# Preventing Carpal tunnel syndrome



## lumberjoe (Mar 30, 2012)

I'm looking for some tips here. To preface, yes I am going to see my doctor in 6 weeks, appointment is made.

I am 34, by trade I work in IT. I use a mouse and type 10 to 12 hours every weekday. About 4 months ago, I started REALLY getting into woodworking. I probably spend 1 to 3 hours a weekday in the shop, and a good 6 to 8 hours a day on weekends in the shop. About a month ago I started noticing some strange stuff.

My right hand (I am left handed) is almost always sore and "weak". At a certain point, I can no longer feel how hard I am gripping things even though I am exerting more pressure. 
As of late, when I lay down to sleep, I am woken up in 4 to 5 hours with both my hands being completely numb. Changing positions does nothing. I have to stand up or sit. I notice this is MUCH worse when I use tools with a lot of vibration such as sanders and jigsaws.

I've got the full ergonomic treatment at my computer work station, any good tips for ergonomics in the shop? I try to take frequent breaks and stretch out my hands a lot. Also has anyone had the surgery? I'm worried about a potential loss of dexterity after.


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## dhazelton (Feb 11, 2012)

It might be tendonitis, which is an inflammation of the tendons that run though your wrists. I got that last summer when I used power sanders a lot. I bought splints to immobilize my wrist, and used something called the Fast Patch which has Chinese herbs on it. Tiger balm, joint supplements etc. It took about a month for me but the swelling went down to where I could do things normally. But I still wear a wrist splint if I have to sand or paint for any length of time. It just forces you to use your arm more for movement than your wrist. Lately when I mow my lawn the vibration through the handle, combined with having my hand wrapped around the bar puts my hand to sleep. Gel gloves don't help me that much, but some. As far as going to bed and waking up with tingling sensation, you may want to get a 2 inch thick 4 pound density memory foam pad for your bed. It helped me greatly with numbness in my shoulders as I tend to sleep on my side. Good luck.


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## bruc101 (Sep 13, 2008)

I've got this problem and have had it for years. After my hand got injured it made things even worse. I spend a lot of hours a day in Autocad and in the shop. 
The surgeons told me that when I sleep at night my hands drop down and this causes the blood flow to the hand slow down so i was waking up with a numb hand with a lot of hurt.
When I sleep at night or when it's bothering me I wear a brace on my hand to keep it straight and on my arm right below the elbow I wear a tennis elbow or tendonitis brace. 
Most nights this is the only way I can sleep all night long without waking up with a numb hand hurting so bad I have to get up.


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## northeaster (Jul 30, 2011)

Unfortunately, carpal tunnel and tendonitis are somewhat interlocking problems.

Carpal tunnel is generally thought to involve inflammation of the tendon sheaths that pass under a very stiff, unforgiving band of tissue in your wrist on the palm side. The problem is that the nerves controlling your hand also pass through that space. If there is significant long term irritation, those nerves are compressed by swelling and sometimes scar-like tissue formation (which is not necessarily visible from the outside) in a space where there is nowhere for them to escape. From that nerve compression, function (feeling, controlling muscle) ends up compromised; hence, you get pain and weakness.

There are many ways to get to overuse (typing, vibration, etc), but the usual treatment path tends be

1) minimize or eliminate the offending activities (particularly repetitive motion and vibration)
2) immobilize the involved joints with (initially often with soft, not necessarily hard) splints as much as possible
3) use anti-inflammatories like Motrin
4) in refractory cases, surgically release some of the fibrous tissue. Surgery is not something most people suggest immediately, because the intervention itself can cause more inflammation and is not invariably a solution. (You can't remove the entire band of tissue for very good mechanical reasons.)

This is not something to be taken lightly and often takes months to quiet down (I have, in a workplace setting, managed it with several employees), but it's great you are taking a proactive approach. Probably already done, but have your IT colleagues suggested voice recognition software as well at work?


