Surgery Beats Splints For Carpal Tunnel 42
Rio writes: "A local6.com article tells us about a study that suggests surgery may be more effective than splints for treating carpal tunnel syndrome. In the study, 87 patients underwent open carpal tunnel release surgery, in which ligaments surrounding the median nerve are cut to relieve pressure on the nerve, compared to 89 patients who wore a splint for their wrists, which reduced movement. The researchers found that the surgery left 80 percent of patients significantly improved after three months. Splints left only 54 percent significantly improved."
Watch out with splints (Score:5, Informative)
My impression is that they can cause your muscles to atrophy and fall out of balance. Anyway, be careful with them.
Re:Watch out with splints (Score:1)
The BEST thing to do is NOT TYPE! I know it's difficult, but you can quickly do real damage.
Now firstly - you can help to stop yourself from getting CTS (there other kinds of RSI) by not leaning on your wrists when you type, of you can get a desk without a sharp corner at the edge that's good too. The worst thing for CTS is the mouse - (probably true for other RSIs) the repeated action of clicking coupled with the odd postures you get into (arm outstreched clicking something on the extreem right) make the mouse even worse than typing.
try exercising (Score:3, Insightful)
Re:try exercising (Score:2, Insightful)
If your muscles are strong enough, there's less stress on the tendons and ligaments. Within a month of easing into weightlifing, i could feel the pain going away.
No fucking kidding. (Score:3, Insightful)
Re:No fucking kidding. (Score:2)
I thought the finding that surgery "should be the first rather than the last option" was pretty egregious.
Re:No fucking kidding. (Score:2)
A drastic procedure does not necessarily mean greater (as in better) effect. For instance, it is has been shown in recent years that surgery for severe ulcer does not have an effect, contrary to what has benn believed for a long time. If people have been "cured" by such procedures, it has been a pure placebo effect! In fact, without reading the article (hey this is /.!), I am thinking that the very fact that people have to rest their wrists after surgery could have something to do with the better results!
Lars
Seriously, Re:No fucking kidding. (Score:1)
Seems to me that better than 50% odds means that splints help most people. Surgery continues to be an option after using splints, but I'm not sure how much use splints are once the surgical recuperation is over.
I also suspect that people who have surgery have little choice but to really not use their wrists.
I don't think most people have any idea how seriously to take RSI. I think the words "permanent" and "crippling" should be used more often. I've seen both.
I'm surprised by the conclusion suggesting surgery as a first resort before splinting too. That violates the medical principle the parent was implicitly referring to, of using the least invasive and drastic procedures first when they show promise.
Sounds to me like we need to do a better job of encouraging people limit their typing once they start to suffer (or worse, as I've seen, taking splints off because they make typing hard.)
As the admin, I get the requests for ergo gear. I do my damndest to encourage use of whatever we can make available. Ergo keyboards, keyboard trays, trackballs, tablets, and ultimately rest. I also think excercise and variety are important. If all you use your fingers for is typing, you'll use them up.
Now, it also sounds like I have a book to read & put on the shelf for my people. Is the RSI handbook by Quilter well regarded by the Slashdot Science readers? Lots of people have lots to say, but it isn't all right.
Re:No fucking kidding. (Score:2)
I also consider it interesting that they missed out the treatment that works better than splints- exercise!
Wonder why doctors would ever do a study that is likely to show that an expensive treatment involving lots of doctors is better than one that involves hardly any, or only physiotherapists. Hmmm. Tricky.
Re:Adaptations... (Score:1)
I definitely hit letters with my thumbs. Looking at how I typed this post, it was mostly "c"s. (There was a previous version of this post that had unquoted "c"s in it.) This is not how I was taught to "touch type" in school, but I type faster than people who type that way and don't get much RSI pain unless I set myself up to type in an odd position. I learned to type this way by BBSing at all hours of the night when I was a young lad.
"Ergonomic" keyboards mostly cramp my style. (I haven't tried "real" ones like Maltron's, though.) The only keyboard I'm really happy on these days is a Mac laptop keyboard.
