
I may have Carpal Tunnel Syndrome and I'd appreciate some advice. (Long Post) - AgentConundrum
Even though I'm looking for general advice, I'd like to go over my situation in detail to minimize the chances of being offered advice that could further injure me. I therefore apologize for the length of this post. I understand that you folks aren't doctors, and nothing you say is medical advice. I'm here because this community is probably at a higher risk than average for this sort of injury, and so there's a better chance of hearing from people who have lived through this here than elsewhere.<p>Anyway, a couple weeks ago I started getting pain in my wrist while I was typing. I managed to get an appointment with my family doctor for a week later, but because of the pain and my fear of doing more damage, I opted to go to a walk-in clinic I've been to a number of times previously.<p>The doctor at the clinic seemed to assume it was most likely Carpal Tunnel Syndrome just based on the fact that the pain was in my wrist. He had me flex my wrists (Phalen's Maneuver) and tapped on the underside of my wrist (Tinel's Sign) but neither of these tests really did anything to me - there was no pain or tingling present in either case (NB: When I try Phalen's now, I feel a bit of pressure in the underside of my wrist, but that's it).<p>The doctor told me to get a wrist brace, and specifically told me to get one made for CTS. He told me that a lot of people flex their wrists into odd positions in the middle of the night, so I should wear the brace when sleeping and when typing. I looked this up later, and there are mentions online about CTS sufferers mangling their wrists like the doctor said, and that this can present as waking up with your hands numb/asleep. I had noticed this a few times recently, so things seem to line up there.<p>After looking at various models in the drug store and discussing the situation with a girl who worked there, I eventually purchased a relatively expensive model (http://www.amazon.com/M-Brace-Wrist-Splint-Size-Regular/dp/B000X9SUKA). I wore this brace home that day, and have generally worn it when typing since then and always while sleeping.<p>Things seemed to be improving until I went to my doctor the following week. At my appointment, my doctor did hardly anything to check on my condition, except trying Tinel's again (no symptoms presented during this test this time either). He examined the brace and had me put it on, and he said it was good. The point, he said, was just to limit the range of movement for my wrist, and that the brace did its job just fine. He asked me why I wasn't wearing it when I came in, and I told him that I only really wore it to bed and while on the computer. He told me I should be wearing it all the time, but that I could take it off to sleep (which struck me as horrible advice, given what I had researched). He told me I should wear it all day, and through the night if I wanted, for maybe the next week or 10 days, which I've mostly done. I asked him if that was a bad idea since I had read that leaving the brace on all the time could weaken the muscles, but he said that that only occurred over the long term, and a week wouldn't do any damage.<p>After wearing the brace all day for several days, I started noticing that the base of my thumb was stiff/sore and the area around my pinky was sort of the same. Everything else felt more or less ok, so I started not wearing the brace through the day, thinking that maybe the brace was constricting my thumb too much. Things have been pretty good for the last couple of days, but there's still lingering... awareness, I guess. I'm aware of a bit of a strain in my wrist/forearm (and there's a tingle in my elbow sometimes) from time to time, but it's mostly alright. In fact, I've typed this entire post without the brace mostly without pain. There is some noticeable strain, but by taking a lot of mini-breaks it's very manageable. I'm also aware that I shouldn't be pushing this hard, but I wasn't really expecting to write quite this much.