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Carpal Tunnel Surgery? 357

Posted by Cliff
from the solution-for-painful-wrists? dept.
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? "
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Carpal Tunnel Surgery?

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  • by Anonymous Coward
    A couple years a ago I had very bad CTS symtops my wrists and fingers hurt like crazy. I had to use an Ice pack to ease the pain every two or three hours. Here's how I solved the problem.

    Deal with the symptoms right away
    -----------------------------------

    - I decreased my computer usage by 90% for about 4 month only ( I am now back normal usage 14 hours a day)
    - Went to physio therpahy sessions, those session were amazingly good ( tryout physio therapy before getting surgery)
    - Bought a split keyboard and a good mouse
    - Bough a good adjustable chair from costco $100
    - Visited a bunch of websites learned how to ergonomicaly setup my computing environment

    Solve the problem forever
    ---------------------------

    During the physio therapy sessions I did a grip strength test. My left hand registerd 30 pounds/per square inch my right 8 pounds/per square inch (the score of 30 was about 35% of the maxium value on the device). So I decided that solving the CTS problem requires strengthing my hands forever. I did this with two steps building the hand strength back to average person then increasing the strength of the hands to twice the strength of an average person.

    To Regain the strength I used a bunch of medical putty (sort of like silly putty) which you sequeeze in your hand and builds up the strength of your wrists. The putty came in different colors each color offers a different level of resitance I think green was easy and blue was hard.

    To increase the strength beyond the average person I joined a kung-fu class (Hung-Gar Style). The kung-fu class involved doing a lot of finger pushups and playing with weaponry( bow staff, nunchaku, tongfa, knife, spear ... etc). The constant gripping and relaxing of the hands as you do forms with weapons did mircales for me. Just a year into the Kung-Fu training my score on the grip test went to 75 pounds/per square inch on both hands(About 70% of maximum value on the grip strength testing machine). I have not done the grip test in a while so I do not know if my hand strength has improved even more.

    Anway it has been a few years and I have not had any problems with my hands, they are in excellent shape. I hope sharing my experiences can help you. Go for the natural apporach don't go for surgery.
  • by Anonymous Coward
    If you're going to buy an ergonomic keyboard (and don't faint when you face having to spend BIG MONEY) then buy a Maltron (or perhaps Kinesis) keyboard. (I think it's patents that stop other companies adopting the same shape.) If you care more about your hands rather than your aching brain, learn to use the native maltron layout as well (though this won't be as beneficial when coding as typing english text.) Unfortunately Maltron keyboards cost approx 500 pounds sterling,but it has helped me. But don't treat it as a miracle; you've also got to heavily cut down on your keyboard use (no more games!): it's not palatable but it's also vitally important
    Dave Tweed (AC only because I almost never post)
  • by Anonymous Coward
    [I am NOT a doctor, but some doctors may miss new developments (e.g. those on the RSI moderated newsgroups)]

    I'm currently taking B complex vitamins.

    The B vitamins help the squished nerve in CTS. I'm hoping that the tunnel will meanwhile expand with time and moderate exercise.

    The main vitamin that helps is the B12, but you need the rest- if you just take one B vitamin alone it can mask deficiencies in the rest.

    B12 is quite nontoxic. And it really helps. In fact when I finally went to a hospital to check it out, the GP prescribed neurobion (which is like 500mcg B12!). Then she referred me to a ortho specialist who prescribed methycobalamin, something even more potent(better absorbed) apparently! (methylated B12, not the usual cyano B12 you get in supplements). Heh after finishing their pills, I went and bought a bottle of B complex supplements- works and much cheaper :). I mean the docs didn't have a much better solution- not like I want to em to slash my wrists ;).

    However do NOT take more than 100mg of B6 - some studies have shown that taking lots of B6 for a long time is bad for your nerves (neuropathy).

    In my case I find that about 40microgrammes of B12 (NOT milligrammes!) help. For some reason most supplements provide 1:1000 ratio between B12 and the other B vitamins. e.g.
    15mcg B12 vs 15mg of B6, B2, B1 and so on.

    It does take away most of the pain. However it is not a cure - it just helps the squished nerve. Use the breathing space to fix things- get a better position - elbows and wrists should be minimally bent. Get some exercise too- take some walks, swing your arms. Virtually everyone says that taking walks is a good thing for most people.

    Apparently there was some research on B vitamins and CTS/nerve problems in Japan. So maybe a lot of US doctors didn't see that. Whereas in Malaysia we're a small country which doesn't do as much R&D so we probably have to be more aware of developments in other nations.

    Cheerio,

    Link.
  • by Anonymous Coward
    To all of you out there who's wrist hurt all the time, as mine do, try glucosimine. It is a vitamin that helps in the rebuilding of tissue and stuff in your joints. It got rid of tennis elbow in my friend, and its helped TONS on my carpel tunnel. I guarantee after a month or so you won't be unhappy. You can buy it at GNC, and other herb/vitamin stores, and its not that expensive either. And I'n not anonymous, just left username and password at home, but my email is joecamel@netcom.com if anyone wants anymore info from me.
  • by Anonymous Coward
    I had similar problems. By lunchtime I couldn't type anymore, couldn't open a door, couldn't brush my teeth. After exploring different keyboards, mice, desks, chairs, and taking regular breaks I'm back to normal, providing I don't overdo it. CTS surgery has horrid horrid success rates. Something like less than 10% of surgeries are successful. Often you're worse off than before. Not worth it. There are some very good books on the subject.
  • by Anonymous Coward
    I agree, there is no easy fix. My wife had carpal tunnel. She went to one of the best neurosurgeons in Houston. He scared the living daylights out of us by saying that her symptoms were unusual, and that he needed to do an MRI to see if she had multiple sclerosis. Well, she didn't. He did the surgery and she got better, for a while. Later we came to the conclusion that it was the rest after the surgery that made her feel better, and not the surgery itself. You also need to be sure that the symptoms are not being caused by neck problems, rather than the wrist.

    Try an egonomic keyboard. That is much cheaper than doctors. Also make sure your working position is ergonomically correct. If your symptoms do not improve you can try a chiropractor. The chiropractor can mobilize your neck and, I suppose, your wrist, but in my opinion the benefits are temporary.

