RSI

[asechrest]

So I appear to be suffering from significant RSI (repetitive strain injury) from computer use, which hit me like a ton of bricks two weekends ago.

I have been ignoring discomfort during computer use for a long time, which it is clear I should not have been doing. I now have dull aches in both hands and arms, and weakness and fatigue in both forearms, and both hands, with significant weakness in my right wrist, even when not using a computer. If I were to take a stab at a self diagnosis, I would guess that I have damaged and chronically fatigued forearm extensor muscles from holding up my wrists and from typing, perhaps with irritation or damage to associated tendons. I feel pronounced fatigue specifically in those forearm muscles and I've read that this can refer pain through the tendons all the way into the hands. I don't know whether carpal tunnel is present though I've heard it is actually relatively rare.

I have a bit of flexibility at work and I'm working on a plan to use voice dictation software to avoid typing. I've been to my PCP who ordered blood work for arthritis just to rule it out, which came back negative. Tomorrow I'm contacting an orthopedic group to make an appointment ASAP.

My primary worry is that I've done permanent damage from which full recovery isn't possible. I'm hoping to take decisive action that starts me on a road to solid recovery. I think that begins with rest from the damaging events...no matter what, even if I have to take medical leave. Any advice or comments? Anyone have experience with this?

Thanks in advance.

PS - don't ignore this stuff if you have it.

 

[Unregistered]

I write for a living so I'm typing 6 hours a day. I had similar problems only a few months ago, although it was mostly in my left hand. (Long ago I learned to use my arm to move my mouse, not my wrist.) I switched to a Kinesis Advantage keyboard. It's a bit of a radical change, but I got used to it pretty quickly. Now, not only is my pain completely gone, but my typing speed has improved significantly. Something about the design of the keyboard creates less movement, and decreases all the crazy reaches the standard keyboard requires us to do. I can now type 8-12 hours a day without any pain whatsoever.

It's not cheap, at around $300, but it's rugged and lasts forever. Obviously, you want to get diagnosed, as some medication (to reduce inflammation) and possibly even surgery may be required. But even if it is, you might want to look into the Kinesis keyboard to avoid having it happen again.

 

[RJM62]

There are some physical therapists and occupational therapists who are specially trained as ergonomics consultants. They can be enormously helpful with these problems. I expect you'll be referred to one eventually, probably after the ortho consult and a neuro consult. If not, I suggest that you seek one out. Ideally, the consultant will actually visit your office and help you redesign your workstation.

Typical work stations are not ergonomically designed, and it has to do with a lot more than keyboards. In fact, most studies have concluded that ergonomic keyboards, on their own, do not significantly relieve RSI or reduce the risk. Things like desk height, keyboard height, posture, and angle of the keyboard and monitor relative to the body also have to be addressed, not just the keyboard itself.

Good luck with this. My understanding is that it's usually recoverable.

Rich

 

[steingar]

Making workspace more ergonomic is a really good idea, lots of products out there. There are surgical remedies for some repetitive stress injuries, but I'd take the ergonomic stuff any day. Way cheaper and less risk of complications.

 

[asechrest]

Thanks for the responses. Ortho appointment on Wed @ 3, which was the first available.

 

[asechrest]

I had a nerve study which shows carpal tunnel syndrome (with motor involvement, whatever that means) in my right wrist, and something with my ulnar nerve in the left arm. I also believe I have tendinitis-type issues on the extensor side, but the doctors have lost focus on that now that the nerve study showed issues (and the tendinitis-type symptoms have backed off some since I stopped traditional typing).

I will be seeing a hand specialist. If it gets to that point, I don't know how I feel about carpal tunnel surgery. Anyone had it done?

 

[pilot1956]

Motor involvement means that the nerve condition test showed abnormalities of the median nerve across the wrist (the location of the carpal tunnel) that included findings of reduced "velocity" or "amplitude" of the nerve fibers that go to the muscles at the base of the thumb (hence "motor") and (most likely) the fibers that allow for the perception of sensation of the skin (touch, etc, called "sensory") as well. Motor involvement often means a more advanced case of carpal tunnel syndrome than the absence of motor involvement.

The docs should look for reversible causes of carpal tunnel syndrome (CTS). They should check for diabetes, low thyroid function and a few other things (they should know what to do). They should also look for reversible risk factors such as forceful and repetitive use of the hands, or use of vibrating tools - the gasoline powered chain saw is the poster child for vibrating tools but there are plenty of others (regular riding of a motorcycle is also a risk factor). Forceful use of the hands appears to be a stronger risk factor than repetitive use of the hands, but both are risk factors. Typing is either a weak risk factor for CTS or has no effect on CTS risk. This has been studied many times and the observation is pretty solid. Forearm wrist and finger extensor pain and tendonitis are fairly common among people who do a lot of typing.

Splinting can control symptoms but is often not a long-term solution. Many people with CTS respond to an injection of steroids into the carpal canal. The hand specialist may suggest this treatment.

The surgery, when done by an experienced surgeon often has good to excellent results. It is pretty well studied. Historically, surgical failure was due to operating for CTS on a person who did not have CTS. Since you had a positive nerve conduction study, you most likely really do have CTS. Of course, the surgery is not 100% complication free. Regardless, in most cases, the risks of not having the surgery are greater than the risks of having surgery.

The problem with not having surgery (if no reversible cause is found) is the relatively high likelihood of permanent loss of some (or a lot) median nerve function. That means loss of sensory function of the thumb, index finger, long finger and part of the ring finger. That is a bad outcome and makes hands feel clumsy and swollen. So, letting CTS go untreated for for too long (more than a couple of months is the beginning of too long) is best avoided.

