Carpel tunnel - ouch

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   Jane@CMposted 14 years ago

   I was on such a roll this morning & then it hit, the carpel tunnel.  It hasn't bothered me in years, why today?  The mouse is the big culprit.  Can't wear the brace, because then I can't type.
   
   Big whine-oh here.

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      rsmalloryposted 14 years agoin reply to this

      I feel your pain...literally! LOL. thank good ness for ibuprophen and heat wraps at night. I got a wrist rest for my keyboard-but I think your right-it's the mouse!

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      Justine76posted 14 years agoin reply to this

      : ( rest. hope you feel better soon. its the weather.

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   rmcrayneposted 14 years ago

   Hello Ladies.  Are you still out there?  As luck would have it, I’m an expert in this.  If you’re not receptive, then I will try my absolute best to let it go. 
   
   I have experienced pain associated with desk work “from both sides of the table”, meaning as a medical provider and as a sufferer.  Despite nerve conduction tests, which in some cases indicate “severe” carpal tunnel, I have none-the-less resolved symptoms in my clients with strategies geared toward posture.  Posture is “the cure” and splints and ice (sorry remallory, but heat is the wrong way to go, no matter how good it feels at the moment) address the symptoms. 
   
   My computer workstation ergo tips are in my hub, Computer Ergonomics- Quick Start Relief Tips for Desk Workers.  These are the basic tips.  The rationale behind the tips takes me about 2 hours to deliver in a class, so that will be many more hubs over time. 
   
   I also have 2 hubs on ice, Ice Packs…Benefits, and Ice Slushy…for Pain and Swelling.  I suggest ice 3 to 5 times a day to wrists and neck/upper back.  This is possible working at a desk- it’s a matter of getting your mental game plan worked out. 
   
   Good luck.

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   Marisa Wrightposted 14 years ago

   I wrote a Hub on this too, based on my experience with rehab specialists at work.  Yes, people tend to blame the keyboard but usually, it's the mouse.

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      rmcrayneposted 14 years agoin reply to this

      I tend to blame posture. Get that part right, and everything else falls into place.  But I'm not disagreeing with you.  There are a couple key issues with the mouse. 
      
      For one, those mouse pads fool you into thinking that you should be static, rest your wrist and just move your hand at the wrist to move the mouse.  This would be using the smallest joint/muscles available (wrist) instead of the largest (shoulder).  Not good in terms of "work" to choose the smallest, weakest workers.  As it happens, the ulnar sided (little finger side) wrist extensors attach at the tennis elbow spot, along with the "tennis elbow" muscles (from the thumb side of the wrist).  I've treated countless cases of "tennis elbow" caused by the mouse.  You should move the mouse with shoulder movement. 
      
      The other issue with the mouse is mousing with the arm outstretched, i.e. elbow more straight than bent.  Also a key culprit in "tennis elbow".  Your elbows should be by your sides, and the center of your shoulder should line up with your ear hole.  Forward posture, with shoulders forward of ears and elbows forward of shoulders, put the upper chest muscles in a shortened position, and they shorten over time.  This creates a posture related "thoracic outlet syndrome".  If doctors would assess for more than carpal tunnel (median nerve compression at the wrist), they would find in many, many cases that all three nerve distributions would be positive at the wrist and forearm.  Good news is surgery is not needed.  Just get your shoulders back.

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      kverdasmithposted 14 years agoin reply to this

      I think it is the cat.

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   wyanjenposted 14 years ago

   Excellent info rmcrayne, thanks!
   I have a two-mouse strategy.
   Left hand for graphics at work, right hand for writing at home.
   It's my right that gets sore sometimes, I think my desk here is too high.
   I'm glad I stopped by, I didn't realize heat is wrong.

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      rmcrayneposted 14 years agoin reply to this

      Heat dilates blood vessels, which tends to feed swelling and inflammation. 
      
      Can you raise your chair height, and rest your feet on the casters or on some books?  Hips, knees, ankles should all be about 90 degrees.  I like elbow angle opened up more than 90 degrees.  Your ulnar nerve appreciates this, and it makes you less inclined to haunch your shoulders.

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         wyanjenposted 14 years agoin reply to this

         Oh, you would just cringe at me I'm afraid.
         I don't have my feet on the floor at all, it's a stupid OCD-kinda thing, I have to be sitting on them to start working.
         Although you have me noticing that I'm doing it right now, so I just put them down
         I do make a point to keep a wide angle with my arms. I use lots of real estate for my mouse.
         
         I'm sure you have explained this in a hub, but here is a silly question:
         Why does heat feel good if it is making the inflammation worse?

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            Justine76posted 14 years agoin reply to this

            heat relaxes muscles

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               rmcrayneposted 14 years agoin reply to this

               Think of it like comfort food.  It feels good, soothing. Doesn't mean it's good for you.