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## lumberjoe (Mar 30, 2012)

Voice recognition will not work for a lot of what I do. I am an IT manager but still 75% hands on in some sort of Cisco CLI (command line interface) environments, ALT-TAB'ing through various ones. Watching my screens while I work could induce vertigo. In addition I do a ton of multitasking while on time wasting conference calls that make customers happy to have "management presence" on. I know where this road leads so I am not taking it lightly at all. If I want to keep my career and my hobbies (I fly fish and tie flies as well as woodworking, which is why I am concerned about loss of dexterity) then I need to be proactive.

I've had tendinitis and that feels a lot different than this. With tendinitis I could induce the reaction by moving a certain way or performing a certain action. Now the pain and numbness is indiscriminate and constant. I'm not a doctor so I could be wrong. Those are some good tips though and I am glad I asked. Given that most repetitive stress injuries are caused by excessive vibration, I figured I would get some responses.


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## dakremer (Dec 8, 2009)

Well these guys have basically hit the nail on the head. "Carpal Tunnel Syndrome" is named after the anatomy it pertains to - the carpal tunnel. The carpal tunnel is an anatomical tunnel in your wrist. The tunnel is created by the flexor retinaculum - a piece of fascia on the anterior surface of your wrist that keeps all the tendons, nerves, vessels close to the body while flexing the wrist. This type of fascia can be found all over the body. Here are some pics from one of my anatomy programs showing the fascia and the tunnel it creates…..



















Not only does the flexor retinaculum keep anatomy close to the skeletal body during flexion, but it also serves as an origin for some tendons of muscles in the hand - particularly muscles that adduct and flex the thumb and pinky (the position your hand is often in while typing and operating a mouse). Overuse of these muscles creates micro-traumas to those tendons which cause inflammation. Like others have said above - that inflammation of that fascia causes nerve compression (explaining your numbness) and also nerve irritation (explaining your pain). As a chiropractic student I've been exposed to lots of research pertaining to this very subject. I can send some literature your way if you'd like. There are many stretches/exercises you can do to help out. There are also different therapies you can apply such as a paraffin wax treatment. Of course cutting back on the computer use (as much as possible) and/or taking more breaks from the computer is ideal. If you continue on this path without giving your wrist a chance to properly heal, you could end up with permanent nerve damage.

For those exercises/stretches - just google "carpal tunnel, stretches, exercises" - I'm sure you'll find plenty. You might want to start icing as well, to keep the inflammation down, no more than 30 mins at a time.

Good luck! I hope you get well soon!


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## northeaster (Jul 30, 2011)

I can't say that I have reviewed the literature recently, but are you certain vibration is the most common primary cause? I would think it varies significantly by work environment (classically, meat cutters, machine operators heavily biased to a particular repetitive motion, as well as big time typists such as yourself, etc.).

The injuries I have been most involved with long term were initially associated with a particular activity that did not involve vibration in any substantial way. I can't comment in an informed way about what you do in the shop, but might guess that it is much less repetitive than your IT work activities.

Once you have significant underlying inflammation, it can be exacerbated in a lot of different ways, though.


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## lumberjoe (Mar 30, 2012)

Yes, according to literature my doctor sent me after I spoke with her:

Carpal tunnel syndrome is often the result of a combination of factors that increase pressure on the median nerve and tendons in the carpal tunnel [......] mechanical problems in the wrist joint; work stress; repeated use of vibrating hand tools; fluid retention during pregnancy or menopause; or the development of a cyst or tumor in the canal. Carpal tunnel syndrome is also associated with pregnancy and diseases such as diabetes, thyroid disease, or rheumatoid arthritis. In some cases no cause can be identified.

There is little clinical data to prove whether repetitive and forceful movements of the hand and wrist during work or leisure activities can cause carpal tunnel syndrome. Repeated motions performed in the course of normal work or other daily activities can result in repetitive motion disorders such as bursitis and tendonitis. Writer's cramp - a condition in which a lack of fine motor skill coordination and ache and pressure in the fingers, wrist, or forearm is brought on by repetitive activity - is not a symptom of carpal tunnel syndrome.

