# Too much Computer Time - Wrists Starting to hurt.



## jtice (Nov 17, 2005)

Well, I think the 12+ hours a day a spend in front of a computer each day,
are finally starting to catchup with me. 

I have noticed that my wrists hurt rather often now, especially when typing.
Even when working the mouse for a few hours my wrist hurts.
I think the fact that my wrist, or forearm, rests on the edge of the desk may be doing that.

Is this the first signs of carpulltunnel setting in? ? ?  
The weather has resantly gotten alot colder, that may have to do with it also.

Any suggestions to make my computing hours more comfortable?

Thanks
~John


----------



## Lynx_Arc (Nov 17, 2005)

Back years ago I was working overtime as a carpenter sanding trim etc all day for 10 hour shifts and coming home and playing computer games for 5-6 hours and my mouse wrist started hurting. I switched to a trackball and the problem subsided. I do have a nice wrist wrest and a chair with arms on it and have my arms high enough I am wresting my palms on the wrist wrest and not my wrists. I have been doing data entry 8 hours a day and on the computer here and have had no problems.

Spend the money on a comfortable wrist rest, elevate your chair higher so your wrists are not getting as much stress on them and take breaks every few hours.

It took me about 6 weeks to get used to a trackball and I now do not care for a mouse as you do not have to chase a trackball which give you no wrist problems. I have had a trackman 2 since 1992 then a trackman marble in 1996 which I have replaced two switches already I have used it a lot.


----------



## greenLED (Nov 17, 2005)

Yup, sounds like it. The next symptoms I got were weird pains on my hands (out of the blue). Here's what I did:

- got myself a contoured keyboard (microsoft brand, but I'm sure there are others). I touch-type, so that wasn't a concern.
- if you insist on using the regular keyboard, at least get a gel pad for your wrists
- you can get a gelpad for your mouse too
- I do regular stretches on my wrists, forearms, neck. 
- change the height/angle of the keyboard. IMO, they should ban those little legs on the back of keyboards, they give the wrong angle to your typing position. Anyway, the ideal angle is actually with the egde farthest from you pointing *down* a bit (this keeps your wrists at a more neutral position).

BRB with linkys

Ha! Found them; these are the ones I do; they work for me.
Here's the NIH page on carpal tunnel.


Hope these work for you!

Here's the keyboard I have. Nothing fancy, and I actually got it for $0.50 at the local surplus place. There are other fancier ones too.


----------



## greg_in_canada (Nov 17, 2005)

I switched to an ergonomic keyboard about 7 years ago (after wrecking my wrists
by typing with a keyboard in my lap for a month) and haven't had much problems
since then. The symptoms were that my pinkies were going numb plus
lesser problems with my other fingers.

I also switched to mousing with my left hand (I'm left handed). At home
we have the mouse on the right. So I guess that balances out the wear
and tear on my wrists.

I also pay attention to my wrist angles when I type to avoid causing
damage.

Greg


----------



## IsaacHayes (Nov 17, 2005)

GreenLED: I totally agree with you on the back feet on keyboards. I allways make mine flat, as if it's angled it hurts right from the get go. I like to keep my chair at a lower height though, so my fore arms are parallel to the ground, and my wrists don't angle up or down from my forearms. If my chair is too high, then my wrists are bent angling upwards, like the legs on the back of the keyboard are up...


----------



## RebelRAM (Nov 17, 2005)

I agree on the trackball comments. I switched to a trackball 2 years ago and it was definitely easier on my wrists. It's so much easier to move your fingers and thumb than having to move your whole hand and wrist to move a mouse. A lot of people hate trackballs, but once you get used to it you can navigate just as well if not better than with a mouse.

I use Logitech stuff whenever I can and their trackballs are very comfortable.


----------



## balazer (Nov 17, 2005)

Posture is really important. Make sure the table, chair, monitor, keyboard and mouse heights and positions are such that you lower legs are vertical, upper legs are horizontal, back is straight and vertical, upper arms are vertical, and lower arms are horizontal. Your wrists should be straight and very relaxed when your hands are on the keyboard or when a hand is on the mouse. The center of your monitor should be at eye level.

Fix ALL of that, and only after fixing those things should you worry about fancy keyboards or gel pads. 

You might consider switching to the Dvorak keyboard layout. It's easier on your hands.


----------



## jtr1962 (Nov 17, 2005)

This thread I started about my carpal tunnel problems contains some helpful advice. The best advice I can offer is stop when the pain starts. It sounds like you're well on your way to developing CTS if you don't already have it. Better to nip it in the bud than let it get to the point mine has where I can't work full time any more.


----------



## Hookd_On_Photons (Nov 17, 2005)

A general overview of carpal tunnel syndrome, at the American Society for Surgery of the Hand website:

http://www.assh.org/Template.cfm?Section=Carpal_Tunnel_Syndrome

The information on the web page is basically the same as the pamphlet that the ASSH offers for sale to its members, which are intended to give to patients in the office.

In the thread that jtr1962 linked to, I'd mentioned "nerve and tendon gliding exercises" as part of a program to treat carpal tunnel syndrome nonsurgically.

If you're interested in clinical studies evaluating their efficacy, here are a couple of references:

http://www.ncbi.nlm.nih.gov/entrez/...ve&db=pubmed&dopt=Abstract&list_uids=11807347

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&dopt=Abstract&list_uids=9730093

And here are the exercises.

