Carpal Tunnel Syndrome

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Two Guys talking about their Carpal Tunnel Syndrome

(Guy 1 in normal text; Guy 2 in italics.)

See practical tips below

I'm 35 now, and have been programming since 10th grade. (That was back on old homebrew 8 and 12 bit computers my Dad built. We were pioneers, in a way; paper tape, LED's, 300 baud modems, wire-wrap, and solder!) I took touch-typing in 11th grade, and am pretty fast on a PC keyboard.

I went through several periods when I couldn't type at all without injuring myself. I was fortunate enough to be a 'hot commodity'; I was being sought after by people who knew my track record, and they were willing to give me a fulltime programmer/typist/apprentice when I needed it. After a few years of that, I found I was once again able to type a few hours a day without ill effects.

Upper body strength seems to be helpful; I think also that riding my bike 20 min/day gave me greater grip strength.

Improving circulation seems to be a good idea. Try alternating 20 times for 1 minute each immersing your whole arms into deep containers of ice water and of very warm water.

Ibuprofin is good, too, but if you take it, swear off coffee and anything harsh on the stomache, and take stomache aches very seriously.

You might also try my home setup- glidepad in the hands and toothbrush (Colgate Plus, rigid, flat, and padded) in the jaws (!) to hunt-and-peck on a raised keyboard (at collarbone level). This lets you get some work done while resting the hands. start out slowly lest you strain your neck!

Plan if possible to reduce typing somewhat by becoming an architect and getting one or two other people coding for you.

I hear there's a Los Angeles rsi support group, http://www.geocities.com/HotSprings/1702/

Thanks for your hard earned tips. I am not as bad off as you, but hell, I'm 26 and heading down that that painful road. I've been fighting this blind (braces 24 hours and hot packs in the morning) off-and-on since December 1994. I used to have relapses where I thought that it had gone away for good, only to find it back stronger than ever after a two month reprieve. But I haven't had a relapse in six months and recently developed a large cyst on my right wrist.

Now I wonder how to survive. Computer work pays so well, but I can no longer program and look myself in the eye. I face the delimma of having to quit or take a 2 month leave of absense in order to get the physical and psychological rest I need. My current typist is great-- not as brilliant a programmer as [the one you worked with]-- but a smart Caltech Junior with a basic UNIX programming background. Still I feel that I'll go insane following the typist route.

To build up strength in the arms and posture in the back I am seeing a personal trainer at World Gym twice a week. Also I've started a 2 hour weekly body massage. I understand that a good chiropractor who's also a kinesiologist could also do me good, but I have't found any recommended yet. And, of course, a hand specialist to aspirate the cyst would be nice, but I'm still looking for a good recommendation there.

My trainer is insisting that I ice my wrists every day with a bag of peas or corn (molds to the wrist well) for 5-10 minutes at the end of each day. But the cold is so hard to bear-- getting better isn't fun.

My General Practicioner has me on 2 ibuprofin 4x a day. It cuts the pain and increases the flexibility in the wrists. Swearing off tea is nearly impossible for me. I've tried many times because it adds to my stress which adds to the tenseness in the wrists which makes them more susceptible to damage than if they were relaxed.

For me, the whole RSI pain seemed to start because of the standard mouse and my tendency to to flex my hand back while resting my wrist on the table. I switched mouse hands 3 years ago and have now grown trouble on both hands. The touch mouse pads are _so_ much nicer!

Thanks for the rsi support group URL, it linked to some valuable info. But also I'm bummed that the pages are so holistic medicine based. Could it be that people who go in for traditional surjury don't need the support group? I don't know, just asking. I'm afraid of doctors and I'm afraid of non-scientific cures.

I should get a trainer, too, but I injure so easily I'm afraid of the gym sometimes.

Do watch out for your stomache. I couldn't give up coffee - until it, the ibuprofin, and the stress blew holes in my stomache. Now I have to deal with pain *there* too.

Oh, and *watch out for lower arm atrophy*. Braces 24/day gave me loss of strength and flexibility! I think some sort of occupational therapy (stretching & strengthening) should be mandatory while on hand braces.

Try the toothbrush typing technique (at home!) sometime, it can help you avoid reinjury. I think.

Yeah, that holistic crap gets to me, too. The sad fact is, most people are pretty gullable. maybe we should take our little email exchange and turn it into a little web page, to fight back a bit.

I have considered alternate careers; now managing software developers is looking possible, but teaching and journalism were interesting. Lawyers, by the way, can also make good money without typing constantly, I hear.

Making our own web page about our experiences would be a fine thing.

So far, no ulcers for me, but I'll watch out. Certainly, I stress out a lot and that probably doesn't help.

I completely agree with you about the braces weakening the lower arm and wrists. The last time I went to my G.P., he suggested I wear the braces only at night. So I have for the past two weeks. A bonus to doing this is that I don't feel so imfeebeled around my co-workers.

Also, the lack of braces allows me to stretch out my wrists quite frequently throughout the day.