    The best suggestion I can make: if a better keyboard and better sitting and working position do not solve the problem, see Dr. Milne Ongley, who is considered by some to be the best Doctor of Orthopedic Medicine in the world. He is a pioneer in the area of using proliferant injections to strengthen ligaments for the purpose of stabilizing joints. You can look up his web site at www.drongley.com [drongley.com].

  • by Anonymous Coward
    Hi, I've suffered Tendonitis due to RSI for about 3 years. It started after I got a new job and had a really bad keyboard setup. I've tried ice, ibuprofen, and simply resting. Living with pain is a total drag. This year I started working out at the gym. My pain has become much much better; it never really goes totally away. Now, I rarely get the numbness, and working upperbody exercises like Lat pulls, curls and anything that strengthens the upper body gets rid of the pain and makes me feel much much better. I would recommend you try going to the gym, explaining to the instructors your problems and asking for exercises which focus on the upper shoulders, upper back, abdomen, forearms, triceps and biceps. This year has been a real eye opener for me, and I am now enjoying a lot of the activities I thought I would have to give up, like motorcycling, video games (carefully), and using the web again. It's much more time commitment, but I would say it's a better alternative than surgery, which I hear actually leaves you much weaker and more suceptible to the condition returning. Anything which can improve your grip strength and the ability to support your wrists independent of wrist support should be good for you. Good luck and in the mean time use ice packs to reduce the swelling, careful not to get frost bite though. yanfali@best.com
  • Here is what worked for me:

    Stopped all unneccesary wrist stuff for a while.
    This included playing the piano, tennis, READING.
    Learned to stear the car with my knees. Stopped
    fiddling with my home PC.

    Took lots of NSAIDs for a couple of months.

    Concentrated on good posture. My neck and shoulders have always been very tight and I could feel the lack of circulation in my arms as a result. Started lifting weights. This can be a strain on the wrists, but at least in my case seems to have been beneficial.

    As many people have mentioned, take LOTS of breaks
    from typing/mousing.

    Good luck!
  • WARNING
    Some experts believe that use of any keyboard may cause serious injury to hands, wrists, arms, neck or back.

    To reduce the risk of such injuries, follow these precautions:

    [] Take frequent short pauses (at least 3 minutes per hour, or more if you feel this is appropriate for you) to let your body rest.

    [] Vary your tasks throughout the day.

    [] Keep your body neutral and try to stand up periodically throughout the day.

    [] Align your keyboard and your monitor to keep your back and neck straight.

    [] Make sure that your shoulders are relaxed and that your elbows are at your sides.

    [] Adjust your chair or workstation height to ensure that there is a 90 (degree sign) between your upper arm and lower arm and that your wrists are straight.

    [] When typing use a light touch to strike the keys and avoid resting your wrists on sharp edges or hard surfaces.

    [] Avoid arching or bending your wrists when you type; and

    [] if you use a wrist wrest make sure that you use it only between keying tasks.


    I never realized how many of these things I did wrong untill I saw them all in one place. Thank you NMB Keyboards!!!! (btw, NMB makes the best keyboard known to man kind. Nice and clicky!) For best effect, combine all of these precautions into one large melodramatic step: Once an hour, stand up and sit down for three minutes straight while wresting your wrists on a wristpad with your lower arms bent at a 90 degree angle to your upper arms, making sure that your back and neck are perfectly aligned and strait throught out the entire exercise.

  • Posted by polar_bear:

    Only try to get surgery if it's a last option - do not go there first! I used to work in a car seat factory and started having CT symptoms. I went to a therapist and modified my work routines - that helped tremendously! I was having pain that was enough to keep me from sleeping, within a month I was feeling much better.

    I now work on a computer about 12 hours a day. I have invested in an ergonomic keyboard and I still do exercises to keep from relapsing. If I use a "straight" keyboard too long, I'll start getting pain and numbness...you never get entirely over it, but it's much better.

    I've talked to many people who have had surgery and the consensus that I have run across is that you never have full function again or the same level of strength. I imagine that the surgery has come a long way since 1994, but I still would heavily advise against CT surgery unless it's a last resort.
  • Here's a question: Which of my pains (listed in a second) are carpal tunnel related (possibly) and which are something else entirely.
    • Pains
    • FIngers hurt all the time
    • Fingers don't straighten fully when hands in relaxed position.
    • writs sore


  • Actually it's not that. I promise. :)

  • I took a typing class in HS and I have no problem with my wrists. But I have been having problems with my fingers. I am guessing this is a type of RSI and not CTS. Anybody with more information about RSI's and how to prevent them?

    --

  • third was to keep my wrists OFF of the desk. don't rest them on the desk, or even a cushy pad.

    That's how you're supposed to play the piano. One thing I've been curious about is why nobody ever considers is how concert pianists -- the really good ones who can play into their 70's -- hold their hands. It's the same principle with computer keyboards: keep your wrists elevated, don't rest them on any surface; there's also an optimal arching of the hands for minimal strain.

    Note that I've been told by people who know that it can be difficult to find a piano teacher who knows proper posture, especially in Canada.
    --

  • 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).

    I think the "just flop your hand on it" description is good for a comfortable pointing device: you should be as relaxed as possible when using your keyboard and pointer. My trackball (Logitech Marble, with the little ball on the left for your thumb) fits very nicely for me; I can relax my whole hand and arm, except my thumb when I'm moving the ball or my fingers while clicking. The buttons are right where I expect from my years of 3-button mouse experience, and the ball moves easily (unless it needs cleaning) and doesn't mis-track even when the rollers are cruddy.

    But if I put it or my desktop in a bad spot, I have to hold my arm up funny; that bugs me enough that I can eventually notice it and stop...
  • My biggest gripe with the usual split keyboards is that they assume you exactly cover the left 50% of the keyboard with your left hand, and thus give you no duplicate keys. The way I type looks a bit funny from a classical typing class style, but my left hand is definitely dominant, putting some of that "2% twist" into my typing as I turn my wrist to cover more area...and making me stub my finger against hard plastic any time I try to type a "Y" on a split keyboard.
  • By the way. I originally preferred the famous Microsoft mouse because it fit in my hand but being out of the work force now I've been using the original 3 button Logitech bear paw for about 2 years. Originally the Logitech seemed too big and that was probably what made them discontinue it, but that big feel was probably more ergonomically correct. A few hours of the Microsoft mouse now causes excruciating pain in the wrist while the Logitech does not.

