Carpal tunnel solutions?

I've mentioned in one or two threads that I have carpal tunnel. The severity varies from mild to severe, depending upon whether or not I avoid certain activities. Anything involving pressing and pushing, like scrubbing or sanding, aggravates it severely. Using a mouse for long periods can also cause problems, as can riding a bike. Typing generally only affects it when I type a lot, as in several pages or more a day. Overall, it's bad enough that working a regular 40 hour a week job has been impossible since 1990 but I get by living with my parents and doing freelance engineering and electronic repair work.

Anyway, I've been ill the last few days so I haven't been doing anything which could possibly aggravate my carpal tunnel. In fact, I've been pretty much lying in bed most of the day watching TV. Anyway, about 3AM early Sunday morning I woke up with a horrible pain in my right hand coupled with a feeling of electricity shooting up the arm. I literally couldn't even bend my fingers for an hour due to the pain. The pain gradually lessened but I still have some, and when I bend my fingers they sort of lock up about halfway. Not literally lock up, but the motion feels that way. I'm completely at a loss as to why this happened. My left hand feels normal. Even when I was helping my brother with ceramic tiling a few months ago I didn't get this much pain.

Any ideas on what caused this? Also, any ideas on how I can lessen the effects of carpal tunnel so that certain activities don't affect it as much? I can't afford to see a doctor and I avoid medications (except aspirin) like the plague. What I'm looking for is maybe certain exercises I can do. Frankly, with a lot of work needing to be done around the house now, and also I anticipate getting a decent amount of freelance work, this couldn't have come at a worse time.

There are stretches and exercises that supposedly can help with CTS. I couldn't find my link to them, but a google search might turn some up. I personally found that swithcing from a mouse to a track ball and from a normal keyboard to an ergonomic, curved one helped out.

Your symptoms sound severe and not typical for CTS. I think you need a doctor.

I get "some" relief by pressing both of my hands, palm first, against a wall, with my hands totally perpendicular to my arms. Hold them there for a few minutes if you can. You will feel a stretch in each wrist.

It's also imperative to wear wrist splints at night while sleeping, and as often as possible during the day. You can pick them up at any Walmart or other store in the pharmacy section.

It takes time for all of this to work. I've had exactly the same problems for 4 years now -- I can't work on flashlights at all. I'm finally considering getting the operations on both wrists. Doctor says it's probably time.

Good luck to you.

Tom

It's a horrible pain! I got myself an ergonomic keyboard and do stretching exercises. I also used braces for a while. It sounds like your case is really bad, though. I've heard severe cases may require surgery... /ubbthreads/images/graemlins/frown.gif

Immediately correct bad ergonomics. I haven't used a mouse in 10 years. Track ball works but even though I'm right handed, I use my left hand. Figure out a way to maintain your hands in a neutral position especially when you're asleep. It helps me to use body pillows on both sides so that my wrists are not overly bent. I couldn't tolerate wrist supports, but maybe you can. Streaching and careful warm up is helpful. Iceing after activity might be appropriate. Find a good physical therapist.

Good luck!

While I'm no doctor (and have never even played one on TV /ubbthreads/images/graemlins/grin.gif ) I would consider surgery only as a last resort.

When I looked into CTS a couple years ago I found something that I thought was very surprising/disturbing. In the States, CTS is often treated with surgery -- but virtually everywhere else it is considered a posture problem. If it is a posture problem it will almost certainly recur at some point after surgery.

I always have trouble getting Google Search Result URLs to post right but this URL will give you all of the results from my Google search:

http://snipurl.com/e38g

I'll second the idea about the trackball. Logitech makes the most ergonomic IMO. A company called CIRQUE also makes a very good touchpad, which is even more ergonomic than any trackball. I've had one for years.

The ergo keyboard is probably a good idea, too. In the search results linked to above, there are many helpful graphics showing how to set up a computer workstation to minimize CTS. Make sure that your monitor is the right height and pointed in the right direction. An office chair where you can adjust both the height of the seat AND armrests will make correcting your posture at the computer much easier. Make sure that you don't have a glare problem. Even after you have conciously set up everything at your computer so your posture is right, glare from your monitor can cause you to twist yourself out of the posture you want.

