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Carpal Tunnel Syndrome

A Look at Repetitive Strain Injuries

Repetitive strain injuries (RSI's), have come to be known as the occupational disease of the Millennium. Even though many of us have never even heard of a repetitive strain injury, they account for up to 60% of workplace illnesses. It has also been estimated that RSI's will cost American businesses an estimated 20 billion dollars this year. What is the source of these new injuries and why haven't I heard of before?

RSI's are a relatively new form of injury. As the name implies, the injury is caused by constant repetitions of a specified motion and by holding an awkward position for an extended period of time. Some high risk occupations include people like musicians, meat packers, grocery cashiers, restocking personnel and above all the computer operator. Even using a mouse or a track ball has been found to be major cause of RSI's, especially since they require the hand to be in an unnatural position during operation.

In the past, much of the work that is now completed on computers used to be done on typewriters. At first look, these two devices would appear to be very similar. However, using a computer keyboard is very different from using a manual typewriter. With the advent of computers, typist actually increased their output to over 120 words per minute. The solution to this modern problem is what is called workplace ergonomics. Ergonomics is the science that seeks to adapt work or working conditions to suit the worker. Typically this can involve anything from the restructuring of a job, to instituting scheduled exercises and stretching programs and to educating employees about controlling additional risk factors such as smoking, weight management and stress. However, one of the simplest ways to get started is with this 10 point quick check list of workplace ergonomics.

When you are at your workstation, the head and neck should be in line with the body in a relaxed state and centered between the shoulders. The monitor should be placed directly in front of the viewer, free of glare and placed slightly below eye level. The document holder should be as close to the screen as possible and placed at the same height. Eyes should be approximately at arm's length from the monitor. The low back should be straight and supported by a forward curve or a lumbar roll. Knees should be placed at approximately a 90 degree angle and placed slightly lower than the hip joint. Feet should be flat on the floor with the legs uncrossed with freedom to move. Hands and wrists should be straight and relaxed without bending up, down or sideways. Frequently used work tools should be placed within easy reach without leaning or twisting excessively. The keyboard should be low enough to let arms hang naturally with elbows close to body. These are the basics of ergonomics, but a few specifics still need to be discussed in order to cover the subject adequately.

First, the most common cause of soft tissue damage to the wrist is caused by a posture we will call the upward rester. The rester will rest his or her wrist on the edge of the table while typing on the keyboard. This causes upward movement of the hand puts a bend in the wrist, which ends up applying excessive pressure over the carpal tunnel. However, I do usually recommend a keyboard pad to help eliminate this problem. The Leaner is another category of postural problem where the person leans their elbows either on the arms of the chairs or the desk, which creates some pressure over the ulnar nerve and in the shoulder girdle. Pounders press the key harder than necessary. Because of the huge number of keyboard strokes an operator can make in a day, this can cause up 2,000 pounds of unnecessary pressure to go through the hands. Long finger nails can also make this problem worse. Pressers are the hold the keys down for to long, which leads to increased joint pressure and eventual joint collapse. Holders keep their fingers extended most of the time while they are typing, instead of in a relaxed position. This can lead to a strain, sprain or fatigue of the intrinsic muscles and tendons of the hand. Grippers are the people who use or hold a mouse excessively tight, while tappers use a single digit and too much force when they click on their mouse. Holding the mouse loosely, using different fingers to click with and keeping the wrist in neutral position while using your mouse will definitely help with this problem. Currently, there are several mouse pads that have built in wrist pads that help to keep the wrist in a more neutral position. if you follow these simple rules your chances for getting a RSI will be substantially diminished.

When we think of RSI's most people think of carpal tunnel syndrome, but it usually only accounts for approximately 10% of the RSI's. However, any type of pain, numbness or excessive fatigue in the hands, elbows, shoulders, neck or low back can be caused by a RSI. If you have any of the before mentioned symptoms or if you work on the computer more than 2-4 hours per day, please begin implementing some of the workplace ergonomics we have talked about in this article. However, if after implementing basic ergonomics your symptoms do not subside, then make an appointment with a qualified physician for further evaluation. Taking frequent breaks to stretch and exercise is always helpful in treating RSI's. Consulting your chiropractor is also helpful because his knowledge of the wrist, elbow, shoulders and neck can help to rule out what is really the cause of the discomfort. If you have any additional questions, please call our office or e-mail Dr. Kruse with your questions.

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