    Professional programmers seem accustomed tobending their wrists for the Microsoft mouse and they wear splints to sleep. I'm accustomed to a bigger Logitech and don't wear a split to sleep.
  • It sounds like you haven't even seen a doctor about it yet. There's a lot you can do before surgery becomes necessary so you need to try those options.

    When my dad had carpel tunnel surgery in the early 90's, the surgery costed a two week sick leave, and pretty much cost him the use of his hands. The purpose of surgery was pain reduction, not recovery of the use of your hands.

    Who knows how it is nowadays, but you need to get it treated quickly. If you can't take time off and get it done now you won't recover from the disease. Unfortunately in CS you can't afford to have surgeryat every whim and take sick leave so the mere acquisition of the disease itself can be considered lethal.
  • It's from Oreilly. Worth every penny!

    Doing streaches helps a lot.

  • 1. My wife had CTS, while she was pregnant, both with our son, then our daughter. Doctor said it was due to water retention, swelling, closing the tunnel, pinching the nerve.

    2. My wife has had minor relapses since being pregnant, but taking B6 vitamin supplements seem to help. She's not really a big-time computer user.

    3. I have chronic tendenitis in my right wrist, (towards the outer side of the joint) - mousing aggrivates it. I tried several of the mice laying around our lab, it's the strangest thing, but the MS mouse was the worst, and an old squarish HP mouse was the best, though I had to swap out the mouse ball in the HP mouse because it was too lightweight to be useful. I took a heavier mouse-ball from an MS mouse and put it in the HP mouse. The wrist still hurts, but it's no longer as bad as it was a few years ago, when I had to actually limit my work to an hour or two per day (then use keyboards only - back then, it was feasible, Windows 3.11 was more consistent in allowing keyboard-only use). I never saw a doctor about my wrist.

    4. My REAL problem is my back, and I've tried all kinds of things - I've found that my upper back problems go away if I keep my shoulders and neck covered when I sleep, otherwise, cold drafts cause the muscles to knot up, and one "knotting incident" can cause me severe pain for up to a week. If I sleep on my back, it causes my lower back to really hurt. Otherwise, no other thing I do seems to affect it in any way, work posture, special chairs, special cusions for my chairs. I know I have a pinched nerve, because when I sit, I have a sharp pain in my abdomen. I've had that checked by a doctor, and there's nothing viscerally wrong. I've seen chiropractors, and they all seem more interested in getting me to endlessly come in 3 times a week for life. I don't have the time, and manipulations just don't seem to help long-term. The only thing that HAS helped is accupuncture. The lower-back problems have improved from intense pain, preventing me from working several years ago, to what it is now, medium discomfort, but not debilitating (unless I sleep on my back).

    "The number of suckers born each minute doubles every 18 months."
  • First, try and avoid the surgery. Some people react perfectly well to cortizone injections. If it does come down to surgery, it's actually pretty simple.

    First, understand that the 'tunnel' that is referred to is a tendon that holds the two bones in your forearm together. Through this tunnel you have nerves and blood vessels and such. In the surgery, a cut is made at the base of your hand, almost at the wrist, between the mounds of your thumb and the one on the otherside of your hand. A good doctor will cut along one of your already existing lines so as to better hide the scar when it heals. Then, they go in and cut the tendon. This allows it to open up the tunnel. When healing is complete, the tendon heals back together and you're left with a much larger tunnel.

    The sergery is outpatient, but if you have to drive to/from the hospital, you'll need a ride as you have -no- use of that hand for quite a while. From the time they wheeled my wife into surgery to the time I met up with her in recovery, I had about 30 minutes to kill. -Very- quick. Oh, and it's local anethesia.

    After the surgery, follow -every- instruction your doctor gives you. Keep it elevated, don't get the bandages wet, etc.
  • I was having severe wrist cramps from using a mouse. I switched to a nice big trackball (Kensington Expert Mouse) and I don't get the cramps in my wrist anymore. Just my experience.
  • He had surgery on both hands... The recovery time for him was about 2 weeks per hand.
    He said it was painless... So... Something I get to look forward to in the future..

    About a month after his surgery he was able to do everything he had before. (Machine Labor)..

    Chief Archer
  • Both had the exact same surgery. It entailed a reliatively quick operation (1 hour). The hand was slit down the centerline from about the middle of your palm to just below where your pulse is read. They tighten up the tendons in some funky doctor way and then sew you up. If your lucky you get to watch the whole thing.. :) Surgery in this area has gotten quite advanced in a short period of time (with my father the procedure had changed drastically over the year or so between hands)... the days of the 3-4 month recovery and full arm incisions is definately over. Another procedure is to make a small incision in the center of the palm and one in the wrist to tighten what they need to tighten. I guess its all a matter of how bad things are.

    Full recovery was about 2-3 weeks.. they both got 6 weeks comp for good measure (ahh.. to have a union job). The first 2 days are the worst. The pain in most cases is quite unbarable unless your doctor is nice and gives you something stronger then codine. My Dad who always plays Mr. Tough guy was a complete baby for a couple days (no doubt for good reason)... For the next week after that expect a gradually disapating soarness and then they will start getting you to do simple tasks with your hands such as writing... get a stress ball, they tell you to play with them a lot to loosen up the muscles... All in all its not major surgery in anyway. Another thing to expect is to use wrist bandages if you are factory or repetitively using your hands..

    For some reason I haven't encountered this problem yet.. and after 14-15 hour days on regular keyboards, lousy posture and using a regular cheapo mouse you would think I would be showing symptoms by now... oh well, no complaints here... oh wait.. my fingertips just went numb...

    Another thing to keep in mind is that every medical system is different. I happen to live in one of the medical epicentres for Canada and we are lucky enough to have a lot of higher profile physicians. Things may be quite different if you live in bartfark nowhere...

    Good luck!

