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Prevention for Carpal Tunnel Syndrome

Laptops are a common cause of carpal tunnel syndrome

Laptops are a common cause of carpal tunnel syndrome

Where does it hurt?

Ask most people about carpal tunnel syndrome, and they'll tell you it's pain in the wrist caused by spending too much time at the computer keyboard. But before you rush out and buy an "ergonomic" keyboard, ask yourself a couple of questions:

  • Is it one hand or both hands?
  • If it's only one hand, which hand is it?

A surprising number of people will answer that it's only one hand. And that hand is - their mousing hand.

Now, if it was the keyboard causing the problem, both hands would be equally affected. If your pain is restricted to one hand, it's the computer mouse, not the keyboard, that's causing your wrist pain.

The Mouse

When mice were first invented, most commands were still keyboard shortcuts. You used your mouse rarely - you'd grab, move and click, then bring your hand back to the keyboard to continue typing. The mouse was never designed to be held continually - which is something many people do these days.

Take a look at the picture below. Can you see the angle between the wrist and the hand? That's the major cause of wrist pain.

The mouse is a major cause of RSI

The mouse is a major cause of RSI

An Ergonomic Mouse?

Be cautious about buying an ergonomic mouse, because many are larger and higher than a conventional mouse. Remember, it's the angle between your wrist and hand that's the biggest problem - having a taller mouse will make the angle even worse, so it's the last thing you want!

If you want to try a different mouse, it's worth considering a vertical one like the Evoluent Vertical Mouse. It is taller, but you hold it in a handshake position (i.e. your hand sits on the side, not on the top), which removes the angle altogether.

The Evoluent mouse

The Evoluent mouse

Don't assume the worst! If you over-use your muscles (at an aerobics class for instance) they get sore and inflamed - and if you don't allow enough recovery time before exercising again, you"ll end up with an injury. The same thing happens with your wrist - you work it for hours every day, and overnight isn't enough time for it to recover. So it may not be carpal tunnel.

Unfortunately you almost certainly have some kind of RSI (Repetitive Strain Injury) caused by over-use of the tendons and muscles in your hand, arm and shoulder. That can lead to carpal tunnel, but you may not be there yet. To avoid your pain progressing to something more serious, you need to take action now. That takes a three-pronged attack:

  • change your desk setup including the way you sit
  • do arm and hand stretches to loosen up tight muscles and tendons.
  • take regular breaks during your work day (every half hour until the pain eases, and every hour or two once you're back to normal).

One frustrating thing about pain is that we don't always feel it where the problem really is. For many people, the true root of their wrist pain lies in the arm and shoulder. That's why correct desk setup and posture is so important, to remove stress across that whole area. It's worth trying some exercises to ease a stiff shoulder and neck- if they ease the pain in your arm, you'll know the problem is bigger than just your wrist.

If you simply "soldier on", it can get much worse, to the point where it's disabling. One of my former colleagues can't cook (she can't pick up a pot) and can no longer carry her grandchild.

If you already have significant pain and numbness, fixing your workspace and doing a few exercises won't cut it. Don't try to self-treat - get professional help.

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Proper Desk Setup

Sit at your desk in work position and look at your arms.

If you can see your elbows (or the crook of your arms), you're giving yourself RSI.

The further you reach forward with your hands, the greater the tension, all the way from your hand, through your shoulder, to your neck. Tension causes muscle spasm and inflammation. Result - RSI.

The same applies to your mouse. If you can see your elbow, your keyboard is too far away.

If you're going to have any chance at all of recovering from RSI, your shoulders and upper arms must be relaxed while you type. The only way that can happen is if your arms are hanging loosely from your shoulders.

That means when you look down, all you should see is your forearms.

Try it now. Stand up and let your arms hang by your sides. Now leave your shoulders and upper arms exactly where they are, and raise your hands in front of you at a 90 degree angle. You should feel your elbows lightly touching your body near the waist. That's the correct position for keyboarding and mousing. As soon as your elbows lose contact with your body while you're working, you're putting yourself at risk of RSI.

If you sit down at your desk and put your arms in that position, you'll see that your keyboard and mouse need to be on or near the edge of your desk. That'll probably surprise you, because you don't often see mice in that position - but then, how many of your colleagues have sore wrists, or stiff necks and shoulders?

That's why wrist rests aren't a good idea, because you need to move your mouse and keyboard further away to make room for the rest.

You may find your desk is too high, so you can't get a proper straight line from the elbow to the back of the hand. In the early days of computers, office desks had a keyboard tray screwed under the desk, to bring the keyboard and mouse down to an ergonomic level. That's still a good idea - the only reason you don't see them in offices now is cost-cutting, not because they don't work!

You'll probably need to bring your monitor closer, as well. You should be able to touch your screen easily with your fingertips. If it's too far away, you'll create tension by craning your neck forward.

How not to set up your office...

How not to set up your office...

What not to do

Take a look at the desk above - it's a good illustration of all the things that are wrong with modern office desks.