This came from the National institute of neurological disorders and stroke. I'm not sure how much stock to take in this since CTS is so common in the IT industry. I never really worried but my workplace takes it very seriously. I work with 2 older women that have had the surgery after years of treatment didn't work.


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## dakremer (Dec 8, 2009)

Well there's no clinical data to prove overuse will cause carpal tunnel because it would be unethical to perform a study to prove this. The only way to prove this would be to have a random group of people divided into two groups and then randomly have one half of the group do repetitive overuse activities, and the other group not. Watch them over a period of time and see how many of each group develop carpal tunnel. This research will never happen because you can't ethically have a research participant perform a task that you believe will cause a "pathology" or state of physiology.

So while there is no "clinical" data to prove this, it is most likely the case (especially for you - with typing and using a mouse 10-12 hours every day). Unless you believe your body is making a mistake (causing the carpal tunnel syndrome) and therefor need a drug or surgery to fix it, then it is 100% caused by the environment your wrist is exposed to. The later (of course) is true. Its not a mistake.


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## northeaster (Jul 30, 2011)

Joe, your point about the relationship between pure carpal tunnel and repetitive motion injuries is really well taken. Still, I think it remains fair to say that vibration injury is only one of a laundry list of possible causes of carpal tunnel: nothing there says it is at the top of the list as a primary cause.

Also, I think I would be on very solid ground to say that repetitive motion syndromes can present looking very much like classical carpal tunnel. Anecdotally, one of my employees in a laboratory setting a few years ago developed what was clearly a repetitive motion syndrome from a particular activity. It had many features very similar to those you're describing (partly localized tenderness of her wrist and thumb, weakness/tingling, and chronic hand and forearm pain). Her pain was made worse by any form of physical activity involving the hand; while she didn't try orbital sanding or jigsaw use, I can be pretty certain those would not have gone well.

However, she was not formally diagnosed with carpal tunnel or simple tendonitis because there was a clearly identifiable, work related motion that led to her problems. As a consequence, she received treatment and time off under Workman's Comp laws rather than through her basic medical insurance: there may be substantial differences for you or not, depending on the setting.

For that reason, you might want to be very careful in understanding what diagnosis you actually have. Occupational medicine people, primary care physicians, and orthopedists in my experience usually get on the same page eventually, but there can be some zig-zagging along the way.

The initial treatment of either problem is, to my understanding, identical: get rid of offending physical motions first. If it comes to a question of surgery later, there may or may not be differences in the way the problem is addressed.

Good luck!


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## Rick Dennington (Aug 27, 2009)

You're going to need c.t. surgery…I know…I went through the same thing about 4 years ago, and had the surgery done on both hands at the same time….Carpal tunnel surgery is a piece of cake, and you're not down that long…..I had exactly the same symptoms as you….both hands going dead/numb, especially at night while trying to sleep…..I even begin to loose feeling in my left middle fingers….either too much woodworking with sanders, vibrating tools, or too much fishing and holding the rod with my left hand, and setting the hook….it got really bad….I went to see my doctor, he ran some nerve test, and said surgery…..it's not bad at all…you go in as an outpatient, they put you under, and the doctor* OPENS *up the tunnel, which is at the top of your hand next to the wrist…..makes a small incision about 1/2-3/4" and "releaves" the pressure on the leaders and nerves…that opens up the tunnel. The neves and leaders are* "pinched*" to the point of causing numbness….once opened up, the feeling starts to come back. He then puts about 5-6 stiches in the wrist, puts a big bandage on your hands, and you go home…...In about 5-10 days, you have the stiches removed, and you're good to go…..Just don't put any pressure on your hands for a long time, like trying to get up out of a chair where you push down…no no….!! But you can use your hands and the numbness is gone….In my case, it took a long time to get the feeling back in my fingers…If you're married, I hope you have a wife that really loves you…you'll find out how much when you got to the toilet….lol. But with your symptoms, I'd get er done and soon…..it doesn't get better…..it gets worse…