    - Xabbu
  • I find trackballs much more comfortable than standard mice. I use the command line and keyboard shortcuts too much to have any real RSI problems with any pointing device, but a trackball just feels better. I prefer trackballs with the large finger-operated ball, such as those made by Logitech and Kensington. I currently use a Logitech Trackman Marble FX. It's for right-hand use only, so if you want to use your left hand, go with a Kensington. I don't recall the model name, but they have one that is a large square base with a button in each corner and a large ball in the middle.
  • an old IBM break-spring (the one with the nice-click) keyboard.


    Is there somewhere on the web from where I can order one of these? I can't find any mention of IBM making them any more. I swear I saw a place on the web that sold keyboards like them (they also had one with a pencil eraser in the middle of it), but I can't find it at all.


    Does anyone know if these are still available?

  • OK, here is what I would recomend and what has worked for me and several of my co-workers/friends. Connect-All is a natural suplement that contains condritin, bromolin and calcium. What is does is reduce the inflamation around the damaged area and gives your body the materials it needs to rebuild the tissues. I swear by it and there are several others with similar stories.
  • I dropped down from 90wpm to a about 70wpm and got a pair of Kinesis [kinesis-ergo.com] Classic keyboards (one for home and one for work). It took about a week to get to grips with it but all numbness and soreness went away. They're a few hundred bucks a pop but that's much cheaper than surgery!

    Good luck.
  • by acb (2797)
    A few years ago, I started feeling pains in my wrists. I then started practicing Tai Chi, and they went away and didn't return.

    I think another poster suggested those Chinese massage balls; they're another good idea. Buy a pair and roll them in each hand for a good few minutes a day, and they will help.
  • If your left wrist and arm continue to hurt even while away from the computer, you might consider the following:

    An acquaintance of mine had complaints of shooting pains in his left hand and wrist, extending sometimes up the arm, and was diagnosed as suffering from CTS. After trying all the noninvasive treatments and solutions available, he decided to get another opinion from a different doctor, as a last-ditch alternative before surgery. The second doctor determined that he was experiencing low-grade heart attacks, treated *that* problem, and the pains vanished.

    If you have a family history of heart disorders, don't overlook this possibility!
  • Does anyone know anything about the ergonomic properties of logitech trackman marble fx. It looks all sleek and ergonomic but i know this doesn't mean anything.

    I switched to this trackball from a normal mouse several months ago and started getting sore hands but i changed my typiung position for the worse and started typing more so i don't know if it was the trackman....should i keep using it? (BTW cut dow o posting to slashdot and other typing and pain went away.
  • I have also experienced some repetitive stress injury problems in my hands in the past. Although I was not terribly happy with my attempts to get advise from doctors, I think my problem was tendinitis that had not yet progressed to CTS. Either way, there are similar things to look at.

    As a number of other posters have written, you should REALLY consider theraputic approaches before trying to have surgical treatment. The surgery won't prevent recurrence if you continue the same repetitive actions afterwards, just delay it. And even if you have some injury currently, you can often alleviate it over time with theraputic approaches.

    Different posters have posted somewhat contradictory advice in terms of what equipment is likely to help. I think different people just have different bodies and different habits, and so the same equipment might not work equally well for everyone. The key is to TRY different keyboards, pointing-devices, chairs, and desks, UNTIL you find ones that cause less damage to YOU. Of course, that's not to say you should not pay attention to postural and activity recommendations that you can find in resources about RSIs. Take pauses, stretch, shift positions, do all that. If you are able to, it might help to alternate use of your pointing device between hands every once in a while (I am ambidextrous enough to do this, but some other people have difficulty with this).

    But also be willing to invest some in your health. Try a new keyboard. If you don't like that one, get rid of it and try another. Whatever you might have spent isn't worth as much as your hands are. Same with a new chair, pointer, etc. When I had problems, I went through a few peices of equipment that turned out just not to be for me. But after finding a good setup, my problems went away within a couple months. I've since had to work in some other spaces... but in each case I try to be conscious of the ergonomics of my work environment, and CHANGE what I'm not happy with.

    And DEMAND of your employer that they change anything causing you injury, if this is applicable. Whatever job you have is also not worth as much as your health. Although it should, hopefully, not have to come to this, you should be willing to quit a job that isn't willing to provide an ergonomic workspace suitable to you.
  • Trak is right. You might be able to avoid dropping any of your favoite activities by proper wrist elevation, and stretches (every hour if you can).

    Stretching will prevent other problems as well, mental and physical. Get a few good books and ask your Doctor for better advice.

    I took up indoor and outdoor rock climbing a while back, and found I had no more wrist pain! It was fun too!

  • I started showing symtoms about a year and a half ago...the pain in my wrists and the sudden numbness of a couple fingers. I don't have a bad case as of yet but I'm only 23 and have used the computer heavily for years. I just can't seem to find the best position for typing that doesn't cause discomfort anymore. I don't think the mouse has much to do with it...I think it is mostly the keyboard.

  • by crisco (4669)
    Since everyone else is telling their story, I'll tell mine.

    First, My RSI seems to be mouse related, not keyboard. Long hours of Doom and then Warcraft II took their toll.

    My symptoms manifest themselves as pain in my right thumb, wrist and elbow. I looked around on the web when I first started feeling it and found info on my seating position. Mine was about as bad as it got. My desk was way too high and my typing / mouse position put my arm in a pretzel. So first thing I did was get a chair that sat higher. That worked great for a while, but the symptoms came back.

    I moved the chair even higher, going so far as to put a phone book (ouch, my butt didn't like that) in there. It helped, but only temporarily. So I had to reduce the computing time. I should have done that in the first place.

    My girlfriend bought me one of those Marble FX Trackballs. That also helped immensely, especially because I still had the old mouse at work and a completely different one at home.

    So, the important factors for me are:

    • Seat position.
    • Amount of time spent at the computer. Mix it up.
    • Change in accessories to help allieviate the problem.
  • My god man, truer words have never been spoken. I'm glad someone else had the good sense to agree with me on this point.

    The human wrist simply wasn't designed to be cocked upward like most typewriters and keyboards want it to go. Ideally, you would want a keyboard that lets your hands drape naturally over it. I, personally think that this would be a keyboard build into the desk, that drops down and away from you. This way, your arms can rest on the desk and your hands can be placed comfortably on the keys.

    Until that comes along, I guess I'm stuck with my first edition MS natural, which is the best keyboard I've found so far...