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                  wyanjenposted 14 years agoin reply to this

                  hmm.
                  That is a perfect comparison.
                  
                  I hate when something gets achy and I don't know how to make it better.
                  Thanks for your info rmc!

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                     rmcrayneposted 14 years agoin reply to this

                     Good to be appreciated   My Ice Packs...Benefits hub explains the rationale/when to ice.  I also have a hub on Heat with when to use heat.

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   elayne001posted 14 years ago

   great help for us with cramped hands. How about red eyes when I wake up - could that be from staring at the screen reading all the hubs for hours?

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      rmcrayneposted 14 years agoin reply to this

      For cramped hands, if it is arthritis pain and stiffness, I recommend contrast baths (alternating warm and cold water).  I have a hub on that.  They work great.
      
      Red eyes could be lots of things.  Outside of my specialty.  I'm sure lots of reading doesn't help.

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   habeeposted 14 years ago

   Oh, Jane, I feel your pain (done in my best Bill Clinton voice!). When I went through the CTS test, the readings were so bad that the neurologist ran out of the room and called others in to see: "Hey, you have to see this! I've never seen a case this bad!"
   
   Sometimes I have to get my daughter to type and "mouse" for me -even my hubs. I met with a surgeon, but mine is so far gone surgery would be "iffy." Also, the doc said I would probably lose some of my grip strength, which I need to grab handicap rails because of back/hip/knee damage.
   
   I'd like some cheese with this whine, please! Maybe some baked brie??

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      rmcrayneposted 14 years agoin reply to this

      Hmmm.  Doesn't sound like something a Hand/UE surgeon would say. 
      
      Did you read my comments?  I have a great track record.  Doesn’t sound like you have anything to lose…

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      rmcrayneposted 14 years agoin reply to this

      You know the lyrics in Shania Twain’s song, “that don’t impress me much”?  That’s how I feel about the NCV and EMG CTS tests.  That’s because there are very few cases where I have not been able to resolve, or at least significantly improve clients’ symptoms.  From my perspective, the “severe” cases of CTS resolved just as quickly and easily as the mild, or the ones whose tests are negative. 
      
      I have found over the years that the carpal tunnel and cubital tunnel cases that I can’t resolve, usually ortho doesn’t resolve them either.  I’ve only “given up” and referred to ortho about 2-3 CTS cases in the last 6 years, and those were women with “small wrist dimensions” because I can’t really do anything about that.  Many cases that wind up having the carpal tunnel release anyway (I didn’t recommend it or refer them), wind up coming back to me because their symptoms are back by 6 months and they don’t know who else to turn to. 
      
      The worst case I’ve seen, many years ago, already had muscle wasting in the hand.  He worked construction and operated a jackhammer!  The “experts” told him he probably would not regain all of his sensation or muscle loss.  This is the kind of case you want to get in for surgery to prevent further “unrecoupable” loss.  That your CTS is “too bad” for surgery is counter-intuitive to me.  Good news is you have not had surgery yet and can try some easy, non-invasive strategies.  You really have nothing to lose.  While ergo and other strategies may not help, there’s absolutely no reason that they would make you worse.

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   rebekahELLEposted 14 years ago

   have you changed chairs or desks?

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   kverdasmithposted 14 years ago

   Seriously, carpel tunnel is hugely mis diagnosed but it sounds like you have some pain that sounds more like an injury. Back and especially neck issues are largely responsible for carpel tunnel symptoms. Hope you feel better soon.

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      rmcrayneposted 14 years agoin reply to this

      I think we agree, but phrase it differently.  In my clinical practice, CTS is grossly over- diagnosed.  It's become a huge waste basket diagnosis for docs when patients complain of an array of hand and arm complaints.  Especially if you tell them you work at a desk or computer.  Pain of the entire right or left upper quadrant (hand all the way up the arm to the neck, or vice versa) is not carpal tunnel.  I absolutely suspect c-spine (neck), which can be from arthritic changes, or low level injuries over time which clients often don’t even remember.  (They tell me on follow-up.)  Most often, even with c-spine issues, I am able to resolve symptoms with soft tissue strategies, seldom needing to refer to physical therapy for traction or mobs.  With obvious acute injury, such as a car accident, I usually co-treat with PT or chiro.

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   habeeposted 14 years ago

   Rmcrayne, the orthopedic hand surgeon told me exactly what I stated. Do you think I should get a second opinion? He's supposed to be one of the best, but you never know...

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      rmcrayneposted 14 years agoin reply to this

      Maybe Army and Air Force Hand Surgeons are more arrogant than civilians
      
      I’ve spent the last 6 years as an observer of the ortho surgeon mentality.  Their perspective is surgical.  So in a funny way, if they don’t see a surgical solution, then there is no solution.  By nature, they have to be arrogant.  It goes hand in hand with confidence, which is a good thing.  I’m guilty of this too. 
      