I often dial phones fast enough to confuse overly complicated ones.
These are all just data points that suggest that yes, if you grow up with keypads and use them constantly, you will adapt in ways that people who haven't don't. (Surprise!)
Which keyboards are the best for preventing Carpal (Score:3, Interesting)
Does anybody use ergonomic keyboards at home or work? Which ones are the most recommended? I had a Microsoft ergonomic keyboard at work and thought it worked fairly well. In particular, I was hoping to get some feedback on the Kinesis Contour keyboard [kinesis-ergo.com]. It's way more expensive ($239 to start) than the Microsoft keyboards so I wanted to see if anybody had success with it (or even liked typing with it since it is so different) before I purchased one.
Oh, and does anybody use the Dvorak layout?
Re:Which keyboards are the best for preventing Car (Score:1)
The RSI page [unl.edu] has a lot more info on the subject. Good luck!
Re:Which keyboards are the best for preventing Car (Score:1)
Also, don't forget to look at your other activities. Your pain might occur while you are typing, but it might be caused by something you do after work that strains your wrists. I tried lots of things before I found out that my pain was caused by how I was playing racquetball, and not by my typing. Now I can type all day again.
You (probably) don't need a new keyboard... (Score:2)
First of all, realize that, while "experts" say these will help, unlike any real FDA approved medical device, these have NO EVIDENCE WHATSOEVER that they will help. Not one whit. A few manufacturers include some "studies" that carry no more weight than anecdote. Do not mistake that for actual clinical trials.
Mind you, I looked into this issue about three years ago and have not repeated it, for the reason I will now give:
You don't need "special" equipment to reduce strain on your wrists/back/neck/whatever. Just rearrange your environment to better accomodate you.
For example, I have personally found that the single most effective (and cheapest, and easiest) way of making my hands hurt less at night requires nothing more than lowering my chair's arm wrests and placing the keyboard in my lap. Yup, nothing more, and it means the difference between waking up in pain, and sleeping well with nary a tingle (or none strong enough to bother me).
I prefer typing to using a mouse, so for the opposite sort of person you might find it works better to putthe mouse in your lap and leave the keyboard on the desk.
Another simple change - place your monitor so if you look straight ahead, your eyes fall approximately 3/4ths of the way up the screen (I've seen suggestions to line your eyes up with the very top of the screen, but that made me *more* uncomfortable in terms of neck and eye strain).
As the only other "important" point, try to arrange yourself so your knees and elbows form an obtuse angle. Sharp bends decrease blood flow to the ends of your limbs, and increased blood flow correllates HIGHLY with increased rate of tissue repair.
Finally, a note on drugs... Believe it or not, most doctors use naproxen (Aleve) as the first-line drug of choice for early CTS. This helps some people, and does nothing for others. Personally, I use it when I *know* I've done too much during the day (or will have to for a big project or the like) and my wrists *will* hurt, and it seems to help somewhat. Some people seem to believe that it will let you damage yourself more by "hiding" the pain. In the case of CTS, that does not hold true... The cause of the pain, the pain itself, and the resulting long-term damage all result from the same thing - inflammation. Reducing that (which naproxen does) reduces the pain *and* long-term damage. Only if you use an opiate painkiller, like Vicodan, do you need to worry about the drug letting you cause more damage to yourself by ignoring the pain (in the case of CTS only... I don't mean that to apply to *all* sources of pain, obviously).
Disclaimer: I do not have a license to practice medicine. I only offer this as an example of what worked for me. It might screw you up even more, for all I know.
A little bit of exercise. (Score:3, Informative)
1. Start with your arms straight out in front of you, the wrists roughly in a line with the arms, and the fingers relaxed.
2. Bend the wrist upwards as far as possible while also extending the fingers as far as possible. Hold for a count of 5.
3. Return the position in step 1.
4. Make a tight fist, then bend the wrist downwards as far as possible. Count to 5.
5. Return to the position in step 1, and this time hold it for a count of 5.
6. Repeat.
Tim
Re:Long-Term effects? (Score:2, Interesting)
SunStation Ergonomic Keyboard (Score:3, Informative)
You can even mess with xmodmap and invert caps lock and control, the way it is supposed to be on those boxes.