  • What I want to know is what type of therapies have you sought out. Surgery is always a last resort in my book. Doctors know so little, and to have them hacking around in a very tightly orchestrated compartment as the hand gives me shivers. I thought I had CTS a few years ago. Would wake up in the middle of the night clutching my wrist/forearm and the pain was almost imbearable. I started wearing a brace almost all the time, started taking Naproxyn Sodium (wonderful anti-inflamatory in Aleave(sp?)) and this really started to help a lot. The second thing I began doing were exercises that would strengthen those tendons, correcting my slouching non-planar use of the keyboard/mouse. Now adays if I've been at work too long, and feel some swelling, I walk away. Know when is enough. Exercise and anti-inflams, along with a temporary brace should patch you up. Never go to the blade unless you've tried many a holistic or medication's. Also, don't let them shoot cortozone in it, makes your tendons thiner and doesn't help the problem.

    Hope this has been helpful,

    Malachi

  • My mother, grandma and her husband have all had surgery for CTS and any of them will be happy to tell you that it's very unplesant and should be avoided if possible. All three of them have wrists that don't hurt anymore though, so the surgery was worth it once their conditions had elevated to the point that it had. My grandparents had their surgery done in the past year, and it sounded to be much less painful than when my mother had it a decade ago, but its still no walk in the park.

    I have also started experiencing discomfort in the wrists lately, despite my attempts to work more ergonomically. So I've sought out the Health Services department where I work. They've been a huge help: suggesting ways that I can work even better, teaching me exercises, things like that. I'm not going to say exactly what, because they've tailored my treatment for me and everyone's different.

    So that's the best piece of advice that I can give: see a doctor, nurse or physical therepist. A doctor is probably want to explore those less invasive routes before performing surgery anyway. If you are gainfully employeed, your employer should pay for it. If they hesitate for even one second, just say, "Workman's Comp". If they don't flinch at that, get a lawyer. If you're a student, see the health services at your school. They probably suck, but it's better than listening to a bunch of /.ers (myself included). Otherwise, you're probably on your own, but it'll be worth it anyway.

    Best of luck in your recovery.

    -"Zow"

  • by Wil (7019)
    I had a brief scare a year or so ago. My left wrist had started to hurt, and while sleeping with a wrist brace helped, I was still worried.

    After a brief interview, my doctor told me that I didn't have CTS, and that the wrist pain was some sort of sprain/strain.

    After a brief survey of my habits, I discovered that my keyboard/trackball technique was ok. However, during the two hours a day I spent commuting through heavy, big-city, rush-hour traffic, I held the wheel only with my left hand. At the top of the wheel. Bent backwards at about 90 degrees. In addition, while biking, I discovered a similar bend in both wrists, which bore a good portion of my 180 lb bulk.

    I spend a night or two every few months wearing the brace on my left wrist, but for the most part, noticing those habits was the biggest step towards keeping the wrists healthy.

    Hope you find something that works, surgical, behavioral or otherwise.
  • For all I know this could be a placebo, but it's worked very well for me and a number of my friends. I don't know what to tell you.

  • Okay, everyone might consider me a nutbag for this one, but I've had run-ins with carpel tunnel and have tried differient remidies with good results. First off, get yourself a chiropractor. In my experience chiropractors can do wonders for carpel. Also, and this is the weirdest of all, go get yourself a pair of those energy bracelets. The copper kind with the embedded magnets. I've loaned mine to several of my geek friends for just a few hours and they always end up ordering a pair. I got into them before the TV adds were around, as my mother is a chiropractor (suprise!) and she got me one for my birthday. I thought she was a total nutbag, but I wore it anyway just to humor her, and just a few hours later it felt like my wrists had been greased. Movement was painless and easier than it had been in recent memory, so I ordered anther one for my other wrist. Anyway, I suggest you at least get a pair of these copper bracelets, because it is well worth it. I'm not totally sure where you can buy a pair, but I can get them for something like $27.00 each. I'm not trying to make a sale here, I'd much rather not have to deal with it, but if you're unable to find them anywhere else let me know and I'll hook you up.
  • Buy a Kinesis Keyboard!! I was showing some major CT signs, then I bought a Kinesis ClassicQD Keyboard. Since then, I can work on the computer for twice as long at a sitting without any pain whatsoever.
  • It's informative, interesting, and highly relevant.
  • 1. *Don't* get surgery. Because of formation of scar tissue, your problem may get worse, especially if you keep on typing the way you do. And remember: cutting in tissue can not be undone, so always use surgery as a last resort

    2. *Do* take all the advice given here about ergonomics, input devices, stretching, breaks etc.

    3. Carpal Tunnel Syndrome is a serious medical condition. If you think something is wrong, you have to see a doctor (which you did not, from what I've read). CTS is a condition which can be objectively diagnosed. If you are "convinced of the need for surgery", it doesn't mean medical science agrees with you.

    SO: Go see a doctor

    4. An important risk factor in RSI conditions is stress. I think you will be much better off doing some kind of therapy or practicing sports

    For stress reduction and muscle relaxation, you might try sports without extreme
    muscle strain (Tai-Chi, perhaps Aikido) or meditation (Yoga?)

    5. An important risk factor in RSI conditions is
    posture. I think you will be much better off doing posture therapy, eg. Feldenkrais, Alexander, Mensendieck, C\'esar, etc.

    As a personal note, I had major complaints for years, and thought I had CTS. Only when I visited a posture therapist (Mensendieck), I discovered that my (backward) slouching made me put strain on my shoulders. My shoulder muscles would swell and put stress on my nerves and vessels, resulting in cold and tingling hands.

    6. There are lots of resources on RSI on the net.
    A good start is the sci.med. (?) .rsi.moderated newsgroup
  • Hasdi said, "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."

