Carpal Tunnel Syndrome (cont’d)
The Human Body's Caldecott Tunnel
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According to dr.koop.com, Carpal Tunnel Syndrome is caused by pressure exerted on the median nerve of the wrist. "The median nerve supplies sensation to the thumb-side of the palm,a nd to the thumb, index finger, middle finger, and the thumb-side of the ring finger. “It also supplies movement to part of the hand. The nerve enters the hand through a gap formed by the wrist bones (called the carpal bones) and the tough membrane that holds the bones together (the transverse carpal ligament). “This gap is the carpal tunnel. The passageway is rigid, so swelling of any of the tissues in this area can cause compression of the nerve (this is also called entrapment of the nerve).” http://www.drkoop.com/conditions/ency/article/000433.htm For more info, click
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Thus, the keyword here is “Ergonomics.” For more on ergonomics,
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    Notice that the word processor's hands are cramped at an awkward angle on a standard IBM keyboard. It is that awkwardness that puts undue pressure on the median nerve, and thus, the carpal tunnel, which results in Carpal Tunnel Syndrome. |
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Note that resting one's wrist on a so-called wrist rest during typing on the keyboard leads to increased strain and injury. According to co-authors Dr. Emil Pascarelli and Deborah Quilter, “I call wrist rests ‘wrist guides’ because that's what they should do: guide your wrists to keep them straight.
“Most people do what the misnomer [wrist rest] implies and rest their wrists on them, which leads to increased strain and injury. You should never rest your wrists while you work...
“[You should] Hover a half-inch above the wrist rest. “Take frequent mini-breaks*...and “Rest your wrists when you're not typing.” Pascarelli, Emil, M.D. and Deborah Quilter, Repetitive Strain Injury: A Computer User's Guide, New York: John Wiley & Sons, Inc., 1994, p. 169.
There are wrist AND mouse rests/pads available for purchase on-line and at computer stores. See samples pictured above. They range from hard rubber to soft gel-filled. Extrapolating what Dr. Pascarelli said, supra, one should use a so-called mouse rest or pad as a guide to keep the wrist straight rather than as a resting place for the wrist. The latter would put undue pressure and stress on the carpal tunnel as opposed to major arm muscles. Resting the wrist on the mouse rest or pad increases the risk of developing carpal tunnel syndrome. Use the hand as a complete unit in a fluid motion [with the arm in unison] when possible instead of relying on smaller muscles and nerves to do the work normally done by their larger anatomical counterparts. Doing so will spread the stress load over larger muscle and nerve groups than the smaller wrist ones resulting in reduced risk of RSI. Example: Instead of using your left hand fingers to press the CONTROL and ESCAPE keys on the left side of the keyboard, use one of your right hand fingers to press the CONTROL key on the right side of the keyboard, and use one of your left hand fingers to press the ESCAPE key on the left side of the keyboard. Try doing the keystrokes this way and compare it with using just your left hand only. There will be a noticeable reduction of pain and stress with the former than with the latter.
www.paratec.com *The writer recommends 2-3 minute (minimum or more) rest periods or break (with ergonomic exercises) every 30 minutes from computer work. An excellent terminate-and-stay-resident (TSR) software program for this purpose is Stretch Break. Every 30 minutes (or different time interval at user’s discretion), the software program pops up with a gentle dialog box reminder to prompt the user to follow several on-screen animated exercises that are easy to do. Just do what the animated characters do on-screen. Stretch
Break is available for a nominal fee through: (1) Para Technologies,
3273 Indiana Ave., Costa Mesa, CA 92626, or (2) visit http://www.paratec.com
and ask the proprietor, Arthur |
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Notice that the standard IBM keyboard keys are cramped together resulting in cramped fingers reaching keys at locations that put undue strain on the hand. Example: Pressing CONTROL TAB or CONTROL ESC keys with the left hand are uncomfortable positions for the hand. The hand is literally twisted to reach the keys.