      Part of this arrogance is their “success rate”.  Some procedures they love to do, because in their mind, the success is overwhelming.  Other surgeries they are not as eager to do, not because the surgeries fail, but they don’t have the same satisfying success rate as other surgeries.  Fewer warm fuzzies.  This can diminish that god-like status.   
      
      I suspect in your case, there are other pieces to your history that put you in the category of not having that big warm fuzzy success rate.  I’m not saying I’m smarter than a surgeon, but our perspectives are different.  OT perspective makes us much more likely to listen to, trust and learn from patients.  This is incomprehensible to many physicians and surgeons.  Really listening to patients has been my best attribute and has made me smart . 
      
      So there are aspects to your story that tells the surgeon this is not going to be a warm fuzzy.  Those kinds of bits of info from my patients make me smile and nod, because I know I can help.  Because they are not surgical, and that is my domain.  For example, many symptoms that ortho surgeons and neurologists “hear” as nerve compression, I have found to be circulatory, and related to posture and position, which means we can change it!

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    habeeposted 14 years ago

    Oh, rmcrayne - I'll ask for more free advice. The neurologist said I have double crush (?) or something like that in one arm. I have an impinged nerve in my C-spine. Does that mean the nerve is being "crushed" from both my wrist and my neck? Thanks for any info!

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       rmcrayneposted 14 years agoin reply to this

       Yes I am very familiar with the term “double crush”, but not crazy about the term because of the lack of [Crayne] logic in it.  In your example, there is presumed to be [mechanical] compression on one or more nerve roots emerging from the C-spine.  There is also presumed mechanical, physical pressure on the median nerve at the central volar [palm side] wrist.  I like the terms “multiple crush” or “proximal crush”.  Years ago I read in the Rene Cailliet book series on pain.  One of the things he said was, basically that wherever the first, or most proximal site of compression was, that nerve distribution was likely to be more provocative, or sensitive, from that point on.  Intuitively this would mean if there was pressure or compression on one or more nerve roots, which in your case included nerve fibers that ultimately contributed to the median nerve (brachial plexus, it’s complicated), then it would take less provocation distally at the forearm or wrist, to cause symptoms. 
       
       Don’t despair though.  Over the years, I referred fewer and fewer clients to PT for things like cervical traction.  I found that even the clients who had c-spine films that made you flinch (therapists were able to examine x-rays at our desks at my last 2 facilities), usually responded well to soft tissue strategies and physical agent modalities (combo US and e-stim etc).  If it were me, I absolutely would not be considering neurosurgery on my spine.

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    Jane@CMposted 14 years ago

    rmcrayne, your input is invaluable!
    
    I've been icing since Friday & wearing my brace.  Its much better today.
    
    My other problem could be that I use the laptop while sitting in my recliner which isn't very ergonomically correct!  Our office is set up ergonomically, but hubby has taken it over!

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       rmcrayneposted 14 years agoin reply to this

       Jane you are correct in your intuition that your laptop is an issue.  The recliner compounds that.  Laptop use taught me a LOT about pain.  That’s a long story, but I’ll try to give you the punchlines. 
       
       It is impossible to use a laptop ergonomically without a docking station or peripherals.  Your eyes should hit the top 1/3 of the computer screen.  Your elbows should be by your sides, with the elbow angle opened up at least slightly from 90 degrees.  This is impossible with a laptop.  We typically wind up looking down, for prolonged periods of time.  Our “carpal tunnel” and other syndromes and symptoms are actually caused in many cases by trigger points in the levator scapulae muscle, with pain and symptoms following the C6 (radial nerve-like symptoms), C7 (median nerve-like symptoms) and C8 (ulnar nerve-like symptoms) dermatomes.  C6 symptoms are most common, and C8 next in my practice.  Doesn’t seem to matter, to doctors it’s all carpal tunnel (C7 or median nerve).  Anyway, punchline is, looking down for prolonged periods of time, at a laptop or at reading and writing on a desk top, is not good.  I use a LogicTech docking station for under $100. 
       
       In the recliner, you have your arms and head forward to counterbalance leaning back in the recliner.  This gets into the whole [Crayne] “postural, positional Thoracic Outlet Syndrome”.  You should be 90/90/90 at hips, knees and ankles.  Shoulders should line up with ear holes and elbows should be at your sides.  I really do recommend you look at my Ergo hub. 
       
       http://hubpages.com/hub/Computer-Ergono … elief-Tips
       
       Good for you on the ice.  I have lots of tips and shortcuts on icing, especially geared to desk workers. 
       
       http://hubpages.com/hub/Ice-Packs-Cold- … d-Swelling
       http://hubpages.com/hub/Ice-Slushy-Cold … d-Swelling
       
       Hmmm...Can you link to a forum thread on a hub?  I'd like to link to this thread on my ergo hub, since I've obviously been dragging my feet in getting the rest of my desk/ergo topics turned into hubs.