    The keyboard is ok, once you get used to the different layout. That actually doesn't take long, but it does get aggravating when you switch computers several times a day, as do I. It takes a couple seconds to remember what keyboard you are using. My only complaint is the mouse. It may sound dumb, but why are mice 'ergonomicly'(sp?) designed for right hands? Is there a mouse designed to fit the left hand comfortably?
  • Take glucosamine sulphate and Chondroitin complex daily for at least a month. This stuff takes a long time to kick in, but the alternative is surgery with rehabilitation time of about that long. I think the reason for the extended time before you see a result is that this type of tissue heals very slowly. In addition to this, you need to make sure that your working conditions don't aggravate the problem more than they have to. Get wrist rests, adjust your keyboard level to something sane, and get a mouse that you can use without killing your hands. It will take a combination of these things to improve your situation without surgery.
  • Okay, I'll try to make a very long story short:
    I had all the symptoms of cts aabout 5 years ago. Numb hands, a kind of pain when typing. I'd wake up at night and my arms would be tingling - I couldn't even feel them. My arms felt like they belonged on a maniquin.
    I spent several months worrying about this. My doctor couldn't tell me what was up. Had the test where they shoot electricty thru your arms to measuring the signal. Everything seemed normal.
    One night I was on the couch, with my neck on the armrest. I heard a crack in my neck like one of my
    vertabrae moved. One of my arms felt normal. I made an appointment the next day for a chiropractor. Turns out my back was completely out of whack and a nerve was being pinched (due to me exercising my abs but not my back). After a few sessions things started to return to normal. I haven't seen a chiropractor in several years, but if I let my back go the symptoms return.
    Moral: It's not always your wrists. It may not be your back, but it could be your posture, or the way you hold your arms / shoulders when you type.
    Your doctor probably won't recommend you see a chiropractor (since many thing they are quacks) but you should check out one on your own. Just avoid the ones who try to sell you a bunch of nutritional supplements.
    However, if you do have cts, glucosamine sulfate and trans fatty acids (usually in the form of flax seed oil) are supposed to help the symptoms and reduce swelling.
  • --
    You are absolutely correct. Almost every case of CT that I've heard of has been from people who learned how to type "correctly." I was fortunate enough to have taught myself.
    --

    I have to second this. I taught myself to type at 8 years old (29 years old now) programming TRS-80 BASIC way back when, and though I only use three fingers and a thumb on each hand I can get 55+ WPM with fast metal playing :-). Never a moment of pain or numbness, except when mousing too much or too irresponsibly.

    Rich
  • I'm a bodybuilder and hockey player so I have pretty big wrists. Does that affect my chances of getting CTS? (So far, I don't have any of the symptoms of CTS. I have an original MS Natural Keyboard and a mouse resembling an Intellimouse. I use my computer 8 hours a day at most, but usually 2 hours a day.)
  • I have one, and it's not for sale. :-)

  • Please keep in mind that AC posts start at 0.
  • I have been diagnosed with tendonitis in both wrists as well as mild CTS in my right.

    The difference, AFAICT is in the type an location of the pain. Tendonitis seems to me to be more of a general 'the bottom half of my forarm is in searing pain' while CTS is much more localised to the actual wrist joint area on the underside.(where the tendon and sheath is most susceptible to stress) but the pain there is supposed to be 'minor' and is usually masked by tendonitis, its the tingly 'Sprite bubbles inside my fingers' thats the sign of serious nerve damage (ive never experionced this. But this is only my experience, and I'm no Doc. The cool zappy test to check for nerve damage is pretty cool, its like sticking your finger in a light socket, but they do it for longer than any sane human would.

    I have avoided surgery because even with new techniques the success rate is, well, not good. But I am able to control the pain with proper positioning of my hands/arms/body and physio and massage. (Painkillers did me no good =)

    Proper posture is key. the top of your arm should be in line with the top of your hand. This is the most 'neutral' position for your wrist as AFAIK. This goes for both mousing and typing.

    Another problem is shoulder /neck/back position and especially feet placement! I find that if I hunch over or tense up my shoulders, or lounge without my feet placed on the floor in front of me, I end up comprimising my arm/wrist/hand position or tensing muscles that cause my tedonitis to flare up.

    I switched to the Dvorak layout on a 'natural' style keyboard and it has helped, it keeps my hands relaxed and my fingers do the work... The keyboard is in tray that is angled down away from me slightly, and I do NOT use a wrist (crusher) rest, my hands float above where a wrist rest would be. I also use a Logitech TrackMan Marble FX with the buttons swapped (use my ring finger for normal click and thumb for secondary click).. man does THAT help. I've tried touchpads, but nothing beats the Marble FX.

    Lots of breaks and massage has helped tons, and my Physiotherapist gave me lots of stretches.

    Worse still, I had to have a tendon transfer operation on my left thumb after hurting it playing football. Let me tell you, surgery on anything in the hand/wrist area is not something I would look forward too. I had a specialist do this and if you dont baby your hands for twice as long as they tell you, then you will be worse off than when you started. I had a spill on my 6th week of recovery (supposedly in the 'safe zone') and it has never been the same. Physio is helping a lot though. Breaking down the scar tissue and replacing the lost muscle (actually, over-replacing it to supplement the weak hack job that the docs did and nature didnt...) ugh.br>
    take lots of breaks, do stretches, learn some Massage techniques to keep your muscles relaxed, sit properly and relax...
  • I've been typing behind a keyboard for 19 years, since age 11. I've been a blind typist almost right from the start, and after a few cups of coffee I can do 60 WPM.

    Earlier this year I've started to get CPS. My advice is to avoid any kind of surgery at all costs, and it should be done only as a last resort.

    Use your head. Pay attention to your wrists. At the first signs of any discomfort, stop. Take a break. Get a cup of coffee. Take it easy for a few minutes, then start again. Even if the pain starts coming back a few minutes later, stop. Take another break.

    You may want to try taking some generic over-the-counter anti-inflammatory drugs like ibuprofen (that's Advil, but don't waste your money on the brand label, buy the drug store generic brand which is the same thing). If your usual aches and pains respond better to acetaminophen (Tylenol), try that. Don't over do it, you can only take a few pills a day, at the most.

    Eventually, your wrists will adjust. It took about a month before the pain went away for me completely. I threw away my old keyboard, bought a new one - "Fellowes" keyboard which comes with a gel-filled wrist pad that is VERY comfortable. I feel absolutely no pain any more.
    --

  • Before you consider ANY surgery, IMNSHO anyone exhibiting symptoms of CTS needs to get this book and read it, cover to cover. It was written by an MD specializing in Musician's injuries, and someone who actually got RSI.