As for the toothbrush typing technique, I'm afraid to try it because I have sensitive teeth and am also worried about getting a sore neck.

Changing careers is such a pain. The whole reason I got sucked into this computer thing in the first place is that I couldn't find jobs as a mechanical engineer, but computer jobs were a dime a dozen.

Becoming a lawyer sounds intriguing. An old darb who graduated around 1990 went on to get a law degree. There's a lot of work to get the degree, but after that, I suppose the typing would mostly go away. By the way, I think that she specialized in patent law.

Time Passes

Subject: RSI: Of Geometric Proportions
My latest RSI self-treatment has worked since mid October 1998. I have consciously developed a nervous habit of wrenching my hands in a very particular way.

In September, prior to this serendipity, my dad observed, "Your mother used to always wrench her hands like you do." His words made me realize that I may have been causing some irritation or misalignment as a result of my habit. As this habit increases with stress, stress would indeed be a correlated factor.

Flash back-- in June of 1997, I was dropping off the grandfather of a friend at his hotel. It turned out that this man was a chiropractor from NYC. We got to talking about the tendonitus in my wrists. In that hour conversation, he physically demonstrated to me that slight mis-alignment of bones and the resulting pressure on nerves and muscle contraction leverage, can be greatly affected.

In particular, this doctor demonstrated what I will call "2 tricks".

Trick 1: The doctor asked me to extend my right arm out to the side. He asked me to resist his downward pressure. I did so. Then he _gently_ pressed somewhere along my mid-spine and my arm gave way under his pressure. He release the spinal pressure and I could again resist him. He repeated the trick to satisfy my incredulity. I was baffled at how he had come to learn of this pressure point and at how he used to make more sweeping generalities-- thinking surely this is how converts are won over to chiropractry.

Trick 2: The doctor asked me to hold my pinky and thumb together. He told me to resist, while trying to pull the fingers apart. With some effort, he was able to slowly pull the pinky and thumb apart. Then he fiddled about with his delicate fingers and rearranged the bone alignment in my hand for 15 seconds. He again had me hold my pinky and thumb together. This time he was able to pull them apart and I felt as though I could not apply _any_ force to resist him. He then fiddled with my bones some more and I could resist the force again. The doctor stated that this pinky-thumb test is a common litmus test for diagnosing carpal tunnel-- inability to resist is an indication of the condition.

This chiropractor recommended that I find only the best kind of chiropractor here in LA. The chiropractor he used to fly out from NY to LA to see had since retired. Apparently chiropractry has many schools of thought, and he wanted me to stick to this uncommon school. Unfortunately, I cannot at present remember his definition of the required training of a chiropractor that he recommended.

Flash forward:

So here I was in October fiddling about with my own wrist bones. Immediately I noticed that I could make the pain and swelling much, much worse. After a couple weeks I came across an alignment that felt better. Moreover this new alignment actually made my wrist look straight too.

What worked for me then, and what I have been doing since is: (for the right hand, obviously mirror for the left)

  1. right hand palm up
  2. left palm up, under right wrist
  3. left thumb reaches above right wrist and is placed on what I call "the bony part of the right palm at the near-left, adjacent to the wrist"
  4. left fingers on the bottom-right side of the right wrist
  5. with hands so aligned, I gently apply upward pressure with the left fingers while pressing down with the left thumb. this twists the right wrist and sometimes results in a scary popping sound. Initially the popping sound was frequent-- several times a day. Now the popping sound has diminished to 3-5 times per week.

    So take this for what it's worth. I personally swear by it, as I have not had an RSI relapse since October. But more months of data would be more telling to be sure.

    The moral of this story: It's geometry, dummy!

    Practical Tips

    I have since found the perfect way to apply the hot/cold bath idea to the whole arm:
    1. Buy two Rubbermaid 30-liter garbage pails (tall rectangular things about the size of a grocery bag)
    2. Fill one with cold tap water and three or four trays of ice cubes
    3. Fill the other with hot tap water
    4. Plunge both arms into the hot bucket; the water should come up over your elbows. Keep them immersed for a minute or so.
    5. Now plunge both arms into the icewater. Keep them there for a minute or so.
    6. Repeat several times.
    This method is great for me because it gets the whole lower arm, and lets me stand in a comfortable position at the kitchen counter while I soak.

    I have noticed software companies actually hiring temps to come in and type for people struck by acute typing pain. Don't assume it's out of the question. Do try to find someone who understands what you're typing, though, or you'll quickly get hoarse!

    This is a bit odd, but it turns out the stomache pain I thought was caused by stress, coffee, and ibuprofen was at least partly caused instead by eating greasy foods! In particular, the high cholesterol level in my blood seems to have caused gallstones to form, and those hurt when you eat greasy food. Pretty tricky. Switching to a lowfat diet (almost no cheese, no mayo, no oil on sandwiches or salads) cut my blood triglyceride levels in half and relieved most of the stomach pain; I no longer take Zantac!