IMO to be really successful in this endeavor it may take lots of attention to detail to get the payoff.

If it were me I would actually start out by considering my painful computer activity as symptomatic instead of causal, until proven otherwise. I would try to take a close look at my posture in every activity I have. I'd try to make a complete list of all of my physical activities and my posture in each situation. You'll have to chip away at it bit by bit. It took a long time for your CTS to get this way and it is only realistic to think that it may take some time and real effort to conquer it.

Read as many of the web articles on CTS and posture as you can and try to think about the problem as you do things in your daily routine. Many, many, many of the articles will be computer related -- so when you get that squared away, run the search again, adding one of the following terms:
<ul type="square">
[*] +driving
[*] +commute
[*] +bicycle
[*] +garden
[*] +golf
[*] +guitar
[/list]
Obviously, throw in words that reflect your activities. Try to find out: (A) if others have associated similar activities to their CTS problem, and (B), find out what they did differently to prevent the activity from aggrivating their CTS.

Below is a link to a search I ran on Google Groups. Google Groups allows you to search their archive of 700,000,000 Usenet posts on a bazillion subjects. Usenet is great because you can search for specific things and find out lots of 'nuts and bolts' solutions from real people. Like CPF, you can ask questions if your search doesn't get results.

http://snipurl.com/e39p

As with the other Google search, plug in words from your own 'activity list' to find real life solutions to what's causing your CTS.

Hope this gives you some things to think about.

Me too. Battling the %^!$@%#!@%#$%^ evil worker's comp *******s now. After trying everything, the best product I've found is contour's rollermouse.. it really eases those mousing pains. Google it and check it out.

Still haven't found an ideal keyboard, and I've tried many.. I'm hoping the answer doesn't end up being 'no keyboards of any sort'. Speaking of which, anyone want to purchase an unused Datahand keyboard..? /ubbthreads/images/graemlins/smile.gif

I don't want surgery.

Physical therapy, and rest have helped the most. Stop doing the things that hurt- completely. Make your loved ones do it, because that's what you need to heal, and if they want to help you, that's what they need to do. If you find yourself resting so much you're getting excruciatingly bored and taking long walks, you're on the right path. Rest rest rest, and stay away from CPF /ubbthreads/images/graemlins/frown.gif I've found it is a proven CTS exacerbator, in fact it is doing so right now...

Also remember CTS symptoms can come from anywhere between the neck, shoulder, elbow, and wrists, so good posture and ergonomics are abolutely essential.

best of luck to all.

One more plug for wearing wrist splints at night to keep your wrist in a neutral position! Wearing them during the day may help, but may also put more force through your wrist. An anti-inflamatory like ibuprophen may also be helpful. If your symptoms are changing or worsening, I'd definately recommend seeing a doctor. There's a nerve test called an EMG that can help determine if your symptoms are from the nerve going through the carpal tunnel or from another nerve being injured in your wrist, arm, or even your neck. Bad carpal tunnel can cause the muscles in your hands to get weaker and waste away and can also cause numbness in your fingers (usually your thumb, pointer finger, middle finger, and sometimes part of your ring finger). The carpal tunnel release surgery actually has a very good track record; much better than most surgeries.

Wrist extension exercises and stretches may help. Definately try splints at night. Avoid bending your wrist either up or down (closes off the tunnel). See a doc if things are changing/ getting worse!

Hope this helps. /ubbthreads/images/graemlins/smile.gif

I battled with my Doctor for more than a year, because I did not believe in CTS.

But when the pain became constant I agreed to the surgery and now some 10 years later no problem.

The surgery is a piece of cake. /ubbthreads/images/graemlins/wink.gif

Thanks everyone for the answers so far. It's good to know I'm not the only one suffering from this. I've read everything and I'm in the process of disgesting it. I think a little family background might help further here.

