Date: Sun, 19 Jan 92 16:50:32 EST
From: beatty@sqhilton.pc.cs.cmu.edu (Derek Beatty)
Message-Id: <9201192150.AA00343@sqhilton.pc.cs.cmu.edu>
Reply-To: beatty+@cs.cmu.edu
To: bovik@cs.cmu.edu
Subject: carpal tunnel

How have your fingers and wrists been lately, Harry?

Here's something my brother in medical school sent to me
on CTS.  (I tried to edit out a few typeos from this
version.) 


 -- Derek

Begin forwarded message:

Date: Sun, 19 Jan 92 16:21:09 EST
From: beatty@med.unc.EDU (George William Beatty)
To: beatty@SQHILTON.pc.cs.cmu.edu
Subject: carpal tunnel

Carpal Tunnel Syndrome (CTS) (if that's what you have):  involves median nerve
and flexor tendons that extend from forearm into hand through a "tunnel" that 

is made up of wrist bones, (carpals) and transverse carpal ligament.  When 

you move hand and fingers, flexor tendons rub against sides of tunnel, get
swelling, pressure on median nerve resulting in tingling, numbness, and
eventual bad pain.  Treatment incl.: steroids, non-steroidal anti-inflammatories,
physical Tx, surgery to loosen transverse ligament.  Recovery is usually 

complete. 

	Causes.  variable and multifactorial.  1) genetic predisposition:
amount of lubricant of flexor tendons is variable 2)  lifestyle:  increased 

incidence seen in people with gout, diabetes, rheumatoid arth., hormonal changes (preg,  
menopause, birth cntl). See increased incidence with increased 

job stress.  More common in alcoholics.  3)  Repetitive motion.  most common 

association.  Important to allow recovery time (which may be seconds to minutes)
after irritation of tunnel to prevent subsequent irritation. 4)  Trauma. 

	Prevention:***   Seating: adjust seat height and position of backrest
armrests helpful.  Table height:  Table surface of 27-29 inches above floor
recommended, more if taller.  If you can adjust table, set wrist angle at 90, 

then adjust table so that elbow makes 90 degree angle when hands are on keyboard
Wrist angle:  wrists should rest comfortably on table in front of keyboard. If
keyboard is thick (so you have to bend hands upward to reach keys) place a
raised wrist rest (say it 10 times fast) in front of keyboard.  Elbow angle:
ideally 90 degrees. Hold elbows close to sides to prevent having to bend wrist 

laterally, as when reaching for "Z" key.  Waist angle:  should be 90 also.
adjust seat height, sit straight like your mother told you to (see what
happens when you don't listen?)  Feets: should be flat on floor, or at least
flat on a footrest.
	Work routine.  Generally need very little recovery time between
keystrokes to cool and lubricate tendons, but if type constantly need for
recovery increases.  Some studies suggest 10-15 minute break for keyboard/hour.
yeah, right.
	Exercises: 1) Make tight fists, hold for 1 second, then stretch fingers out
out wide and hold for five seconds.  Repeat sev. times. 2)  With arms outstretch
outstretched in front of you, raise and lower hands sev. times.  Rotate your
hands ten times (making circles in the air with fingertips).  Chant.
	Variety:  Don't do all your typing at once, try to spread it out 

during any given day.
	Detection:  Most painful cases are those caught late, if catch early
can prevent pain.  Early symptoms:  tingling in fingers, often beginning sev. 

hours after finishing work.  Eventually tinging leads to stiffness and numbness
in fingers and hand and then to severe wrist/hand pain.  Go to MD and pay
generously.  Tip.

	corrections: i mean tingling not tinging.  "causes, #3" should read:
"rubbing" leading to irritation, not irritation leading to irritation, which
makes no sense.Lucky people like me who make approx. 7-8 typos/line and have to
pause to fix them will never develop CTS, bye, g.