<p>Another factor seems to be that I'm typing sitting upright on my smaller couch, with ample room for my right arm (the pained one). Normally, I type lying down on my other couch while watching TV or just relaxing, and my right arm can sometimes get pinned a bit. Another factor I think is probably relevant is that not terribly long before I started getting the wrist pain, my elbow/shoulder would feel a bit cramped while lying down and typing. I moved the pillow beside me out of the way and that seemed to help the issue. For this reason I'm wondering if I might have pinched a nerve or something which is helping cause these issues.<p>Before it's mentioned, I know that my "laying on the couch" arrangement isn't good for me, but it's a habit that formed out of convenience. I don't have a good desk chair (and even my cheap piece of crap chair is broken to the point that my posture would suffer), so I don't really use my desk anymore (I really never have since I got this laptop three years ago).<p>I'm currently unemployed (one year today!), so money is extremely tight right now. This means that I consider a lot of typical fixes (better desk, better chair, laptop dock with ergo-keyboard and trackball mouse) are hard for me to considr out of financial concerns.<p>The one expenditure I am considering is massage therapy. There is a school across the road from my apartment that only charges $27 per session, so I think I could talk myself into paying for a single session to see if it'll work out any pinched nerves I might have.<p>I have a few questions regarding the "free" fixes I can try:<p>* I've been taking a lot of Ibuprofin as an anti-inflammatory on the advice of my doctor. For the last couple of days, I've been taking two pills right before bed on the assumption that if my body does most of its healing while asleep, then the anti-inflammatories would do the most good if they reduced inflammation during periods of increased healing. Is this an accurate assessment, or is this more likely to be a placebo?<p>* Regarding icing, I've read a number of different options for this (rubbing ice directly on the wrist until the skin is pink to promote bloodflow, icy dips followed immediately by hot dips and repeated several times, gel packs, etc.). Is there a "best way" to go about icing? How often should I be icing the arm?<p>* Regarding stretching, am I risking damage by stretching (see http://lifehacker.com/5195481/exercises-that-protect-against-carpal-tunnel-syndrome) while the condition persists, or should I wait until the pain has dissipated via rest before beginning a stretching regimen?<p>* I lead a pretty sedentary lifestyle at the moment, but I've been thinking that cardio is likely a great idea since increased bloodflow would likely promote healing in the wrist. I'm told that the wrist, being a smaller tunnel, doesn't always have the best bloodflow, which is partly why wrist injuries like this can take so long to heal. Does this seem like a good idea? I'm thinking of walking all the way up the stairwell in my building (it's 9 stories to the top from my apartment) and back down.<p>* I've heard that the electrical nerve tests (or whatever they're called) are extremely painful, but would they be worth it to determine if this really is carpal tunnel? If the problem is carpal tunnel, I've heard that the surgery is pretty much batting 1000 in terms of permanently ending the pain. If the nerve conduction tests show carpal tunnel, should I get the surgery as a preventative measure? What's recovery like?<p>Sorry for the extremely long post, but I'm extremely worried about my present condition. I'm only 25 years old and I'm terrified that I'm going to end up unable to work or go back to school because of this issue. Just writing this post has been incredibly theraputic to me, especially since it hasn't been particularly painful to write (though there are pre-cursor signs in my wrist, so I should really rest a bit after this).<p>Thank you so very much for any advice or anecdotes or support you can provide!
======
anigbrowl
_I may have Carpal Tunnel Syndrome and I'd appreciate some advice. (Long
Post)_