My mom got CTS through a combination of job-related and home-related factors. Being practically the sole caretaker of three young children (me and my siblings) because my dad rarely lifted a finger to help, she did the bulk of the housework. In the mid 1970s she went back to work-first as a railroad clerk for the MTA and later as a Bridge and Tunnel Officer. Both jobs required constant use of her hands. The BTO job also added severe weather to the mix. By 1985 at age 46 she was completely unable to work, although the symptoms had appeared for years before (the doctors called it "arthritis"). She had the EMG tests done several times. Doctors who examined her said that it was the worst case of CTS they had ever seen. Most of the nerves were completely dead. She had the operation mentioned here with mixed results. While the pain has been reduced, she never regained full feeling or motion in either hand. BTW, for years prior to the operation she tried splints with some minor positive results. She was able to qualify for disability from her employer after she was rejected by Social Security. Don't forget, recognition of CTS and other RSIs were in their infancy then because they didn't become commonplace until everyone started using computers.

Now on to me. I probably developed the early symptoms of this maybe even in high school or college. It's difficult to tell because I used to write lengthy reports and take tons of notes. I chalked up any pains to overuse of my hands. In summer when school was out I felt fine but from what I understand the effects are cumulative. Unfortunately, after graduating I couldn't find work in my field so I took whatever was available. I spent about a year taking inventory. This involved hitting a keypad all day long, and often counting frozen foods. After this job I was hired by a taximeter repair shop. Here also a lot of my duties were repetitive, including some assembly work. By mid 1990 my hands hurt so badly that I would have quit by December had I not been laid off when the NYC branch was closed. After that I did taximeter repairs at home, and also quite a bit of home-related chores (ceramic tiling, concrete work, gardening). My hands didn't seem to get any worse since then, but they didn't get any better either, even with long periods of rest (in 2002 I went almost a year with no work because the economy slowed after the 9/11 attacks). My first post in this thread pretty much describes the state I'm in now. I think I read somewhere that smaller than average wrist size is a good predictor of who is suspectible. I'm not sure what's average for my height (5'9") but my wrist measures 6.75" around.

To address a few points brought up:

1) I've tried my mom's splints with mixed results. Part of the problem is that they're simply too uncomfortable for me to sleep with on a consistent basis. One person here also mentioned that he couldn't tolerate them. If none of the other things mentioned work I'll reconsider trying them for a few weeks and see if I get any results.

2) I've been using a wrist rest for my mouse and keyboard. I found that for the mouse especially it made a huge difference. I don't use the keyboard enough to have noticed it making the problem any worse, but keeping my hands in a neutral position does seem to speed up my typing. I've tried trackballs but found they lack the precision of the mouse, and also felt weird. Maybe it's a matter of finding the right one perhaps? Any mouse alternatives besides trackballs and trackpads? Ideally, something that tracks the cursor to my eye movements would be ideal but I don't think that exists yet. So long as I limit my computer use to 2 hours a day or less I find that my present setup causes no additional problems, but there are times my usage exceeds that for work-related reasons. When I do eight or ten hours a day for a few days straight it hurts.

3) Surgery. Based on my mom's mixed results and Sub_Umbra's post that the problem is often posture related, I'm not sure I want to go this route at all. Right now it's out of the question for cost reasons anyway. My mom's insurance paid $6000 for the procedure over 15 years ago. For me it would be out of pocket, and would cost who knows what now. Does anyone know roughly what the procedure costs nowadays in case I eventually warm up to the idea (and have the money)?

4) Continuing about posture causing this, I will seriously look at exactly how I do every activity. Just based on my observations so far, I usually sit erect when I'm at the computer or working at my electronics bench. Nobody has told me I slouch or anything unusual when I walk. I think cycling may aggravate this because I ride a bike with drop-down handlebars which results in my wrist being bent at awkward angles, often while applying the brake levers. I'll have to look into this further the next few rides and see if there's anything I can change. I'm sure a recumbent would be 100% better, and not just from a posture standpoint. Maybe this is worth looking into when I can afford a new bike.

5) Regarding numbness in the fingers and so forth, I'd say that 50% of the feeling in my hands is gone on a good day but I retain enough to still solder surface mount parts (with the help of a good tweezer). On a bad day, or sometimes when I wake up, I have almost no feeling in my hands. In fact, on one of these bad days once I burned myself with the soldering iron and didn't notice it until I washed my hands two hours later. Based on the posts here, I think that means I've got a pretty severe case which surgery may not help.

6) I intend to try the exercises mentioned here and also google for some more. I've tried elevating my arms above my head and keeping them there for ten or twenty minutes while I watch TV. I can't say it's helped the carpal tunnel, but it's made me feel better in other ways.