The monitor is pushed all the way to the back of the desk. The user can't read the screen without poking their neck forward - which not only causes tension all the way down the arms, it will affect their posture while they're standing and walking, as well. Try standing against a wall - the back of your head should touch the wall. If it doesn't, you're developing a permanent "turtle" neck and a humpback because you're spending all day with your head craned forward. Bring that monitor closer!

The keyboard and mouse are also pushed back. The user has bought wrist rests, but to get his wrists onto the rest, he still has to reach forward.

I know, I know - sitting up straight doesn't look nearly as cool as an artistic slouch. But trust me, once you've experienced the pain of RSI, you'll be prepared to look uncool to avoid it happening again!

Where has RSI come from?

Generations of typists have used the same design of keyboard all over the world for over 100 years - and before the computer was invented, RSI was virtually unknown amongst secretaries and other keyboard users. It only became an issue with the advent of word processors. And strange though it may sound, it was the ability to rest your wrists that caused the problem.

On manual typewriters, there was nowhere to rest your hands on the machine. Electric and electronic typewriters had super-sensitive keys, so you didn't dare rest your fingers on them - the process of erasing a mistake was too laborious! If a typist needed to stop and think, she would drop her hands into her lap or rest them on the desk, safely away from the keyboard.

By contrast, computer users frequently rest with their wrists on the edge of - or worse, on the desk in front of - the keyboard, creating the same dangerous angle as using the mouse. You can even buy a wrist rest, to encourage you to do so! Resting your wrists can actually cause RSI.

In the old days, typists were trained in proper posture. It simply wasn't possible to attain the speed and accuracy they needed for their jobs without it. Like a concert pianist, they had to get their fingers in a position where they had optimum control. Computer users don't need that accuracy because mistakes are so easy to correct, so there's no impetus to learn correct posture.

The introduction of flat screen monitors has made things even worse. CRT monitors had a big, boxy back and often, they sat on top of the hard drive. All that equipment took up a lot of space on the desk, so users didn't have much choice but to keep the keyboard and mouse near the edge.

The temptation now is to push a flat screen "neatly" all the way to the back of the desk, and everything else with it. The result is a posture that is an ergonomic disaster!

Laptops are an even greater curse, because as well as resting your wrists on it, you have to look down to see the screen, causing huge stresses on the neck. The only way to use a laptop ergonomically is to add either a separate screen (and use the laptop as a keyboard only) or add a separate keyboard (and prop the laptop on its edge as a screen).


Kristen Howe from Northeast Ohio on December 29, 2015:

Marisa, this was a great hub that's so full of information on how to prevent carpal tunnel syndrome for everyone who works on the computer. The cure is handy and useful. Thanks for posting this.

Kate Swanson (author) from Sydney on September 22, 2012:

Good point, Glenn! I also have a herniated disc in my neck (which I knew about - it was due to an accident), so when I started to get wrist problems, it was the first thing I suspected. Thanks for reminding me, I will add something in the Hub to make it clearer that wrist problems can sometimes originate elsewhere in the body.

I must say, it's scary that you can get as far as having surgery for carpal tunnel that didn't exist!

Glenn Stok from Long Island, NY on September 22, 2012:

Hi Marisa, great hub with lots of useful information. There is another thing about carpal tunnel that I experienced and I thought I'd share with you.

I actually had carpal tunnel surgery, but later discovered it was misdiagnosed. My hand was getting numb, not because of carpal tunnel, but because of herniated discs in my neck.

My monitor was too high and my chair was too low -- so I was crimping my neck back, looking at the screen, all day.

I discovered this when my doctor did an MRI of my neck for another unrelated reason. All I had to do was lower my monitor and raise my chair. That helped.

Carpal tunnel can actually see be misdiagnosed if the doctor doesn't consider all issues.

Anyway, your hub is very meaningful for important carpal tunnel avoidance techniques and I gave you a vote up and useful.

Kate Swanson (author) from Sydney on November 29, 2010:

Paul, I certainly don't deny that carpal tunnel existed before computers, but I was a typist and secretary for many years over three continents. I knew it existed, but it was sufficiently rare that I never met anyone who had it, nor anyone who knew anyone who had it.

Yes, we did type 'as fast as possible' - but 'possible' was limited by the fact that making a correction gave an imperfect result. These days I type far faster because I don't have to worry about accuracy - I can simply backspace. In the old days, I typed as fast as possible CONSISTENT WITH ACCURACY. There's a big difference.

When I said the feel of the keyboard, I was referring to exactly what you describe.

As for the leading hand - I'm a left hander and use the mouse in my right hand. The right hand is the one that has given me trouble.

Paúl R. on November 29, 2010:

Hi, Marisa,

Let's just say I am a member of the lists which discuss the neuromuscular disorders, mostly those related to typing and piano-playing.

"In the days of manual [mechanical] and electric typewriters" these disorders were frequent enough already to become noticed by the medical profession. However, you are right: they were less frequent than today's industrial-scale problem caused by typing on a computer keyboard.

Why were they less frequent then? You quoted the speed and the "feel" of the keyboard. I am afraid it was not the speed, because, just like us, today, in those times the typists also typed as fast as possible.