That is your major problem, right there - you are still typing a lot! When
you're in a hole, _stop digging_. I had similar problems about your age, made
some splints at home to correct some weird posture habits I had developed (eg
crooking my pinkie fingers), and I took a break from typing for most of a
month. Amazingly, the world continued to revolve without my help :-)

So here's what you do. First, set up an auto-responder on your email: 'Hi,
this is me, but I've hurt my wrist and can't type for a few weeks. You can
call me on 555-1212 if it's really important, but otherwise I may only be able
to send you a one-line reply, if at all. Sorry!'

Next, like Zed says, stop lying on the sofa. this is bad for you in a bunch of
ways. Sit up straight - it's uncomfortable at first but once you get used to
it it's actually much more sustainable for hours at a time. You can't type, so
don't torture yourself by surfing. As you're unemployed but still consider
going back to school, how about a few textbooks (cheapie used on amazon, or
from the library) to pass the time in a useful manner? You can make notes with
a pencil and notebook - not much strain on your wrist when you're doing it at
a leisurely pace, and writing is slow enough compared to typing that you'll be
a bit more selective about what _needs_ to be noted.

Of course, I am no doctor, and certainly not your doctor. But based on my own
experience and that of many others I've spoken to, simple rest is one of the
best therapies. You can still perform other tasks, the nature of carpal tunnel
and the like stems from spending too long performing a limited set of
movements with poor posture. Take it easy, chill out, and you'll find your
brain still functions perfectly well without a keyboard.

~~~
AgentConundrum
I'm considering going back to school at some point in the distant future,
assuming I can save enough cash that it becomes feasible.

I know how this sounds since I'm _typing_ this comment, but I've been really
afraid to write lately. The problem first presented right as I began taking
notes on an Australian CS course available on YouTube/iTunes. I had only been
watching and noting for a few days when this hit. At first I thought it was
just unused muscles complaining about the sudden workload, but as it persisted
I started to realize I was wrong.

Perhaps I'll start up again today, now that my wrist feels a lot better.

As for taking a break, I've been trying, but it's not easy for me. In addition
to my usual laziness of browsing reddit all day, my unemployment and severely
depleted funds mean cover letters need writing and resumes need tweaking. I
think the break is finally doing good though, so a little while longer can't
hurt.

------
rmc
It could be another form of RSI (Repeditive Strain Injury). Carpal Tunnel
Syndrome is one particular form of RSI affecting your wrists, but it's also
possible to get RSI and pain in other muscles. Just because the Carpal Tunnel
tests are negative doesn't mean you don't have some other illness. You
shouldn't be in pain. If you're in pain, and all the Carpal Tunnel tests are
negative, then it's something else.

I've frequently had RSI pains for about a year now. One solution is to change
(somehow) your typing set up. e.g. if you use your right hand to use the
mouse, and have pains in your right hand, then change to your left hand. This
will give the (damaged and strained) muscles in your right hand a break and
they will start to heal. Likewise, change your keyboard. I got a €25 Microsoft
Natural Keyboard. When typing on a laptop it's common to rest your wrists on
your laptop (before the keyboard). This means you have to bend your wrists
upwards. If you do that a lot (like I used to), then you'll get pains along
the top of your lower arms. The solution is to not do that as much. I got a
new keyboard which means I don't bend my wrists up like that. This means these
muscles are not doing as much, and hence aren't being strained, and hence are
given a chance to recover.

Install a typing break programme. This is something that will lock your screen
every X mins for Y mins, forcing you to take regular breaks from typing. If
you're using Linux & Gnome, this is built in as part of the keyboard
preferences.

------
gtani
[http://www.reddit.com/r/programming/comments/cmx8r/has_anyon...](http://www.reddit.com/r/programming/comments/cmx8r/has_anyone_suffered_from_carpal_tunnel_syndrome/)

I have 3 exercises here, which involve the Dyna-flex spinning ball thing and a
wrist curl bar. You also need to pay attention to not cock your wrist at funny
angles when you're driving, riding your bike, using power tools, etc and don't
sleep on your arms.

<http://news.ycombinator.com/item?id=1269951>

\------------------------

[http://lifehacker.com/5195481/exercises-that-protect-
against...](http://lifehacker.com/5195481/exercises-that-protect-against-
carpal-tunnel-syndrome)

<http://news.ycombinator.com/item?id=104977>

<http://news.ycombinator.com/item?id=199493>

<http://news.ycombinator.com/item?id=224604>

<http://news.ycombinator.com/item?id=427743>

(lots of reddit threads too, google those)

------
dmfdmf
Don't be too quick to conclude that its a physical condition. It could be
emotional or psychosomatic. That would be consistent with being financially
strapped, unemployed, not in school, no clear life direction, etc. Not
judging, just pointing out that such a state is emotionally stressful and
could manifest in phantom physical symptoms.

For more, start here but the net is full of success stories using Sarno's
approach, so do a search... <http://en.wikipedia.org/wiki/John_E._Sarno>

~~~
AgentConundrum
I read an article (found via SearchYC actually) earlier today about this.
While I definitely understand how that emotional turmoil can lead to
psychosomatic symptoms, I don't think that is what is happening here.