7) As loalight mentioned, stopping activity which aggravates this is a good idea. Unfortunately, I'm too much like my mom who either fights through or denies pain. That's probably why we've both gotten as bad as we have. Anyway, I have avoided certain activities altogether which aggravate the condition in short order. The most notable of these is anything involving applying pressure while pushing forwards. I'm just puzzled as to what exactly happened this weekend since I don't remember doing anything known to aggravate my condition. Can this condition suddenly take a turn for the worse even when you're not doing anything to aggravate it?

8) As for ibuprophen or similar anti-inflammatory drugs I haven't tried them personally but my mom had absolutely no results with a few different types, and some side effects (rectal bleeding IIRC). I did try some aspirins yesterday with no results. I'll try to keep an open mind here anyway despite my mom's negative results with drugs.

Now I'll avoid CPF for a while since it is a known aggravator of CTS. /ubbthreads/images/graemlins/wink.gif Please keep the answers coming. I'm encouraged by what I've read so far. If I can't cure my condtion, hopefully i can alleviate it. If nothing else, I'm amazed at how commonplace this condition is becoming, both due to computers and also to jobs which are increasing specialized (and hence repetitive).

jtr,

Sorry to hear about your situation but as others have said, splinting at night, along with NSAIDs, is your best bet for night time relief.

Contrary to what was good medical advice several years ago, PT does not help the CTS healing because movement is what caused the problem in the first place. Inaction is best until that modality doesn't cure or relieve you from the effects of your injury.

If R&R doesn't help you might consider a steroid injection to relieve the inflammation around the sheath. Not the most pleasant thing to have done but for some, it provides relief.

When nothing else works you should give serious thought to having surgery. Finances aside, it is one of the most successful surgeries around with most orthopaedic surgeons finding 90% or more as either improved or obtaining complete relief.

Something else to consider is your overall health and in particular any factors for diabetes. It's a known cause of peripheral neuropathy giving CTS symptoms. I do not know you ethnic background but African-Americans are more likely to suffer from sarcoidosis which has the nasty side effect of producing granulomas in the wrist giving rise to CTS. It's not common but something to consider.

Finally, do the ergo thing as best as you can.

Good luck.

Improving the ergonomics of my work station helped. Taking ibuprofen also helps me. I to take it on a regular basis for a couple of days, though (don't over-do it, 'cuz of side effects on your digestive system). And yes, I'd get pain out of the blue sometimes. I really hope you can find the right combination of therapies that can help you!

Correct posture, a good chair at the right height and other ergonomics have been helpful for me. I use an Aeron chair, a Kensington trackball, the Kinesis line of keyboards, a keyboard tray and my monitor adjusted to a comfortable height. Add some stretches and monthly acupuncture, and I hope to stave off surgery for as long as possible.

good luck
daloosh

There isn't much good research about therapy's long-term effects on the natural history of carpal tunnel syndrome. It's difficult to perform good science on human subjects. These studies probably have the best methodology of the ones generally quoted in the medical literature:

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&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

I have not found anti-inflammatories to be of much help in long-standing carpal tunnel syndrome. The only situations in which I've found it helps are: 1) a patient who has an inflammatory condition such as rheumatoid arthritis, or 2) a patient without significant prior symptoms, who has an injury or other episode which causes aggravation of symptoms accompanied with swelling and other signs of acute inflammation.

Vitamin B6 has been recommended as a treatment for carpal tunnel syndrome. However, several studies with good methodology have not demonstrated a statistically significant benefit. In the United States, B6 deficiency is rare, as many foods are vitamin fortified.

Avoid alcohol and tobacco. There are other conditions that are associated with carpal tunnel syndrome which may need to be addressed as well: diabetes mellitus, hypothyroidism, gout or rheumatoid arthritis. Obesity is also a risk factor, but that is a condition for which there is no easy cure...

Some splints come with a flexible flat metal bar on the palmar side that maintains the cocked-up wrist position. Some people find it uncomfortable to sleep with the wrist cocked back. See if you can remove the metal bar and flatten it, so that the wrist is in neutral (straight) position.