    Emil Pascarelli and Deborah Quilter

    Repetitive Strain Injury

    ISBN 0-471-59533-0

    My S.O. had RSI symptoms and came real close to having surgery, but between this book and a specialist MD locally whose expertise was with athletic injuries, she avoided it. Behaviour modification (as in: keep yer dang wrists straight!) was the key.

    RSI is not to be taken lightly.

  • 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.
  • I did that and it made my thumb hurt and shake when I used it!

    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.

  • 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 [microsoft.com]
  • 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/ [ucsf.edu]) 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.

    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 . . .Also, get some of those wrist-braces to immobilize your wrists while you type . . .
    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 ... 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.

    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 ... 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'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 ... I must be doing something right.
  • Surgery is bad, bad, bad, bad, bad. Avoid it at all costs. It doesn't treat the problem, it only makes the symptoms go away for a while, and then they just come back even worse. The best thing you can do is take a month off from using the computer. Failing that, use it strictly in moderation and either stop touch-typing (hunt-and-peck instead) or get an ultra-ergonomic keyboard such as the Datahand [datahand.com] if you can afford it (the Datahand is about $1000, but there's others such as the Kinesis ErgoFlex which aren't as ergonomic but are "only" $250 or so). Also, get some of those wrist-braces to immobilize your wrists while you type, and try a topical anti-inflammatory cream such as Aspercreme. (I've been through CTS a few times, and know how to make it go away for the time being using non-surgical means.)

    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.

  • Your fingers should never straighten fully when in the relaxed position. Your hands should form somewhat of a 'cup' when completely relaxed; that is the neutral position.

    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.

  • 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.
  • 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.
  • 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?
  • 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 [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 [ergointerfaces.com]. 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
  • Do some web searches for full travel keyboard.

    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.

  • Is there a doctor out there (or anyone, for that matter) who can describe the symptoms of CTS?

    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

    • You were born with a small carpal tunnel (congenital) and are predisposed to the syndrome. Sorry!
    • Pregnancy - hormonal changes in the mother lead to widespread changes in the tissues of the body, many of which are quite noticeable. CTS often results, but usually improves or resolves after delivery. Some women on oral contraceptives will develop CTS for similar reasons.
    • Hypothyroidism
    • Major Wrist Trauma - i.e. wrist fracture. The geometry of the carpal tunnel can be unfavorably altered by the fracture.
    • Repeated Minor Trauma - also known increasingly as Repetitive Strain Injury (RSI) for those of you who are buzz-word compliant. Repetitive minor trauma to the median nerve/carpal tunnel complex may lead to a swollen nerve and secondary inflammation that causes thickening of tissues. This is a fairly straightforward concept that is really just common sense. Joggers with bad technique will wear out their knees, pitchers with bad techniqe will wear out their shoulders or elbows, etc. Why does hacker X get CTS when he types just like hacker Y, who doesn't get it. Answer: Hacker X may have other factors at play (smaller carpal tunnel, more active inflammatory response to minor injury, etc.) other than the repetitive strain that predispose him to CTS. Hacker Y may type with bad technique all his life and never get CTS because he does not have enough other contributing factors to develop a pinched median nerve. Then again, some people smoke like a chimney and never get lung cancer.
    • Rhematoid (and other types of) Arthritis - excessive inflammation leads to thickened tissues and a tight carpal tunnel.
    • Acromegaly (Giantism)- excessive growth hormone leads to thicked tissues.
    • Certain types of tendonitis - inflammation
    • Sarcoidosis - another inflammatory condition
    • Diabetes - nerves are more sensitive than in non-diabetics
    • Renal Failure
    • Others..

    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

    • Behavior modification - this is where the RSI stuff fits in. Sometimes this is sufficient to turn the tide, other times not.
    • Anti-inflammatory medications - most causes of CTS lead to at least some degree of inflammation, which can lead to thickened tissues when it becomes chronic.
    • Wrist Splints - helps prevent motion of the wrist. Especially helpful for keeping wrists straight at night when you are not awake to supervise them.
    • Surgery

    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.
  • I have one little suggestion on where to aquire a Dvorak keyboard. There is a company called Unicomp [pckeyboard.com], 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...


  • 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 [mega-tex.com], 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


  • One reason that Windows is so bad is that they were purposefully trying to *not* copy the MacOS interface, which had extensive ergonomic and efficiency research poured into it from the beginning. If one OS is specifically designed to be as comfortable as possible for the user, and another OS comes along and does the *exact opposite* to avoid a lawsuit...you get where I'm going.


    Aaron
  • I actually got a tip from another slashdot user about where to go and get an old style one, brand new, for $24. The shipping is a little steep, $14, which is why I bought two. :)

    This is the place to look [computer123.com].

  • The old MS Natural Keyboards were the best thing to ever come out of Redmond. The bar in the front which elevates the front of the keyboard was the greatest idea, I have one, I have always used that bar.

    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.

  • 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
  • Be careful with Chinese medicine. In other words, don't try to figure out to take on your own or let a quack do it for you. Some of the herbs that they proscribe can do you harm if they're not taken right.
  • I've heard that the tendons that connect your wrist to your fingers (running up the back side of your hand) become very sore, strained and stick out. I know I have had this a few times and dismissed it due to the weird angle I have been typing at.
  • 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.
  • The MS Natural Keyboard is actually one of the worst ergonomic keyboards. It is arguably better than standard keyboards, but there are better alternatives. One of the best, is the SmartBoard by DataDesk Technologies. It takes a little getting used to, but is well worth the effort. It is also well worth the $100 price tag.

    http://www.datadesktech.com [datadesktech.com]

  • by scrytch (9198) <chuck@myrealbox.com> on Tuesday September 28, 1999 @06:47AM (#1653627)
    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)
  • by humphrm (18130) on Tuesday September 28, 1999 @06:36AM (#1653628) Homepage
    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.
  • by Quigley (18976) on Tuesday September 28, 1999 @06:18AM (#1653629)
    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 [ccsi.com]

    A Basic Course in Dvorak [karelia.com]

    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.
  • by jtv (96323) on Tuesday September 28, 1999 @08:31AM (#1653631)
    First off, be sure of the diagnosis! If you are suffering from Repetitive Strain Injury (RSI), please note that CTS is only one of the possible underlying symptoms that apparently is easily misdiagnosed.