My last job, by pretty much any measure other than income, was worse for me
than being unemployed. Near the end I had been out on multiple stress leaves
(I think the total was 5 weeks out, beginning about 9 months prior to my
dismissal) and was generally in bad shape. My stress level was so high, in
fact, that my boss (the good boss I had for about six months, but before the
stress leaves) took me on a detour during our morning coffee run and bought be
a bottle of Valerian pills to try to calm me down.

During all of that, I never developed these sorts of symptoms. The only
physical effects I can really think of were the insomnia and a case of strep
throat during one of the leaves which that same boss said was likely caused by
my stress decompression.

Having said that, however, after reading that article this morning, my wrists
have felt better than they have in months. I've been attributing that to a)
the stretches I found on YouTube this morning, and b) the right-before-bed
ibuprofen regimen I described above.

I'll definitely give Sarno's work a second look, but I'm so worried about
ruining my life by permanently damaging my wrists that I doubt I can really
commit to any approach which requires me to actively ignore signs of potential
damage.

------
fjabre
You want to get what's called a Nerve Conduction/EMG Test to determine whether
it's actually Carpal Tunnel or not.

There are other neuropathies that can look like Carpal Tunnel like onset
peripheral neuropathy, an entirely different condition.

If it is indeed Carpal Tunnel Syndrome and it's moderate to advanced you might
want to consider surgery. They're standard and minimally invasive these days.

------
zedshaw
Hey, so, I've been coding and playing guitar for ages, two things that
_definitely_ give you carpal tunnel. But I also studied Aikido and Judo, two
things that give you strong flexible wrists. This means that I generally
rarely get pain in my wrists, and when I do I can fix it with some exercises
and stretches.

So, I'll try to give you some advice, and hopefully this helps without hurting
you.

The very first thing you need to quit doing is:

"I'm typing sitting upright on my smaller couch, with ample room for my right
arm (the pained one). Normally, I type lying down on my other couch while
watching TV or just relaxing, and my right arm can sometimes get pinned a
bit."

What the hell is wrong with you? I'm saying this to kick you in the ass, but
in no way is this comfortable or good for your body. You are probably
contorting your whole body into all sorts of weird problems, and I'm betting
you don't exercise, stretch, take breaks, or do anything physical to maintain
your health.

First clue, get a damn desk and a good chair, or invent one. Then, don't sit
at it for too long at a time. Take breaks. Setup a rule where you don't code
while watching TV. It's just a bad habit and it's actually hurting you.

Next up, your whole body is probably screwed. You need to start doing some
stretching at a minimum. Stretching your whole body. You can easily go get a
book on how to do it, and you should do it every day, twice a day: when you
wake up, and before you go to sleep. If you can take a yoga class then that'd
be even better.

You should next make sure you're eating right. Stop eating crap, and in fact,
eat out if you can if for no other reason then it gets you away from the
computer and walking around. Eat vegetables. Lots of them, and not too much
meat. Quit eating junk food, meaning fake food that's crapped out of a machine
into a plastic bag. Eat real food.

Finally, for your wrists. As you start fixing up the rest of your body and
learning to relax through stretching, you'll probably find a lot of tension in
your neck, upper shoulders, and back. It's important to stretch your whole
body, but focus on these areas specifically. As you sit and code, keep track
of tension in your body and give it a number. Then try to change the number up
and then down. You want to start analyzing where you hold tension, and using a
number system helps you visualize it.

Once you've got some control over tension, and you've got yourself getting
more relaxed, you now need to start working on getting your wrists mobile.
Now, your doctor sounds like a retard, but he's a doctor and I'm not, so he
wins. However, keeping your wrist in a sling is not going to make it improve,
so unless he's giving you exercises that improve it, then you need to find a
new doctor.

There's no way in hell I'm going to give you wrist stretches online, even
though you need some. You could sue my ass. I will say you should talk to your
doctor about getting exercises to work with, and potentially that you should
find a free Aikido class and see if they will teach you their wrist exercises.
They probably won't let you do them since they also don't want to be sued, but
they can teach them to you and then you can ask your doctor.