Avoid forceful grasping and squeezing. Avoid prolonged or repetitive wrist flexion and extension (those positions increase carpal tunnel pressures, flexion [towards the palm] is worse than extension).

Corticosteroid injection can be helpful. It provides symptom relief about 80% of the time. The problem is, it's usually temporary. Only about 22% of patients will still report good relief of symptoms a year later.

Surgery works very well *if you have carpal tunnel syndrome* (some people have the surgery, when they don't actually have CTS!). You have to weigh potential benefits vs. potential risks with any surgical procedure. If you've tried nerve/tendon gliding exercises, ergonomic adjustment, splints, and injections without adequate relief, then go ahead with a carpal tunnel release. If you have constant numbness in the fingers, significant weakness, or thumb muscle atrophy, have the surgery as soon as possible. If the nerve damage progresses to a certain point, it may not recover even after surgery.

That's my free advice, and it's worth every penny...

I've got some symptoms of an RSI in my right wrist. When it starts to get bad I focus hard on my posture for a few days, take Ibuprofen for a few days, and it usually starts to clear up.

Having a variety of computer input devices helps. Right now I have at my disposal:
PowerBook Keyboard
Apple Bluetooth keyboard
PowerBook trackpad
Logitech wireless optical mouse
Logitech wireless optical trackball

Even my traditional input devices are wireless, so I can use them wherever on my desk is most comfortable.



Get yourself some advil or similar, take it in moderate doses for a week or so, watch your posture, and things should clear up.

I really need a better chair for home use. We have Steelcase LEAP chairs at work and they're fantastic, I want one for home when I can afford one. We have Aeron's at our disposal too and most people prefer the LEAPs.

I got the onset of CTS back in 1988. I had to learn to switch hands and spread out the work to both of them. Now I am not quite ambidextrous but I can do most stuff with either hand. I also switched to a trackman II and that helped tremendously. A wrist wrest on my keyboard helped and getting the right heigth to my keyboard also. I found frequent stops of work and massaging the wrists and shaking them helped some also. I now use a trackman marble and notice they no longer make the model awhile back so I had to figure out where to buy switches from to repair it. a wrist rest on your trackball/mouse helps some also for some people.

Well, I had carpal tunnel for decades and didn't realize it. In typing classes they kept saying it was just because I needed conditioning, it got worse by the day.

I'd also noticed it while playing the Tuba.

Working with one of my favorite past times for over three decades, electronics, those little tiny things, and small tools, and obviously working with my hands, it got so painful, I just grinned and beared it.

When dealing with a back surgery/injury issue, the doctor grabbed my hands one day and said, wow, do you have carpal tunnel problems? I said no.

He thought a bit and asked me some questions, and then I told him that lately, in addition to the regular pain, the pain got to an incredible level and then were going numb so that I couldn't feel them, and they didn't work all that well, but still moved fine. He informed me that I did indeed have carpal tunnel.

We did one hand at a time. The first one was bad, as the anesthesiologist got called away, and it was a local. The replacement fella didn't know I'm near immune to alot of anesthesia and many pain killers. When the surgeon started cutting, it hurt so bad my body uncontrollably shaked alot, the fella said he put enough to put down four horses, and it still didn't have much effect- not even taking the edge off firey white hot instrument of near blinding pain and torture. While the surgeon was cutting, I so wanted to get up and punch his lights out, I could feel every stroke of the scapel as it grated against the tendons, and the snap-ping as each finally got cut through, and my hand opening up in the process. The surgeon said I had the biggest and toughest hand tendons he'd ever seen in his decades of surgery (I also had a rare tendon not present in many folks that he had to also cut). He actually had to change blades. Nothing like being cut open "alive", I tell ya (only worse pain was when I crushed a nerve in my back that has left one hand partially numb on the finger tips). The surgeon and I, both soak and wet from sweat from the ordeal, left together, and he wheeled me to the room, and stayed with me for as long as they could keep me down (maybe 15 minutes). When they wouldn't give me my clothes as soon as I got back to the room, I got them myself. I remember the nurse arguing with me about having to wheel me to the door in a chair, and something about paperwork. I think I said something to the effect that she could step aside, or I'd be going through her. To her credit, I did have to physically move her out of the way to leave. The poor surgeon looked really nervous and quite white.

