Tenosynovitis for computer programmer

Question: Well, like most people, I never expected RSI to happen to me, but here I am. I’ve been working as a computer programmer for about 3 years, and started to develop very mild and occasional tingling in my wrists over the last year or so. Last week I went on a cycling holiday, which caused a nasty pain to develop in my right wrist. This morning I saw my doctor, who diagnosed it as tenosynovitis. He said take some nurofen to reduce the inflammation, and try to improve my working practices, while I wait 12 weeks for an NHS physiotherapist appointment. Does anyone have any advice?

1. The pain is only in my right wrist, which suggests to me it’s something to do with the mouse. The RSI-UK FAQ says the mouse should be directly in front of me, so where does the keyboard go? I use a wrist-rest for the keyboard, should I use one for the mouse too?

2. I’ve noticed that I tend to constantly use the wrist-rest while typing, which I’ve now stopped. But should any other part of my arm be supported? (e.g. my elbow). I’ve also raised my seat and monitor to their correct positions today, but already my shoulders seem much more tired. Could I have done something wrong?

3. Is there anything more I can be doing to help my right hand recover – how much should I be resting it? Should I wear a support?

4. I also play drums and guitar — how can I tell if these are contributing to the problem?

5. I’ve stopped cycling for now. Would using dropped (racer) handlebars as oppose to straight (mountain bike) ones help?

Answer 1: In my experience, wrist-rests and chair-arms are a bad idea. They’re just another source of pressure on the limb.  I find a trackball much better than a mouse, but this is something preferences vary on. Using the mouse in alternate hands on alternate days helps some people. Might be worse – you have to play off stretching your arm to reach from the more upright riding position, against the extra weight on your hands in the lower position. This trade-off may be different for different people. I know someone who switched from a normal bike to a recumbent because of RSI, and found it helped.

Answer 2: I too am a programmer, but have only been working as one for just over half a year, although I have messed around with computers since I was six. (I’m now 23). Looking back, I guess the problem really started in my final year at university when I was spending a lot of time at my computer using the mouse. By the end of each day, my right hand had “molded” itself into a mouse shape and it took lots of stretching and massaging to get it to behave normally. Over the past few months, I’ve noticed that my fingers (in both hands) have started to tremble almost imperceptibly, and it takes great effort to click the mouse buttons usually resulting in a sharp pain in my forearm. Using the keyboard for any length of time is also painful. I also used to play three musical instruments, and now I try to work out regularly at a gym. I’m not sure if any of these activities have affected me. I’ve decided to try things such as a keyboard wrist support, and a wrist support for my mouse, as I’ve found placing a book under my wrist has helped a bit. I’m off to see my GP at the end of the week and I guess he might diagnose me as having tenosynovitis. I only hope it as a condition that can be cured.

Answer 3: I bought a left handed ergonomic mouse to take the strain off the right hand. But be careful not to get RSI in both hands. I found a rest useful. Get voice recognition. Don’t push it. Regarding the musical instruments, ask an expert, but they often do…

Answer 4: Regarding your question about cycling: I have RSI, and I experimented with several types of handlebars for the back end of the tandem that my hubby and I ride, and I found that upside-down drop handlebars were the best option – they allowed me to remain fairly upright (i.e. minimising the pressure on my hands/wrists) whilst giving me a number of hand positions. That might not help for a solo bike, but might give you some ideas. Someone else has already mentioned recumbents, and I would agree that the riding position for a recumbent is much easier to cope with. I have a recumbent tricycle, and the handlebars are under the seat, so my arms and shoulders can remain relaxed and my body weight is not supported by my wrists. Hope you manage to keep cycling!

Answer 5: Can you afford private physio? You’re more likely to get someone who’s knowledgeable about RSI, and you won’t have to wait. Lots of things have proved helpful for different people. You have to experiment (cautiously) to find out which ones work for you. I found it helped to use a small trackball I could hold in my lap. If you have the mouse off to one side, it means you’re having to hold your arm out unsupported, which can cause problems in the shoulder. Again, you have to experiment to see what set up feels best for you. There’s a lot of information about keyboards and pointing devices on the tifaq site — http://www.tifaq.org/.