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          Jane@CMposted 14 years agoin reply to this

          You are so kind for sharing all your information and advice!
          
          Today I was able to use the office as hubby is taking a class all week.  I lasted about 1/2 hour before the pain started again. I have so much to write!!!   My hand is freezing (not from icing it), so a nerve is not happy!  I can't take Advil, so using Tylenol.

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             rmcrayneposted 14 years agoin reply to this

             “Cold” is a vascular symptom.  Again points to postural issue. For pain, try your health food store and ask for Arnica drops or sublinguals for pain. Advil hits the kidneys.  Tylenol is not kind to the liver.
             
             Keep working on the ergo part.  That is the “cure”.  Along with the postural stretches and later a few exercises for the upper back, like rowing motion and what we call IYTs. 
             
             Take frequent micro breaks and take stretch breaks, both postural and arm/hand. 
             
             Ice at least 3 to 5 times a day, including shortcuts and cheaters.  Ice wrists/arms and neck/upper back until your body tells you what is most time efficient.  Often icing the neck/upper back relieves wrist or elbow pain.  You could substitute contrast baths a couple times a day for hands/wrists.  If you do indeed have CTS, contrast baths are highly recommended in the literature. 
             
             Splint wear per frequency and severity of symptoms.  For you sounds like 24/7 right now.  Clients can wear splints and do desk work.  Think of it like this:  If you broke your arm, and had to wear a cast, you wouldn’t have a choice.  At least you can remove splints for hygiene.  Splints should be laced snuggly, essentially “locking down” the wrist.  If you lace loosely, to allow greater wrist movement, you defeat the purpose.  If it’s something you absolutely cannot do with the splints, it’s probably something you shouldn’t be doing.  Problem with over the counter splints is that they tend to be short.  Splints should extend 2/3 to ¾ the length of the forearm for the proper biomechanic.

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                Jane@CMposted 14 years agoin reply to this

                Your right, I need to stay working in the office for posture sake.  I have two spints, one is a really tight pull on, the other is from when I broke my wrist 19 years ago, it has a metal bar on the palm side that I had to wear after the cast was removed. 
                
                It doesn't bother me at night, just when I type, frustrating! So I'm just typing in short increments.
                
                Rose Mary - you are amazing, helpful & kind!!!!

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                   rmcrayneposted 14 years agoin reply to this

                   Not too tight!  That could cause cold, numbness or tingling. 
                   
                   I like the splints with the metal stays, but the angle is often too much and I usually adjust it. 
                   
                   I'd still wear the splint at night.  Like putting rest in the bank.  Once you're used to sleeping with it, you're used to it right?  Try to not sleep with your hands at or under your face.  Try not to bend elbows more than 75 degrees, and don't close down on the upper chest. 
                   
                   Rest is good.  The trick is to take that rest break before your body tells you that you need it.

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    rmcrayneposted 14 years ago

    Thanks Jane and habee for taking my input in the helpful manner in which it was intended.  Great questions ladies.  I have some answers and I'll work on my responses this afternoon.  Stay tuned...

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    wyanjenposted 14 years ago

    I'll be reading along too

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       rmcrayneposted 14 years agoin reply to this

       I'm up to the challenge

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    habeeposted 14 years ago

    Wow, Rmac! You've given me new hope! Thanks a bunch!

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    rmcrayneposted 14 years ago

    Whew!  And now I think I am caught up!

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    Sue Adamsposted 14 years ago

    I am now using a tablet and pen instead of a mouse. It helps a great deal. I have also written a hub on Re-Designing Your Work Station. My new arrangement allows for a much greater variety in the positions I can work in and eliminates RSI.

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    Miss Belgraviaposted 14 years ago

    I used to suffer terribly from carpel tunnel -- waking up in the middle of the night feeling like I had hit my funny bone, numbness all the way up my arm, wearing wrist braces constantly. I switched to a ergonomic/split keyboard, which takes some getting used to, but it made a huge difference. I also use a stationary roller ball rather than a mouse, which also helps a lot. I haven't had to use wrist braces in years, and the only time I've had the funny bone sensation is when I've typed for long periods on my laptop keyboard. I'm a huge baby, so no surgery for me, even though that was suggested when I was suffering the most.

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    wyanjenposted 14 years ago

    I agree with the split keyboard as well.
    I have one at home, and I bought one for myself at work (with the company credit card )
    
    World of difference, when you do a lot of typing!

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       rmcrayneposted 14 years agoin reply to this

       But more likely because of the difference in your posture, not what your wrists and hands are doing. 

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