That is not the case with so-called ergonomic keyboard such as the Microsoft Natural Keyboard (above) for PC Windows computers. These-so-called alternative keyboards have several split groups of keys that space the hands and fingers for more comfortable typing without the aforementioned cramping. Once you try such a keyboard over an extended period of time, you will feel a noticeable difference in your hands compared to your old IBM keyboard. The hands and fingers are more relaxed with this ergonomic keyboard. The original Microsoft Natural Keyboard was longer and more comfortable than its successor, Microsoft Natural Keyboard Elite. The latter has a mushy feel, instead of a strong tactile feel one is used to with other keyboards. Also, the Elite is somewhat shorter in width resulting in relative minor cramping of hands compared to that of the original Natural Keyboard. I recommend that you buy the Microsoft Natural Keyboard PRO which is built sturdier than the Elite. The tactile, strong feel of keys is still there. Unfortunately, the PRO is not as wide as the original Natural Keyboard. It figures that when Microsoft finally gets something done right, they abandon it.
Of course, there are so-called split ergonomic keyboards for the MAC as well as the PC (left) which further separate the key blocks for more comfortable typing. The more exotic version of the split ergonomic keyboard is the seemingly-piecemeal-hinged version (above). Yes, they would take some getting used to because of their unusual structure. And note that although one's hands, wrists and forearms would be raised slightly parallel to the desk surface, they appear to be uncomfortable. That was my experience when I tested such a keyboard at an ergonomics products trade fair several years ago. However, in the interests of fairness and full disclosure, refer to The Comfort Keyboard Company for more product information. Although such split keyboards originally ranged in price from $400 to $2,000 several years ago, now they may usually sell for around $149.00 plus tax and shipping. Prices may vary, of course. However, they may not necessarily be worth even the reduced price. According to Hilary Bryan, ergonomics consultant, thebodyatwork.com, “I wouldn't feel comfortable using one of those because they're so fragile that I would be afraid of breaking them while typing.” |
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Injury or trauma can result from repetitive movement of the wrists which in turn causes swelling of the tissues — Carpal Tunnel Syndrome.
Note that CTS is a soft tissue and nerve injury which develops cumulatively (over time). Hence, the synonym “Cumulative Trauma Disorder.” It is not a sudden, traumatic injury such as bones broken in a car accident. Since CTS develops over time, one may not know that an injury is developing until it is too late. Such injury is cumulative, not traumatic in nature. Also, soft tissue and nerve injuries may take longer to heal than broken bone injuries depending on the nature and extent of injuries.
[Note that when the injury “occurred” is particularly significant when determining the so-called “date of injury” for purposes of workers’ compensation claims. Since CTS/RSI are cumulative, not traumatic, then a specific date of injury arguably is when your doctor diagnoses your condition as CTS/RSI. It is difficult to determine a precise date of the occurrence of a cumulative injury which, by definition, develops over time as opposed to being caused by aforementioned trauma. However, consult with your attorney concerning this and all legal issues regarding your case.] By then, the body has overcompensated for awkward movements which strains other parts of the body which could result in tennis elbow and other RSIs. Your workers' comp attorney may advise you to cite the date of your first medical exam, or when the symptoms have reached the “unbearable” stage, as your “date of injury.” |
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CTS Symptoms:
An often overlooked cumulative effect of CTS is the patient’s concomitant loss of self-esteem, anxiety, and depression since one can't do the things one used to do. That can be particularly traumatic for musicians, word processors, writers, photographers, butchers, cooks, etc. who can no longer make a living with their hands as they used to do. Diabetes can also be an unexpected result of developing CTS/RSI. If one sits all day and all night 7 days a week hacking away nonstop on a keyboard with few, if any, rest breaks, eats but doesn't walk or do other exercises, then one gains weight and runs the risk of developing diabetes. Again, the author is speaking from personal experience. Fortunately, I lost the 40 pounds that I gained as a direct result of working in the electronic sweat shop known as “Dean Witter Reynolds Corporate Finance.” Thanks to my RSIs, I have had Type 2 Diabetes for a decade. Unfortunately, there is no cure for diabetes. INDIRECT RSIs/CTS are not ordinarily thought of as being the direct results of RSIs, even though they are proximately caused by RSIs, such as: - Depression - Diabetes - Weight Gain - Loss of manual dexterity and/or grip control (as well as grip strength) - Unemployability (since employers may not necessarily want to hire you and risk liability for further/future RSIs and/or other work-related injuries. Also, employers want to avoid paying higher workers' comp insurance premiums. Example: You may be understandably depressed, angry and anxious when you try to use your RSI-damaged hands for pre-injury tasks only to find that you clumsily drop things and now lack the fine dexterity control that you used to have. |
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