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## joebloe (Feb 13, 2012)

About three years ago I had the same problem,but it was my left arm.It started slowly,at first every once in a while it would go numb,then it started to ache. then it was both ache and numbness.I ended up having surgery,it was carpal tunnel syndrome.It got to the point that it felt like a toothache in my wrist and forearm.After Surgery the pain was gone,still had numbness,but over time the feeling came back.The Doctor told me that I might never have all the feeling come back.Well three years later and I would guess at about 80% feeling has came back.If it was to happen to the other hand,I wouldn't hesatate to have the surgery again.The Doctor told me a exersize to do to help prevent it,hold your arm straight out in front or you,fingers pointing up,take your other hand and pull back towards you until you feel it streach in the palm of your hand.This helps streach the ligament that is over the tunnel.hope this helps. northeaster,repetive motion is only one of the causes,power tool vibration is also one of the things that that will cause it.Something else that I have done to help prevent getting this again is I wear a pair of gloves that have gel pads in the palm.I have cut the finger tips off them so I can feel the boards when sanding them.


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## Loren (May 30, 2008)

Read up about DMSO.

I use it from time to time and while it does cause some 
discomfort in the first hour or so after applying, in my 
experience the effect is worth it.

Seriously though, try to lay off the typing and the mousing. 
I've had problems related to typing and playing the guitar
myself and in general I've found the way to heal is to
back off on the repetitive activity. Way off.

Look at wearing compression gloves or bandages on 
your hands and wrists.

Also - invest in a higher-end sander and jig saw if you
insist on power sanding. Festool makes some good
sanders and the Festool jig saw has really low vibration - 
lower than the Bosch ones I've used. In terms of 
lower vibration sanders Festool isn't the only game in
town. If the sander is balanced in such a way that
you can steer it by the cord, that is a boon and reduces
hand numbness considerably. DO NOT bear down on 
the sander. Doing so will wreck it and possibly make
vibration effects worse.


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## dakremer (Dec 8, 2009)

man I have to totally disagree with Rick…..make sure the surgery is YOUR VERY LAST OPTION!! oh my gosh!


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## northeaster (Jul 30, 2011)

John and Rick, it's really great to hear that surgical interventions have apparently helped both of you.

I am not a patient who has undergone carpal tunnel surgery myself. However, I am a boarded MD/PhD with several years of clinical experience and have participated in the care of a number of patients who saw surgery for similar problems and a number who were treated conservatively. Please qualify that by the fact that I am a research person at this point, not a practicing primary care physician or orthopedist. In that way, I have a perspective that is informed differently, but may still be relevant.

If I gave the impression of having certainty about how Joe might best go forward, please forgive me. I clearly don't have a complete history, physical examination, or laboratory studies (particularly, nerve conduction velocity) that would be crucial to understanding what steps to take next in this particular instance.

That said, it seems to me that by history the problem is not necessarily either woodworking or a particular kind of repetitive motion (typing) alone: it may well involve both activities.

One might guess that a couple of months of daily hobby woodworking for an otherwise normal 34 year old (no disrespect, Joe ) is unlikely to yield a problem this severe, but I don't know that anyone has really good numbers on the frequency of the problem in hobbyists.

The only other obvious risk we know about is the IT background of presumably years duration, with 10-12 hours of typing a day in a field that has a significant risk of carpal tunnel (or repetitive motion injury, depending on who diagnoses, codes, and treats it). That kind of chronic trauma is well associated with the OP's problem, but the onset of symptoms around the beginning of woodworking is hard to ignore.

Other conclusions about surgery might be different and more correct than mine. I would say that many of the people I have worked with before would be a little less certain about moving immediately to surgery in the context of one to two months of pain without a trial of more conservative treatment unless there are very substantial physical findings, though.


