If you use your hands in a repetitive fashion at work or at play and notice your hands and wrists are feeling achey and fatigued, it’s partly because the muscles in your hand are out of balance. Usage of the hands is predominantly a flexion action, where the flexor muscles of the arm contract to bend the fingers inward. This is true for gripping and typing.
So what happens is that the extensor muscles of the arm, which are the ones that straighten out the fingers and bend the wrist upwards, are “overwhelmed” by the action of their reciprocal muscles, the flexors (flexor digitorum, flexor carpi ulnaris and radialis). The action of the joints in a flexor-dominated repetitive activity puts excessive wear to the same, small area on the joint surfaces and can gradually lead to stiffness and pain in the hands. And, it de-conditions the extensor muscles over time; meaning, makes them weak and less responsive. That explains the fatigue factor.
The solution is to do exercises for the extensor muscles to counteract the amount of flexion you do. A simple yet effective exercise is to use a thick rubber band (like the ones that hold together broccoli in the grocery store) and place it around your fingertips and thumb. Open your hand (extend your fingers till they are straight at the knuckles), about one repetition per second. Do about 50 every hour, four hours per day; depending on how much you use your hands. What you’re trying to do is work the extensors as much as your flexors to ensure both groups are getting an equal amount of work out. This will keep the hands strong and resistant to weakness and pain from frequent use.
Carpal tunnel syndrome is a condition where one of the major nerves of the arm gets compressed in the wrist. It can lead to pain, numbness, and tingling in the hands. Advanced symptoms are muscle weakness in the hands, muscle atrophy (shrinking), especially of the thumb pad; and loss of motor coordination in fine dexterity skills, like buttoning a blouse.
The three main nerves that are responsible for controlling the arm are the ulnar, median, and radial nerves. The median nerve, like its name implies, travels down the middle of the arm. It passes through the carpal tunnel which is just above the crease in the wrist before splitting into branches that go to the thumb, index, middle, and inner half of the ring finger.
The carpal tunnel is a small diameter hole formed by the wrist bones and the transverse carpal ligament. It contains the tendons that flex the fingers (flexor tendons), and the median nerve. Pressure as light as a penny can adversely affect nerve tissue, so any pressure increase in the carpal tunnel will over time injure the median nerve.
The most common cause of increased pressure in the carpal tunnel is thickening of the flexor tendons due to long term repetitive use of the fingers such as in typing. Over time the tendons press the median nerve against the rigid transverse carpal ligament. The nerve loses oxygen and it starts to malfunction. Left alone, the damage will be permanent as nerves have a limited ability to regenerate.
Other possible causes are prior injury to the wrist that narrows the carpal tunnel and arthritic or other pathological changes in the wrist bones that cause them to occlude the tunnel.
Pregnancy and thyroid conditions may mimic symptoms of carpal tunnel syndrome.
TREATMENT:
Image via Wikipedia
If the symptoms are advanced (pain, numbness, tingling especially at NIGHT and loss of hand coordination and muscle atrophy) see your doctor. The doctor should refer you to a hand specialist who may order a nerve conduction test to diagnose carpal tunnel syndrome. If your test is positive, you may be referred for physical therapy, which will involve mostly stretching and hand exercises. If that doesn’t work, you may be offered a cortisone injection and exercise prescription, a wrist brace and orders to avoid prolonged hand usage. The last option is carpal tunnel release surgery, where the transverse carpal ligament is surgically cut to relieve pressure in the tunnel.
If your condition is not advanced, do the following:
If your job or hobby requires lots of finger and hand activity, there is a good chance that this is the cause of your symptoms. Check your work station set up and ensure the following:
a. Keyboard should be low enough so that your fingers are at the level of the keyboard when:
your upper arms and shoulders are relaxed; your upper arms (above the elbow) are to the side of your body almost touching;
your elbows are bent 90-100 degrees
your wrists are straight or even bent slightly downward
The most important part is having your shoulders relaxed. To see if you are doing it right, using your right hand press the top of your left upper shoulder, from the neck down to the shoulder joint. It should be relatively soft. If it is not, you are unconsciously contracting the neck and upper trapezius muscles and lifting the arm.