Ulnar nerve issues are quite different and treatment depends on the location of the compression of the nerve (elbow is most common). Surgical treatment can be less successful and is probably best used as a last resort. Partly, it depends on whether a specific cause of the compression of the nerve can be found.

Finally, having two nerves that are both showing compression (that leads to either slowing of the nerve velocity or diminished intensity of nerve response, called low amplitude) is a bit of a coincidence. The docs should be sure that this is just a coincidence and not an indication of an underlying systemic susceptibility to nerve compression.

Remember, I do not know anything about you (age, medical history, medications, etc) so my comments are for general information only and should not be used as medical treatment or medical advice.

BTW, although a bit of a generalization, I tend to prefer ergonomists who come from a biomechanical engineering background than a physical therapy background. Both can be excellent, it depends on their perspective.

 

[asechrest]

Thanks for the comments. My right median motor amplitude was 2.6 mV, vs. 10.3 for the left. Says normal is >5. Sensory shows normal, but I'm having altered feeling, tingling, etc. in the palm and fingers. Looking forward to seeing the hand specialist.

Left Ulnar motor has a low velocity number at the elbow. Amp is normal.

Overall symptoms are quite similar bilaterally, so my normal numbers on left median confuse me.

 

[docmirror]

Motor involvement means that the nerve condition test showed abnormalities of the median nerve across the wrist (the location of the carpal tunnel) that included findings of reduced "velocity" or "amplitude" of the nerve fibers that go to the muscles at the base of the thumb (hence "motor") and (most likely) the fibers that allow for the perception of sensation of the skin (touch, etc, called "sensory") as well.

~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

BTW, although a bit of a generalization, I tend to prefer ergonomists who come from a biomechanical engineering background than a physical therapy background. Both can be excellent, it depends on their perspective.

Jeez, well done sir. I have a feeling I should be writing a check here. Thanks for this, even those who aren't suffering from any of it can use a lot of this.

 

[docmirror]

Thanks for the comments. My right median motor amplitude was 2.6 mV, vs. 10.3 for the left. Says normal is >5. Sensory shows normal, but I'm having altered feeling, tingling, etc. in the palm and fingers. Looking forward to seeing the hand specialist.

I have to ask this.

Do you play a lot of computer games?

Sorry....

 

[asechrest]

I have to ask this.

Do you play a lot of computer games?

Sorry....

Not in a number of years, but was practically addicted in college. I am a habitual computer user, though. All day at work, plus hobbies that involve the computer: hobby coding, dabble in web design, tinker in Linux, etc.

 

[asechrest]

Need to offer additional thanks to pilot1956 for the really detailed post. I appreciate it.

 

[pilot1956]

Glad it was useful.

Bilateral carpal tunnel syndrome is not uncommon and would explain similar symptoms in both hands. The ulnar nerve provides sensory function to the small finger (pinkie) and part of the ring finger. The median nerve provides sensory function to the thumb, index, middle, and part of the ring finger. So, the location of symptoms should be quite different on each hand if the test results are correct.

It gets hard to second guess the test results. When done correctly, the nerve tests are excellent. But, if not done well, they can be error prone.

If your symptoms are extremely similar in both hands (especially the same fingers), I'd be concerned that you have CTS in both hands and that the test was not correct.

Sorry to add uncertainty.

 

[asechrest]

Thanks. You're helping me formulate questions for the doc. I was not impressed with the technician doing the NCV. She was also doing receptionist duty and was incredibly rushed during the procedure. I also had an EMG, performed by the doc. All normal and I felt good about that one.

I'm going to pay close attention to the palm-side symptoms between now and my appointment to see if they're in different spots on each hand. I think I have some non-CTS problems (described in OP and substantially subsided since I stopped traditional typing) that are confusing the issue with additional symptoms in various areas of the hands and wrist.

It's interesting in that what sent me to the doc a few weeks ago was the weakness and fatigue on the extensor side of the forearms and wrists, but that has subsided and now some classic CTS symptoms are flaring up. Other CTS signs are non-existent: I never wake up at night with numb hands, and the Tinel Test was negative on my right wrist (apparently the bad one), and only barely positive on the left wrist.

I'd rather be cut 1000 times than deal with non-definitive internal stuff like this. It's hell getting old, and I'm only 35.

 

[SCCutler]

Probably not relevant, but let me tell you my experience.

I was feeling a great deal of pain in my right hand and wrist (especially, wrist), and on up into the forearm. It seemed to me that it was exacerbated as I used the mouse on the computer (use the computer all day at work), so on a lark, I bought a trackball to replace the mouse; because I am right-handed, I got one with the ball on the left side for my thumb to manipulate, with the buttons on the right side for my forefinger and second finger.

I almost threw the thing against the wall several times before becoming accustomed to its use, but after about a week I was fine; the pain completely disappeared. This has been for, probably, five years now.

 

[asechrest]

Spike: Thanks for that. I definitely need some workstation changes when this is all said and done. I've already gone from typing 90 WPM to two-finger typing or voice dictation while on mobile. Seems to have helped me tendon and top forearm issues.

My pain has been mild - 2 or 3 on the scale - but frustrating because it's constant. But I don't mind pain. What I don't do well with is the sense that my body isn't working right. So the nerve issues, numbness, and fear that I've done permanent damage that'll affect use of my hands, grates on me more than the pain.