Personally, I felt they were quite lucky I didn't get up and leave in the middle of surgery.

As I found out later, they'd used one of the deadening medications that has nearly no effect on me, and this didn't get written down, so the second guy didn't know.

I was more than pretty nervous and very worried when I went in for the surgery on the second hand (trying to mentally prepare myself for the same thing again- even though the surgeon said he would not start unless he was absolutely certain I could feel nothing), and the surgeon came into the prep area and administered 12 large shots of something different, enough that my hand looked like a off-white balloon.

Guess what? Didn't feel a thing, thank goodness!!!

In the end, both of my hands opened way up, and after 3 months, I hardly felt anything from the surgery. Now I can do things for hours with my hands and it is great. To imagine I put up with it all that time.

I did do a few things to lessen the pain, before. Motrin seemed to help a bit with the swelling, especially if I took it before I had problems. Raising the wrists, and keeping them flat, straight, and inline with my forearms also helped alot. Pausing every five minutes and working the wrists and forearms, shaking out my hands, wiggling the fingers, and such helped alot. Every so often, pause and stretch things out, possibly stretching a bit before you start. It only takes a few seconds worth of wiggle and stretch.

Sorry to hear about your problem.

jtr

Although some folks knock the UK at least our National Health service avoids the misery you are going through and if it affects your job you'd get an operation FOC in a short period of time. The operation is actually carried out in a day procedure unit.

I've watched numerous CTS release operations being performed and the surgery carries minimal risk. The recovery phase including physio therapy takes up to 2-3 months (sometimes much quicker depending on your age and state of health) but doesn't always avoid continuing paraesthesia.

Whilst I dont want to pour cold water on anyone else's advice the fact that you have CTS will undoubtedly mean that exercises will probably speed up the compression on the Carpel tunnel rather than help. I note that you seem to be wary of using Non Steroidal Anti Inflamatories (NSAID's for short) I agree that they can cause gastric irritation but the chances of this occurring will be lessened by taking them after food and by taking the minimal dose recommened but ensuring that you take them regularly! (They should only be used during and for a few days after an acute episode of pain)

Please, please, dont use Aspirin for more than a few days as Aspirin in greater doses than 75mg daily (and then only to try to prevent heart or strokes occurring) is directly implicated in causing gastric irritation and CAN definitely cause abdominal problems.

Whilst the outlook without surgery is not good you can try the following to alleviate pain: When you experience episodes of severe pain you can try to use ice packs around the affected area to calm the irritation (dont use heat) and limit mobility rather than increase actively using the wrist. Splinting May help at night but shouldn't become the norm due to encouraging immobility. Take NSAID's sparingly but at regular intervals during (and only) during flare ups of the pain.

Hope this helps a bit?

Doug

[ QUOTE ]
...Please, please, dont use Aspirin for more than a few days...

[/ QUOTE ]

Asprin is an excellent anti-inflamitory agent. Asprin is safe if you take it with half a glass of water and avoid taking it on an empty stomach. That's it. I've taken it every day since I had a heart attack over 20 years ago -- as have tens of millions of others. Asprin has gotten a bad rap because there is no money to be made on it. If it weren't for heart disease, asprin would be unavailable now.

It is MUCH safer then the OTC drug which is pushed the hardest, Tylenol. The active ingredient in Tylenol is also found in OTC flu meds, OTC sleep meds and others. If you OD on Tylenol, either by taking too much of one med or, more commonly, taking multiple meds with the same active ingredient, you can really mess yourself up. A Tylenol OD can cause permenant, irreversable damage to the liver even before the patient ever becomes symptomatic. Asprin, on the other hand, tells you that you are taking it wrong before any great damage is done.

All drugs are dangerous if taken in a thoughtless manner. Asprin has not fallen out of favor with the medical community because it is unsafe. It has fallen out of favor because it is unprofitable. That is an unpardonable sin in medicine today.

BY the WAY, as I sit here in my 66º room as it rains outside...

Temperature also plays a big role! I found this out this winter when it got cold down here in my office. Warming up a heat pack (I use a warmer thing that's essentially a big rice bean-bag) and having it handy can help greatly, as cold fingers and hands are more prone to inflammation and irritation.