These are the nerve stretching exercises. Maintain each position for seven seconds. Go through the cycle of exercises five times. Go through the entire sequence for 3 to 5 sessions a day, perhaps worked into a rest break from typing or whatever activity aggravates symptoms.

A: forearm in neutral rotation ("karate chop" position), wrist neutral (straight), fingers and thumb flexed (clasped to make a loose fist)
B: forearm neutral, wrist neutral, fingers and thumb extended
C: wrist dorsiflexed (bent "back"), fingers and thumb same as B
D: wrist and fingers same as C, radially abduct thumb (stick it out away from the other fingers, so the fingers and thumb form an "L")
E: forearm supinated (palm facing up), fingers and thumb same as D
F: same as E, gently stretch thumb





And here are the tendon stretching exercises. Same number of repetitions and sets as the nerve glides. All exercises are done with the wrist in neutral (straight).

A: fingers extended
B: interphalangeal joints flexed (the two distal joints in each finger), metacarpophalangeal joints ("knuckles") extended
C: all finger joints flexed and thumb opposed over closed fist
D: IP joints extended, MCP joints flexed (opposite of B)
E: flex MCP joints and proximal interphalangeal joints, extend and radially abduct thumb (like making a "thumbs up" sign, but keep the joints at the tips of the fingers extended)






Some hand therapists recommend "contrast baths", which involve soaking the hand(s) in warm water for 4 minutes, then cold water for 1 minute, prior to performing the nerve/tendon gliding modalities. The heat probably helps to limber up before doing the exercises, but it can be a hassle to find a sink or tub of water several times a day in order to do the program "by the book".

The theory behind these exercises is to prevent the median nerve and flexor tendons from becoming restricted and "bound down" within the carpal tunnel.

Everybody intuitively understands that there is some excursion (to-and-fro motion) of the tendons when the muscles contract and the joints move. The median nerve glides too, with joint motion. Cadaveric studies have demonstrated median nerve excursion of about 20 mm when the wrist goes from maximal extension to flexion. In vivo observations during surgery have reported excursion of 20-30mm. If things get "stuck" within the carpal tunnel, you may develop traction on the nerve that can irritate or eventually damage it.

There are nine flexor tendons that are contained within the carpal tunnel: one flexor for the thumb, a deep system for the other 4 fingers that flexes the distal interphalangeal joints (the joint at the tip), and a superficial system that flexes the proximal interphalangeal joints (the joint "in the middle" of the finger).

The nerve, flexor pollicis longus tendon (thumb flexor), flexor digitorum profundus tendons (deep system), and flexor digitorum supericialis tendons (superficial system) are all supposed to glide independently. Each of the exercises focuses upon a different aspect of the nerve and tendon system, promoting independent excursion of each.

Sorry for the long-winded explanation, but some people prefer to know the principle behind the recommended treatment, and why just flapping the wrist and fingers from flexion to extension wouldn't be good enough.


----------



## InfidelCastro (Nov 18, 2005)

I've had the same problem for quite awhile now. I switched to my left hand for using the mouse, but my left wrist doesn't like it much either. Hope I don't get carpal.


----------



## greenLED (Nov 18, 2005)

Hooked_on_Photons, the back of my hands got sore when I do the movements you recommend. They also feel "tight" after performing the motions. I did not expect this to happen (why did it happen?). Would there be any added benefit to doing complementary stretching exercises? I'm one of those who likes to know how things work  :thanks:


----------



## Hookd_On_Photons (Nov 18, 2005)

You might be stretching the intrinsic muscles of the hand, which could result in some muscular soreness.

There are _extrinsic_ flexor and extensor muscles. The muscles originate at the elbow or forearm, and insert via tendons to bones in the hand. If you relax your hand and dorsiflex your wrist, notice that the fingers passively drop into flexion. That is due to the passive tethering action of the extrinsic flexors. Likewise, palmarflexion of the wrist results in passive extension of the fingers due to tenodesis of the extrinsic extensors.

There are _intrinsic_ muscles, which originate and insert entirely within the hand, such as the wad of muscles on the palm at the base of the thumb that oppose the thumb.

Explanation and some diagrams here:

http://www.wheelessonline.com/ortho/intrinsic_muscles_of_the_hand

If the pain is in the metacarpal region (on the "top" of the palm), the interosseous muscles are probably being stretched. The intrinsic muscles flex the MCP joints and extend the PIP/DIP joints (position D in the tendon stretches). Position B is the "intrinsic minus" position (the opposite of D), and stretches the intrinsic musculature.

If the pain is in the wrist region, you might be exerting too much muscular force to actively dorsiflex the wrist and hand. The exercises should be done gently.

You do not have to maximally dorsiflex the wrist, either. 60 degrees or so (as measured from the reference of a line drawn straight down the axis of the forearm) is probably enough. Excessive dorsiflexion could pinch the extensor tendons on the dorsum of the wrist, as they exit from under the extensor retinaculum:

http://www.wheelessonline.com/ortho/anatomy_of_the_upper_limb_6

The retinaculum is that band-like structure at the wrist region. It prevents bowstringing of the tendons with wrist dorsiflexion.

Do whatever exercises are comfortable for you.

I posted those exercises, because those were the ones performed by patients in the studies in the links I provided.

The exercises you linked on eatonhand.com aren't bad, but I would caution people with carpal tunnel syndrome to avoid the extremes of wrist dorsi/palmar flexion. Several studies have shown that pressures within the carpal tunnel increase dramatically with extreme dorsi/palmar flexion of the wrist.

That's my free advice, and it's worth every penny! :nana:


----------