And it wasn't the "feel" of the keyboard, either (I mean, it wasn't the crucial factor). It was because the use of (especially) a mechanical typewriter demanded more movement in the upper limb than today's keyboards. This movement gave the hand the opportunity to disperse the accumulated, excessive tensions.

Today, we got ourselves under the spell of "movement economization", and it's so strong that we can't see this problem clearly - even though the experts in Human Factors (Ergonomics) keep telling us that following the economization principle does not always bring the best results.

By the "leading hand" I meant the nature-given dichotomy: we are either left- or right-handed. The left-handed persons operate the mouse with the left hand.

Kate Swanson (author) from Sydney on November 26, 2010:

You don't say what your background is Paul - if you're an expert, then I defer to you. However, my own long experience as a secretary and typist contradicts you.

In the days of manual and electric (not electronic) typewriters, carpal tunnel and RSI were very rare among people who used keyboards. The electronic keyboards changed the speed and "feel" of keyboards and that's when I started to notice problems in my typing pool staff - however the real epidemic began with computers, and nearly always in the mousing hand.

I'm not sure what you mean by the "leading hand" on a keyboard?

Paúl R. on November 26, 2010:

Hi, Marissa,

You wrote: "...for most people, it's the computer mouse, not the keyboard, that causes wrist pain."

You shouldn't say that as it's very misleading. It's the leading hand which gets affected in this activity first. It happens that it's also the hand which operates the mouse. However, (1) there are many testimonials from affected people who hardly used the mouse, (2) typing has been known to affect the typists' hands well before the mouse, and the computer, was invented.

Katie McMurray from Ohio on April 29, 2010:

Great and helpful hub! Just what I needed, it was in the back of my mind as my pinkies grow numb from typing all day long. Thanks for the Carpal Tunnel Prevention and Care Hub! Thanks and Peace :)

bima on April 17, 2010:

Wow,this is really good.I love this info.

Sheila on March 18, 2010:

Thank you for this informative article, you can read about my journey overcoming Carpal Tunnel here

AdamGee on February 09, 2010:

Thanks! can't wait to try these techniques.

Patrick Ng on February 09, 2009:

Oh so true. I developed RSI, and at the beginning thought it was the keyboard, but when I stopped and thought about it, I realised it was the mouse which caused the problem since the pain was mostly in one hand only. Moreover, it started after I replaced my mouse with a heavier one which I tend to move using my pinky and thumb.

masoncutey from Hampton, Virginia on October 05, 2008:

Thanks for the information. I wish I had this information two years ago. I had been performing computer work for 27 years before I noticed any pain in my wrists. It wasn't until I encountered a "trigger thumb" that carpal tunnel was diagnosed. I had surgery on both hands and so far I haven't had any more pain. I hope it is gone for good.

Again, thanks for the info.

2patricias from Sussex by the Sea on March 31, 2008:

Hi I've had carpal tunnel pain but was initailly due to a tethered nerve in the thumb following an infection from a cut. The advice given here is helpful. Bowen therapy has eased my pain after nearly a year & many sleep disturbed nights. I'm now sleeping well.

Frank from Montana on March 21, 2008:

I had carpal tunnel and mine was caused from pulling items off a drum for 6 years,then it got to where i could only drive so far and my hands would start tingling with a hurting sensation in the palm of my hand..

Zsuzsy Bee from Ontario/Canada on March 10, 2008:

As a tailor, the problems with my hand came from using scissors too much not from mouse or keyboard overuse. I need to wear a brace whenever I have to do any type of repetition or heavy work.

great hub regards Zsuzsy

Dave McClure from Worcester, UK on March 08, 2008:

I was suffering from this quite seriously, through using the glide-pad on my laptop. Recently I've been training myself to operate it with mt right thumb instead of the forefinger. This was awkward at first, but i volves far less contortion, and so far the strain seems to be easing. Regular short breaks also are esential though. Good useful hub.

Shelly McRae from Phoenix, Arizona on March 08, 2008:

Good hub, Marisa. I'm very conscientious of my computer set up because I know how painful CTS can be. You nailed it with this hub.

Ricardo Nunes from Portugal on March 08, 2008:

Great hub! In my last wrists surgery they enlarge my carpal tunnel in both hands and I have to wear the wrist brace for 5 to 6 weeks, so I probably will never get this problem but on the other end I also will never get total wrist functionality.

Merle Ann Johnson from NW in the land of the Free on March 08, 2008:

All is so very true..but I have it and I just got a computer...My doctor says it is from repeating the same tasks over and over.  Like knitting, crocheting for many years I have.  Checkers at stores get it .  In my hands on the right side the thumb, first finger and middle finger go numb. On the left hand the baby finger and the one next to it go numb at night when sleeping I mean.  I had a nerve test done (weird) and on my left side I have severe pinched nerves and on the right side not so bad.  But the surgery is big and 6 weeks of a brace that you can't lift anything heavier then a fork.  So now I just take Advil once a day. I had been going to the chiropracter for  a year and a half..but Advil works best as of now anyway.  I also take a pill to help my stomach from the Advil..Great Hub dear as always.  G-Ma :o) hugs

C.S.Alexis from NW Indiana on March 07, 2008:

This is a Hub that all hubbers should read.

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