Best is to go somewhere like Computability (tel 01926 312847) to try out different keyboards and devices and software. You could also consider using voice recognition to cut out or cut down on the keying. It sounds like you’re putting a lot of effort into sitting. It might help to take Alexander lessons — http://www.stat.org.uk/ to find a teacher, or if you say where you are, someone on the list might be able to recommend one. Don’t key with one hand to rest the other — it often means you end up with both hands hurting. Don’t wear a support while using the keyboard. Some people find splints at night helpful. Lots of musicians have problems with RSI.

Answer 6: I would certainly agree that wrist-rests are a bad idea, and I can’t understand why so many health professionals recommend them for typing. When I learned touch typing, I was taught that the line from point of elbow to fingers should be as straight as possible (with the forearm parallel to the floor or sloping very slightly upwards from elbows to fingertips), and the arm should be free to pivot horizontally from the elbow. I can’t understand how anchoring your wrists on a wrist-rest can help, especially since I have learnt that one of the prime causes of carpal tunnel syndrome is cocking the wrists. Can anyone tell me the logic behind the commonly-given advice to use wrist-rests for RSI?

Answer 7: Wrist rests are not designed as “launching pads” for the hands while typing and unfortunately that is what some people use them for. They do have benefits if people do use them as resting places in between typing, if their other option is to rest their hands on the desk and the fingers on the keyboard, (which obviously cocks the wrist). I believe that some of the misinformation is that in the effort to seek a solution to pain people will try anything, and then there is also the marketing aspect. How many times do we see information, this will cure RSI etc by purchasing this equipment, without any regard to the individual’s working habits, basic height requirements etc. I have worked with many people who have turned around their aches and pains without the purchase of expensive accessories, but have concentrated on their work process. Having said this there is certainly a need for alternative pointing devices in certain situations and voice software, but I believe the whole situation needs to be assessed and not just the purchase of equipment.

Answer 8: I did ask a while ago if there is anyone out there with RSI who rides a motorbike and no-one responded – is there really no-one else out there who does?! I wonder if bikes of any description add to RSI problems? I would be interested to know if anyone else has any experience with this. Personally I found that a push bike, with straight handlebars is OK, but I don’t cycle a lot which must make a difference. 

Answer 9: It sounds as if you are gripping the mouse much too tightly. Try changing to a different sort of pointing device — a trackball for instance. Some people — I’m one — tend to go at everything too tensely. I get caught up in the problem I’m working on and my whole body tenses up, without my being aware of it until afterwards. I think that various bodywork techniques — Alexander, rolfing, Feldenkrais, yoga, etc — can help with this, although the only one I’ve tried personally is yoga. (My preferred therapy these days is to switch off the computer and switch on the music.) 

Answer 10: “I’ve decided to try things such as a keyboard wrist support, and a wrist support for my mouse, as I’ve found placing a book under my wrist has helped a bit”. This doesn’t sound very good. Don’t use supports while you’re actually keying. Some people use them to rest on when they’re not typing. I think that “cured” isn’t exactly the right word. There are different things you can try for dealing with it, avoiding further injury, avoiding pain, etc. See the faq and the website, and the archives of the mailing list. 

Answer 11: I have the same problem as you and yes mine is definitely mouse related from doing extensive presentations on Powerpoint. I’m not a doctor but I would rest your right arm for a week and see how it goes – be very careful not to aggravate it while it is so painful. Try and use the mouse in left hand while you source maybe a trackball or touchpad. You can get keyboards with a touch pad in the centre (so no need to have a mouse at the side to reach for) or there are keyboards with trackball included. I believe Dixons stock them (not exactly sure of the name). As others have said, it is a matter of trying things – some equipment maybe one man’s dream and the others nightmare. You may find Ability Net worth a try to recommend models for your situation. I would really try and see a private physio – I can never believe how long the waiting lists are I’m sure they contribute so much to people’s problems increasing while they wait.

Answer 12: I used to have to cycle to work on a mountain bike – this did my hands no good at all I’m afraid and I have had to give up.

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