But, the most importan thing is quit living so unhealthy. I'm not saying
become a granola eating hippie, but hell man I work at home and I've got a
decent setup and don't kill myself coding for hours without breaks infront of
the TV.

Good luck.

~~~
AgentConundrum
I've lurked HN for a long time, barely even commenting, so of course I
realized the sort of people who frequent this site. Despite this, I did a
double take when I read your username. I just got told off by _the_ Zed Shaw!
Sorry, I digress...

I'm using this situation with my wrist as a wake up call. I suppose I never
really realized the damage I was doing to myself laying on the couch with my
laptop. It started as a necessity when I lived with an asshole and confined
myself to my closet of a bedroom where there wasn't room for really anything
other than the bed. Slacking off, lying down watching a vid feels pretty
comfortable (for the record, are you against lying on a couch in general, or
only when that _in_ activity is coupled with a laptop? I've always thought of
lying on the couch as being a good way to decompress, but I can change my ways
if it's an overall bad thing) but I definitely see how I let things get out of
hand.

I _may_ have a job lined up to start in a couple months (I'm not a rockstar
like most people on this site, so this is the best I've been able to do), and
I'm bookmarking a few articles and HN comments to setup a proper office when
cash allows. For the time being, money is quite the issue. I do have a desk,
but as I said my chair is absolute shit. How important are laptop docks? Just
sitting up at the desk will, I'm sure, be at least a step in the right
direction. Can I get away with a shitty $20 Staples chair for now (as a first
step) or is it essential that I dip deep into my reserves and get a $200+
proper office chair?

I'll Google for some introductory stretches for my whole body. I had real
stress issues due to being a workaholic and having an asshole boss, so I need
to learn stretching/relaxation tecniques as a matter of survival, since at
least one of those two problems will persist throughout my career. From the
tone of your post, I'm definitely leaning toward trying the massage thing at
least once, if for no other reason than to get an initial boost on releasing
any pent up tension.

As for the wrist stretches, I've been doing some I found just before I wrote
my initial post tonight. I haven't felt any pain so far as I write this post.
I guess they help.

These wrist problems seem to be a good kick in the ass to correct a systemic
problem. I guess I came to HN looking for what amounts to band-aids for a
bullet wound, and your additional ass kick was a good reminder that that's not
what I need to be doing. I'll go price some new chairs tomorrow, and I'll take
some initial steps towards better overall fitness.

Financially, some bigger measures have to be post-poned, but I can at least
start with the things that are in my reach now.

Thanks for the kick in the ass. Seriously.

Edit: Oh, and you're right about the doctor. This isn't even close to the
first time I've questioned his treatment (For instance, his office completely
failed to fax in an ultrasound request for me last year, though when I called
to check up on it they said they'd sent it and were just waiting on the
hospital. At my appointment last week, he noticed there was no fax date on the
form, so he had to admit it was likely never sent). There's a reason I tend to
go to the walk-in clinic before I bother making an appointment with him.

~~~
zedshaw
Oh, laying around, relaxing, getting good sleep, are all healthy things to do.
What will mess you up is contorting your body while you type, which includes
laying down, propping your feet up on the desk, or just generally not sitting
comfortably.

Typing is already pretty weird and unnatural for the body, so you just want to
reduce the stress on it as much as possible while you work. Same goes for
playing guitar, sewing, drawing, writing, anything that involves lots of tiny
motions and focus. It's these activities that tend to turn off your awareness
of your body and make it so you don't notice you're hurting it.

Also, definitely take some yoga and focus on meditation. It'll help you a lot,
more than you know.

Finally, very few people on here are rock stars. Don't let their blowhard
attitude make you think they're so damn awesome because the truth is, human
aptitude is a power curve, not a normal curve, and 99% of people doing
anything suck because of it.

Myself included.

Edit: And you're welcome. :-)

