with CTS the numbness and tingling is in the thumb and first two fingers, with UNS it is in the other two fingers and along the outside of the forarm. (When you "hit your funny bone", what you've done is bash your ulnar nerve. The symptoms are similar to that feeling, but they don't go away.) My wife's neurologist (she's been going through a bout of it) said there are many causes, but a common one is some activity that constantly rubs the elbow. In her case it is almost certainly typing while resting her elbows on the arms of a chair. One danger is that carpal tunnel syndrome is so hot, such a fad right now, that a physician might automatically connect "numbness" with "programmer" and say "carpal tunnel". My wife's physician did this, and only changed his mind after we had looked in some medical books and found that CTS symptoms did not match hers. (Physicians deny that they reason this way. Experience tells otherwise.) Treatment is basically like CTS: ice, avoid bending the elbow as much as possible (not easy to do), don't do things that rub the elbow a lot, anti-inflammation drugs. There is surgery, but unlike CTS, ulnar nerve surgery is not a good option. Apparently it has about a 50% chance of making things worse, according to my wife's neurologist. (That might have been an estimate that took the nature of her condition into account, i.e., there are cases where it has a high probability of success, but hers isn't one of them.) -- mike ------------------------------ Date: 29 Jun 90 19:36:47 GMT From: tok@stiatl.UUCP (Terry Kane) Subject: Re: info on carpal tunnel syndrome (CTS) I am a long time sufferer of CTS. The first symptoms I recall were during high school, nearly twenty years ago, but it was not properly diagnosed until I was in excruciating pain, dropping things, not sleeping because my hand was burning at night and more, all about four years ago. Tests said that I had "a very mild case"!? That reassuring info did not make my hand better. I used splints, Motrin, ice until I finally insisted on the carpal tunnel relief operation. That was two years ago, this month, but I still have recurrences - especially when I meet the same RISK which pushed my CTS over the edge: using a MOUSE. The typical mouse promotes all the bad habits that can result in CTS symptoms. One typically rests the heel of the palm on the mouse, and press the chord keys - frequently with constant pressure (on Apple's mice, the required pressure is substantial for me, and their new mouse reqlly aggravates the problem with its stylized, aerodynamic "look"). I cannot use a mouse to this day without suffering a "mouse hangover". Track balls are better for me, but I still would rather avoid them. I am really looking forward to _getting_my_hands_on_ ;-) a touch screen. I've seen some very nice ones with quite satisfactory resolution! And please - If you think that you might have CTS - don't waste time. See Your M.D. Terry Kane, Sales Technologies, Inc, Atlanta, GA (404) 841-4000 ------------------------------ End of RISKS-FORUM Digest 10.14 ************************