    According to one book I've read, there are some 15 different physical syndromes usually associated with RSI, and most sufferers actually have combinations of these. The same book said that CTS was for a long time the most well-known of these, but was actually found to be among the rarer ones. Nevertheless, repetitive strain-related injuries were generally pigeon-holed as CTS.

    What this boils down to is, that if your problem is really RSI, chances (statistically, based on what the book said) are slightly against your having CTS--and heavily against your having *only* CTS.

    Before you consider anything radical like surgery, be damned sure the diagnosis is correct because surgery might do anything from fixing the problem permanently to giving only temporary relief, or even making things worse. Get a doctor who specializes in RSI; he/she may eg. treat a lot of musicians (who tend to get the same kinds of injuries).

    Get your workplace analyzed for proper attitude, keyboard etc; don't expect to be able to walk into a shop and buy a magic device that solves your problem. What works for one person may make things worse for another.

    Little things that helped myself and others were things like drinking less coffee (today's programmers drink water instead! :), not smoking, and staying away from Windows.

    I'm serious about that last bit. I've drawn up a long, long list of features _specific to Windows_ that aggravate these injuries. In some cases they almost seem designed for that express purpose.

    I've never had a problem in more than 15 years of programming with the weirdest keyboards and in the most reckless positions, but the first trouble I had was after a few months' use of Windows. For the first few months after that, even heavy computer use at home caused me no problems, even when at work I was in agony.

    Finally, try to keep some rest. Keeping those wrists absolutely still probably is no good (it's the hidden tension and controlled, nimble movements like typing that hurt most), but relaxation is. Never type for long periods or ignore minor pains.

    Mainly, remember that YMMV. RSI symptoms can be very different from person to person. Don't be put down by doctors expecting you to match any narrow set of symptoms!
  • by Anonymous Coward on Tuesday September 28, 1999 @06:53AM (#1653632)
    My advise is to use Microsoft Keyboard and/or Microsoft Mouse.

    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.

    1. She switched from her company mandated Microsoft (un)Natural Keyboard to an old IBM break-spring (the one with the nice-click) keyboard. Her doctor suggested the IBM keyboard, because you have to hit it harder than her old Microsoft (un)Natural keyboard. I tried using her old Microsoft keyboard, and it made my hands ache. The continued fear of just barely touching the light/spongy keys accidentally made me tense. I can understand why her doctor was so adament about her disregarding company policy (and possibly getting fired) in order to stop using the Microsoft keyboard.
    2. She stopped using a rounded mouse (like a Micros~1 mouse) and switched to an old Logitech mouse (square with 3 buttons, like used on old HP Apollo's or Sun's). Her doctor said that the very curved finger position used on the rounded mouse makes CTS much worse (if not causing it in the first place). The straight(er) finger position on the logitech mouse is a good stretch. Think about the stretches a doctor has you do for CTS, your fingers are straight (like on a logitech) versus curved (like on a M$ mouse).
    3. She lost weight. That allowed her to place her elbows much closer to directly in front of her. Before, she had to "chicken-wing" her arms out to the side in order to type. The angle between the outside of her arm and her hand (when looking from above) is much less now. (please, no jokes)
  • by jilles (20976) on Tuesday September 28, 1999 @05:56AM (#1653633) Homepage
    "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.
  • by jarv (22298) on Tuesday September 28, 1999 @10:13AM (#1653634)
    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 :)
  • by Petethelate (96300) on Tuesday September 28, 1999 @06:46AM (#1653635) Homepage
    I've been programming for about 25 years (at least, getting paid for it that long) and have had tendinitis/carpal/medial/ulnar nerve problems off and on for several years.

    Soreness (horribly so) is generally a sign of tendinitis, but it's when fingers start to go numb, or tingle, that's when one of the tunnels are getting too crowded. I've had a few rounds of therapy, but the one that has helped the most has been re-learning how to type. My therapist/teacher was a pianist who had CTS and had to relearn, then discovered she could make a fair living helping geeks and nerds.

    The basic method is described in _The Hand Book_ ISBN 1-884388-01-9, but the short summary is to use the largest muscles to do the job that you can. The catchphrase is to use hands "as paws, not claws". Your hands should be moving all over the keyboard, with the fingertips only moving up and down. I find it tough to do all the time, but it's usually OK.

    I've had nerve damage (the mylograph method of determining this is one of the more uncomfortable methods of medical torture), but it's holding steady.

    As far as equipment is concerned, some things will help, but bad technique is stronger than bad equipment. I have a few old pointing devices that didn't make the cut....

    What has worked: The Microsoft "Classic" natural keyboard--have one at home and another at work on my workstation, as well as one of the smaller "elite" ones on a barely used computer at home. I find the Contour Mouse to be the best bet for me, mostly because I have really large hands and most desk rodents are too tiny. (The HP mice on workstations are horrible.) The backup computer has a Microsoft mouse--it's tolerable for a while. Other computers at work use standard keyboards and mice, and I get by.

    BTW, going to voice recognition software can lead to a strained set of vocal cords. I was thinking of foot-rodents until I figured out that I'd be trading wrist problems for ankle problems....

    Bottom line: surgery works, but there's a lot you can do before it comes necessary. My aunt lives in the wilds of southern Michigan and had to have both wrists done simultaneously. She said it was, er, interesting.

    Pete (got no sig worth noting)

  • by Hasdi Hashim (17383) on Tuesday September 28, 1999 @05:55AM (#1653636) Homepage
    [netaxs.com]
    Carpal Tunnel Syndrome Home Page

    A Patient's Guide to Carpal Tunnel Syndrome [sechrest.com]

    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
  • by Scurrilous Knave (66691) on Tuesday September 28, 1999 @06:38AM (#1653637) Homepage
    I had only minimal wrist and hand symptoms until earlier this year. I decided to switch to a Dvorak keyboard layout to, as the previous message says, "stave off" further deterioration.

    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.

  • by dgr116 (72203) on Tuesday September 28, 1999 @07:00AM (#1653638)
    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

"From there to here, from here to there, funny things are everywhere." -- Dr. Seuss

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