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Carpal tunnel syndrome info. Not too thorough, but
KEYBOARDS DO NOT CAUSE CARPAL TUNNEL SYNDROME
by Julia S. Lacey with Tom Dickson, DC,CN and
Howard Levenson,OD
Excerpted from HOW TO SURVIVE YOUR COMPUTER WORKSTATION:
15 EASY STEPS TO WORKSTATION COMFORT published by
CRT Services, Inc. Box 1525, Kerrville,TX 78029
Five short years ago, Carpal Tunnel Syndrome (CTS), a major
type of Repetitive Strain Injury (RSI), accounted for a modest
2 percent of all workplace illness, according to the Occupational
Safety and Health Administration (OSHA).
Today, it accounts for over 50% of all workplace illness.
More than five million people now suffer from RSI, most of which
involves CTS, according to the National Institute for Occupational
Safety and Health (NIOSH). Nationally, CTS annually affects some
230,000 workers, costing each victim about $3,500 in benefits and
and rehabilitation, for a total cost of about $800 million.
NIOSH estimates that more than half of all U.S. workers in
jobs with the potential of repetitive strain disorder, including
nearly half the work force, or some 60 million workers, who use
computers. Some 100,000 cases were due to go to surgery in 1992
at a cost of about $20,000 per worker.
Staggering Rise In Incidence
A 25-fold increase in five years is alone grim news.
Consider, then, that the number of VDTs in the workplace has
increased by only three-fold. Further, CTS is a cumulative
condition which often takes years to develop.
. CTS is generally excrutiatingly painful;
. it can be debiltating;
. surgery is the conventional treatment;
. surgery-plus-recovery generally runs about $20,000;
. surgery is not only painful, but often not successful.
What Is CTS?
CTS is a wrist and hand disorder caused by a pinching of the
median nerve which runs the length of the arm and wrist, then up
into the hand. This nerve has its "home" in the cervical part of
the spine, in what is called the C-7, C-8, nerve root area. The
seventh cervical, just to locate it for you, is the very prominent
vertebra protruding about three inches below the base of the skull.
Among those reporting discomfort or pain, I find most, when asked,
report that in fact they have terrible neckache, and discomfort
at this part of the spine.
What Causes CTS?
Improper use of neck muscles can cause pressure to be
applied at the originating point of this nerve. Neck muscles,
exhausted by holding up a surprisingly heavy head, finally
spasm, gripping this C-7 area like a vise, and resulting in
severe pain shooting down the arm, up through the hand where
median nerve branches terminate. Other signs of RSI include
numbness of the hand, inability to maintain a hand grip,
tingling (especially at night), some degree of swelling on
the palm side of the wrist, and a "pins and needles" sensation
in the arms and hands; and finally, excrutiating pain.
While all keyboards are not "created equal," their role
in CTS is mostly one of exacerbating as opposed to causing, the
condition. Also exacerbating the condition is lack of frequent
work breaks, work breaks that are so useful for increasing
productivity that I have finally come to call them
"productivity breaks."
Is CTS Avoidable?
CTS is indeed avoidable. Avoidance calls for proper work
station set-up. Micro-breaks of two to three minutes on the half
hour, coupled with in-place exercise, also prevent stress from
ever setting in in the first place. However, once contracted,
several other ingredients are typically in successful treatment
of the condition, most of which will be covered here.
Proper Workstation Set-Up
Avoiding CTS entails a four-part formula to proper work
station set-up.
First is optimal placement of your monitor. In order to
minimize use of neck muscles, your monitor must be placed about
eye level. Eye level placement of your monitor allows your head
to balance atop the natural pivot provided by the neck. A monitor
placed too far below eye level causes neck muscles to overwork
in their effort to hold up a head that weighs about as much as
a bowling ball.
Equally critical to preventing RSI/CTS is optimal placement
of your reference material stand. It should also be set about
eye level. And it should be placed closed to your monitor. This
gives rise to the "let-your-eyes-do-the-walking" concept, keeping
your neck upright.
Next is keyboard placement. Your keyboard should allow for
your upper arm to be naturally at your side, with forearm
(elbow to hand) to run parallel to the floor. Arms seem most
comfortable in this position.
Wrist rests, when used, should effect the same 90 degree
angle at the elbow.