It's $80. I think most of the money is the fact that Sun beeps come from the KEYBOARD not the pc speaker, so the adapter has to intercept ^G and beep itself (it does). Freaky stuff.
It also allows you to use a normal serial mouse (Crystal Trackball!!!!!!).
I forget the part number but if people email me and ask me I can look it up, and maybe even supply my xmodmap file if you're that lazy.
But it exists!
You will hold the envy of your crippled coworkers.
Like playing the piano (Score:1)
Do you think maybe the experience of millions of people who have been using keyboards for hundreds of years may be right?
Everytime I find my wrists hurting, it is due to bad form, and practicing good form is what makes the pain go away.
Happy hacking!
Beware of Surgeons! (Score:2, Insightful)
Know this. If you seek medical advice each doctor will recommend his speciality. It's whatever tool is handy. Surgeons think they can cure anything with a knife.
Do your own research by talking to actual patients. If you talk to a few people that have had CTS surgery you will soon be talked out it.
Look into ergonomic solutions, massage therapy, abstinence from computers (that or stop masturbating, your pick), exercise, etc.
Cheers,
Beal
Re:Beware of Surgeons! (Score:1)
My sister and I are both contemplating CTS remedies and virtually everyone that we have met (anecdotal to be sure) who've had the surgury are worse off and wish they had made a differant choice.
Bottom line with all medical situations IMHO: Do your own research.
Cheers,
Bill
Cutting ligaments? (Score:1)
Easy Solution: Small Keyboard Shelf (Score:2, Insightful)
Since the unnatural contortions and stresses that lead to carpal tunnel seem to stem from typing while resting your wrists in front of the keyboard the absurdly simple solution would be, hey, don't do that.
I've often pondered how it happened that I've managed to use a computer continuously for the past decade without developing CTS while I've had friends have to quit after three years in similar jobs.
The answer? I had shitty computer furniture early on. It was too small. I hated the fucking thing. But, because the keyboard was forced right up to the edge of the desk, I got in the habit of hovering over the keyboard rather than resting my wrists in front of it.
Now, even though I could get a good four inches of desk in front of the keyboard, I still have my hands floating above the table top as I type. Plus, I suppose I get some small amount of exercise by supporting the weight of my arms... heh.
I am not a doctor, o' course, so don' go tryin' this jus' cuz I sez it works fer me.
Try taking Manganese first (Score:2, Interesting)
make sure the diagnosis is correct (Score:1)
it's still surgery (Score:2)
Re:it's still surgery (Score:1)
That's the statistic for outcome at 3 months, but the original research article says that by 18 months, 90% of the surgery subjects were improved. And, 41% out of the splint group went on to get the surgery during that time.
An interesting statistic that doesn't make it into the popular press is this one, quoting the JAMA article,
" After 18 months, only 29 of 79 patients indicated to be improved by splinting alone, resulting in a final success rate of 37% for the splint group."
So, your point about the people who are not helped by splints going on to get surgery is a good one, but in the slightly longer term, the choice looks like 90% chance of cure vs 37% chance of relieving symptoms.
I just went to the Doctor last week. (Score:2)
I now work 6 hours a week (ordered by doctor) with an option for more, if the pain doesn't go away.
My suggestion would be to make sure you have good posture (back straight), that you are above the keyboard and in front of it (you'd be surprised how people type) and make a point of stopping and stretching every 5-10 min. (for 30 sec to a min or two.)
All these things have helped, but YMMV.
Oh I also stopped playing drums and guitar for 4-5 day. (though those didn't hurt...hmmm)
Rock more, work less. That'd be swell.
ok questions... (Score:1)
Also, just a comment for those who haven't developed it yet, I suggest start working the muscles in your arms and forearms. Strengthen your fingers. I don't know if it helps, but I know every programmer I climb with, has not had any problems w/ carpal tunnel.
Stretching to help carpal tunnel (Score:1)