If you find you can’t accomplish the above, due to your desk being too high, you need to get an adjustable keyboard tray and install it under your desk. Place the keyboard on this tray and lower and angle the tray so that you can meet these requirements (see video below on how to do this).
b. The top 1/3 of your monitor screen should be at eye level. Use phone books or a monitor lift to get it to this position. Place the monitor close enough that you don’t have to bend your neck forward to see text on your screen, or adjust your screen settings to magnify the text.
c. The mouse and frequently used equipment should be close so that you don’t have to reach forward for them. Your keyboard tray should have an attached mouse pad; use it.
d. Remember to keep your head in a position where your ears are directly over your shoulders.
e. Every few minutes, relax your hands and wrists for 20-30 seconds.
f. Every hour do the wrist, neck and shoulder exercises in the video.
g. When symptoms are gone, you can do wrist strengthening exercises.
Wrist pain from overuse affects over 50% of people whose job requires frequent typing on a computer keyboard. However, any job or activity that requires repetitious finger movement is capable of causing this type of wrist pain.
The leading culprit is tedonitis, or tendinitis — inflammation of the wrist tendons; more precisely the flexor digitorum tendons which pass through the wrist. As you move your fingers alternating between flexion and extension, which is essentially what typing is, the wrist tendons rub against one another. The tendons are protected by a slippery sheath to allow smooth gliding during movement, but if this sheath loses its protective qualities, it can cause the tendons to inflame and swell. Certain drug side effects and illnesses can cause this; check with your doctor.
The problem with tendonitis is that, by nature it affects tendons of muscles that are needed for work or play; for example the wrist for typing, the elbow for golf and tennis, and the achilles tendon for running. The individual therefore continues in the offending activity until she can no longer tolerate the pain, and by that time a lot of microtrauma has occurred. The microtrauma (tiny tears and fissures in the tendon and sheath) releases inflammatory products and attracts scar tissue formation, which makes them stick together even more. The tendons undergo trophic changes (changes on the cellular level) and don’t function as well as before leading to chronic pain.
Prevention is the key for all cumulative trauma/ repetitive strain injuries– these painful conditions are totally preventable and don’t need to happen in the first place. You don’t want to ignore prevention because tendonitis takes a long time to resolve once it is entrenched. In some cases, tendonitis can lead to carpal tunnel syndrome, where the median nerve in the wrist gets squeezed and injured leading to numbness and weakness of the hand.
For wrist tendonitis from typing, make sure your workstation is ergonomically set up:
Use an adjustable keyboard tray to lower and angle down your keyboard at a level where you don’t need to contract your shoulder muscles to raise your arms above the keyboard.
Keep your upper arms in the same plane as your torso, and close to your sides (don’t type chicken winged).
Keep your elbows angled at about 95-100 degrees, wrists straight in line with the forearm or slightly bent downwards
Use a good chair with lumbar support and if necessary a foot stool to rest your feet on
Head up, ears directly over shoulders, eyes in line with center top 3rd of computer monitor; shoulders relaxed.
Take 30 second to a minute mini-breaks if you are going to be typing more than an hour straight.
Stretch wrists periodically in flexion and extension; hold for 10 seconds; do wrist circles ten times in both directions.
Do shoulder circles ten times in both directions.
Do chest and neck stretches every other hour during the day.
Stand up and do wall angel exercises (50) at least twice during the day to counteract the tendency for neck and shoulder flexion during sitting.
TREATMENT:
1. Do ice massage every two hours during the day if your pain is acute (feels hot, swollen and in some cases, reddish skin). Here’s a YouTube video of how to do it.
2. Apply Red Light Therapy to your wrist. The Red Light torch is great for this. Press it gently but firmly into your wrist and depress the button. Do three times/ day, 10 minutes each. Research shows that red light therapy reduces inflammation, almost as good as a non-steroidal anti-inflammatory medications.
3. To further accelerate healing, apply Pulsed EMF to the painful areas.
SUPPORTING EFFORTS
Eat an anti-inflammation diet for 2-3 weeks: go heavy on fish oils; reduce grain intake; eat plenty of alkaline foods (green leafy plants).
Don’t do stretches when your tendons still hurt; introduce light flexion and extension stretches when the pain drops by at least 75%.
Do your best to reduce the activity that precipitated the tendonitis for 2-3 weeks.
When you have cured yourself of the pain, implement the preventive strategies mentioned above so it never happens again.
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