Carpal Tunnel Surgery?

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? "

Re:trackball

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)

CTS, My experience (and solution!)

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.

Learn Dvorak!

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 :)

Your not lefthanded are you?

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.

Re:symptoms

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!

Re:Some useful links

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)

there is no easy fix

"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.

Something I know fairly well....

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 :)

Re:symptoms

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)

Some useful links

[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

Re:Learn Dvorak! (but be careful)

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.

DO NOT GET SURGERY

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
[e-mail]