We addressed computer ergonomics today in physical therapy. I am of course a mess. The hardest part of all of this is how tightly the convenience of a laptop is intertwined into my life.. My early feelings on the matter are that I’m going to have have to set up my desk at home and any office I work for more than a day or two. It’s vaguely depressing to drag around a split keyboard and stand everywhere I go but I keep reminding myself it beats surgery..

Here’s an example of what she recommended:
http://www.medicinenet.com/script/main/art.asp?articlekey=22781

Basically: sit back in a chair with lumbar support. It should push your shoulders back. Your knees should be 90 degrees, your ankles should be 90 degrees. Your chair should of course be high enough to allow your knees to be 90 degrees. The top of the monitor should be level with your forehead. Your arms should be at your sides, 90-100 degree bend in your elbows, wrists neutral. My PT says you usually want a keyboard tray to place the keyboard at the right height but in my case I may be able to get away without one because I’m tall enough to reach the keyboard on a table and maintain a neutral wrist position. Hands should bend in naturally.. You want a keyboard that takes minimal finger effort to type on. You should use as little force as possible while typing.

What this means for a traveling laptop user is a portable notebook stand and a split keyboard:
http://store.ergocube.com/gotrnost5.html and
http://www.amazon.com/Goldtouch-Apple-Compatible-Keyboard-Black/dp/B001IIP9UY/ref=sr_1_1?ie=UTF8&s=electronics&qid=1231819997&sr=8-1

You can buy them both at goldtouch.com but their return policy is draconian and I have never seen either in person.

Yes, that’s a Mac keyboard.. draw your own conclusions. No, it hasn’t arrived yet.

A conventional mouse is fine.. so I’m just going to carry one of of the dozen or so Dell mice hanging in my closet.. eventually I’ll pick up a bluetooth mouse.

Traditional molded ergonomic keyboards are apparently bad: they’re one size fits all, ie don’t allow adjustment. Keyboards that tilt toward you are bad. If a keyboard has feet you’re better off folding them down and laying it flat.

I find it surprising that no one makes a bluetooth split keyboard. Goldtouch will have a travel split keyboard in February: http://www.goldtouch.com/p-139-goldtouch-go-travel-keyboard.aspx

So I’m 34, a computer consultant and I’ve worked and played on computers since I was in third grade. It should come as no surprise that I’ve been diagnosed with Cubital Tunnel and Carpal Tunnel Syndrome in both arms.

Basically my ulnar nerve which passes from the neck through the two bumps at the base of the elbow and to the hand is damaged at the elbow. I had nearly constant pain in my elbows which was exacerbated by bending my elbows more than 30 or so degrees.

While typing is probably a major contributor I believe sleeping with my arms bent is a significant factor. More on this later.

The therapist pointed out just today that if I tap my wrist just below my palm I get shooting sensations up my index and middle finger. This I believe is the carpal tunnel.

I won’t go into too many more details of cubital or carpal tunnel syndromes as there’s plenty of descriptions of each online but my experience might be helpful. I have read some really great accounts of the surgery but not so many of the early symptoms or conservative approach to treatment. I am of course not a doctor so please take this as my experience.

I have had pain in my hands off and on most of my adult life–I type for a living and it comes with the territory. Around the time I became self employed and thus started working more I began to get pain and numbness in the side of the hand with the pinky and ring fingers. That was almost two years ago. What I didn’t know then is that is the first signs of cubital tunnel syndrome. Knowing what I know now I would have gone to a hand specialist immediately.

Thanksgiving of last year, about 6 weeks ago, I began to have constant pain in my forearms from the palm of my hand up to my elbows. The pain didn’t go away so I called my doctor and got a referral to the Philadelphia Hand Center.

I met with a surgeon I had been to many years ago for a minor hand injury. She called for an EMG to determine the severity of the damage but talked about surgery a little too early and spooked me. After reading up on the surgery and talking to smart people in my life who have been through similar situations I resolved to get a second opinion if she called for surgery. The EMG showed about 43 in my left elbow and 47 in my right. The therapist who gave the EMG was both very good and very patient.

The surgery for Cubital Tunnel syndrome by all accounts very straightforward and generally successful. It does require six or so weeks of no or limited use of the arm and in my case potentially both arms one after the other. There is potential for serious side effects I think mostly because there’s potential for damaging the nerve. Either way I prefer a conservative approach.

The EMG is brutal but manageable–it involves sending electric pulses from different places on your arm and your wrist and measuring the subsequent pulse generated by the nerve. The voltage is benign but it is really surprising. The needle part involves pushing inch and a half needles into the three meaty parts of your hands.. it’s not so bad if you close your eyes and your therapist knows what he’s doing. It’s also key to diagnosing the severity of the problem so do try to be patient.

Early treatment is sleeping with your arms straight, bending your arms as little as possible during the day. This means drinking, eating, showering, putting on a motorcycle helmet, buttoning your shirt, hugging your gf are all painful. It sucks. Anti inflammatories make little difference in the pain but long term may help. Icing my elbow helps a lot. I bought a brace but I was surprised at how quickly I learned to sleep with my arms straight. It still bothers me a little but it only took waking up with half my hand numb once or twice to scare me into straightening my arms. My arms are a little sore after six weeks of minimal bending.

Just from minimizing elbow bending and maybe regular anti inflammatories I have seen a 5-10% improvement in my symptoms. Right now I can button my shirt, braid my hair and eat and drink with little to minor pain. Braiding my hair in particular was a 4 or 5 on a scale of 1-10.

The surgeon says I’m in a gray area and I may benefit from physical therapy. I went in today for my first session. J, my therapist, worked me through various tests to identify the severity: I have no measurable loss of sensation or strength and no signs of atrophy. J feels I am a good candidate for a full recovery from physical therapy. I pressed her for a time frame and she feels I should see a full recover in 8-10 weeks.

I’ll dig up some online examples of the exercises she gave me since I probably shouldn’t publish the paperwork I have here. I absolutely love the carpal tunnel exercises–I am to do them once an hour while I type. They seem work the muscles you use when you type and it feels great on tired hands.