What Role Do "Productivity Breaks" Play?
For those spending long hours and days at the monitor, brief
but frequent work breaks have such a positive effect on the
worker and on output that I have come to call them productivity
breaks. Investment in computers and workstations is so high that
employees are kept at their stations, without respite, in an
effort to maximize output and, therefore, overall return. Alas,
stress and other health problems clearly identified with this
workpattern have the opposite effect on "the bottom line."
Once stress has locked into the neck and shoulder area,
it is very difficult to eliminate. Micro-breaks of two to three
minutes on the half hour, during which time the VDT user can do
head, neck and shoulder rolls, coupled with deep breathing,
prevents stress from ever setting in. (One should note that
allocating time for productivity breaks-two to three minutes per
half hour, or five to seven minutes per hour-amounts to allocating
less time than the 15 minutes per two hours recommended by others)
Can Exercise Help?
Exercise is useful. It strengthens muscles. Your physical
therapist and your chiropractor are generally at the ready with
specific exercises for specific parts of the body. In this case,
ask for upper body exercises.
Also take time to do simple arm and wrist exercises, being
careful not to strain the delicate wrist area. Whatever exercise
you do, remember that exercise should never cause pain or
discomfort.
Can Vitamins Play a Role?
The most intriguing information I've encountered comes from
Marion Ellis, MD, in Mt. Pleasant, Texas, who has conducted
considerable research into vitamin B-6. Having lived his life
in the cotton-growing area of East Texas, Dr. Ellis points out
that, prior to the bleaching of wheat, cotton-pickers managed
to pick 300-400 pounds of cotton daily without complaining of
wrist problems. In the bleaching of wheat, all nutrients are
removed from the wheat. Only a few of the 20-odd nutrients
removed are returned to the wheat. Dr. Ellis' research indicates
that B-6, which protects the median nerve, is among the nutrients
removed and not replaced. While he suggests taking 100mg of B-6
daily, he recommends taking 50mg in the morning and another 50mg
at bedtime because the B vitamins are water-soluble, meaning
they are thrown off in all the ways water leaves the body.
Morning and evening doses keep the B-6 dispersed. Dr. Ellis
finds that 90% of his patients respond to B-6 treatment within
a period of 12 weeks. Patients who exhibit patience, endurance
and consistency in taking B-6 will be rewarded by healing, he
promises. If symptons remain after 12 weeks, Dr. Ellis recommends
further diagnosis to determine several matters, among them,
whether or not an anatomical aberration is present.
Dr. Tom Dickson, chiropractor and nutritionist practicing
in Winston-Salem, NC, explains that the B vitamins are never
found isolated in nature, provoking nutritionists to feel that
the Bs work best when taken in a complete B-complex tablet such
as a "B-50" (so called because it contains 50mg of each of the
available B vitamins). Dr. Dickson points out that B-6, used
in conjunction with a B-50, can produce best results in the
control of edematous buildup (i.e. fluid retention) that can
congest the carpal tunnel and subsequently reduce nerve axial
flow.
While finding the B vitamins helpful in reducing edema
surrounding the various tunnels of the body, it has been shown
that by reducing the localized fluid buildup, the carpal tunnel
is decongested.
Can Wristwraps Help?
Some authorities feel wristwraps should not be used during
work itself, but only before and after work. It is felt that one
may be working against the restriction, however slightly, applying
further pressure against the injured area. Some workers, on the
other hand, find it comfortable to wear them while working.
Judge for yourself.
Wristwraps can be made from handkerchiefs, or of Ace
bandages. Wrap lightly in order to only slightly restrict
movement while not constricting blood flow itself.
Can Surgery Be Avoided?
Considering or scheduled for surgery? Chiropractors are
experts in reducing nerve pressure in the cervical spine. Ask
your chiropractor to check the C-5, C-6, C-7 and T-1 vertebrae
of your upper spine. Numerous alternative therapies exist and
should be explored: massage therapy, physical therapy, and
acupuncture are but a few.
Different bodies will respond differently to various
treatments. On reflection, however, it seems the most successful
outcome is reached by following the three-pronged approach
which includes chiropractic adjustment of the cervical spine,
setting one's monitor and reference material stand at eye level,
and use of vitamin B-6 coupled with a B complex such as the
B-50.
..... End
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