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## lumberjoe (Mar 30, 2012)

Thanks for all the responses. To be clear, I want surgery to be my LAST and final option. I've had far less severe and less frequent symptoms for a few years, but nothing to be overly concerned about as the symptoms would often regress for a while. as of late they have not. Now that I think about it, the first onset of constant soreness came after I refinished my 3rd floor into a master bedroom. Carrying numerous 2X4's and 4×6's up 2 flights of stairs on top of 25 sheets of drywall was a lot of work. My wrists started getting sore and I just attributed it to doing "actual work" for a change. The woodworking started as honey do lists from my wife. "if you can turn a crappy attic into a beautiful bedroom, surely you can make some night stands".

Anyway, I'm not looking for a diagnosis here but I really appreciate all the input. I am really looking for a safer way to practice my hobby. Whatever the root cause of my pain may be is still unclear (although from my research and my PCP's initial diagnosis, I am the poster child for CTS). With that said woodworking does aggravate whatever it is quite a bit. It is not something I wish to discontinue, in fact I just invested close to 4,500$ in tools to outfit my shop. I will take the tips under advisement. I did get a wrist brace. While uncomfortable, I wore it for the 40 minutes it took me to do some sanding tonight and it made a noticeable difference. I should also mention that my wife is a registered nurse and practices/manages in a rehab facility. She's given me some good stretching advise, but her overall cure is not satisfactory to me - "get out of that god damned garage and do some laundry!"


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## northeaster (Jul 30, 2011)

Aha, now the real story!

In that case, I'm pretty sure I can speak for all of us here: avoid doing laundry altogether, you never know what might exacerbate the problem…


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## ssnvet (Jan 10, 2012)

I'm a CAD jockey and after 10 years I was having significant problems with my right (strong) wrist….

I fooled around with ergonomics and braces, but finally just switched over to left hand mousing. It took about two weeks to build up my dexterity.

Many CAD guys switch to track balls as well.

In the shop, I use a belt sander more, and only jitter bug when I switch to 220.

Wrist position at night is a big contributor… I've played around with pillows quite a bit and have come up with o.k solution


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## Loren (May 30, 2008)

Switching to the Dvorak keyboard layout reduces movements
in typing quite a lot. It may seem radical to learn a new layout
but it really is not that hard to learn it. I never mastered it 
myself but working with it for awhile improved my Qwerty 
habits as well.


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## lumberjoe (Mar 30, 2012)

Dvorak is something I tried but can't get used to. They keyboard I use (Das keyboard; pictured below) has no markings on any of the keys, so it's easy to switch the layout. I actually ordered the one with markings but they sent this one instead. It's one of the only keyboards with REAL mechanical key switches. I got used to it and decided to keep it. As an added bonus, the wife and kids are never tempted to use my computer(s)! Trackballs frustrate me beyond belief, and I do switch up my mouse hand from time to time.

Thanks for the tips! keep them coming.


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## twistedscrew (Apr 1, 2012)

I had carpal tunnel surgery on both of my hands at the same time, My dr. said it is not as bad as every makes it out to be. I could not believe the difference once I got over the surgery. It had the surgery on Thursday, and was back to work (light duty) on Monday. ( I work for a rural electric coop), It took about three weeks to have full use of both hands. If I had to do it again, I would not hesitate to get it done. Good Luck


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## Rick Dennington (Aug 27, 2009)

I still believe that with your symptoms that you are describing and the pain and numbness, etc., that you'll eventually have to have surgery….I don't think that any amount of exercizes or wearing the wrist brace (I wore one too for a good while, and even at night) is going to help that much, if any…..It did nothing for me.. I can tell you this*.....it'll get worse before it gets better*....The surgery will take care of the c.t. problem, and you can get on with your life w/o having to deal with the pain and misery…The longer you put it off looking for a *" miraical cure", the worse it gets…..There have already been 3 testements for the surgery posted here..*You have to make the decision….noone can do it for you….I wouldn't hesitate in a heartbeat to do it again, if I had to…..But I don't think I will ever have to do it again…..I'm fixed and cured of that demon…..!!!!


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