RSI update March-August

Let me start with a time line to set up the history:

I was nearly pain free until the end of March.
3/25: Went to a 3 day conference and typed for 3-4 hours with my laptop in my lap. I was not in pain at the time.

4/1-30: I was in pretty constant (4-5/10) pain for most of April. I had only been doing nerve glides 1-2 a day so I increased frequency to 4-5 times a day. By May 1 I was nearly pain free again.

5/1-10: B and I went on vacation near the end of which we spend a few days riding a motorcycle all day. Pain stayed minimal.

5/17: I rode my dirt bike for the first time in quite a while. The pain returned at 4-5/10 at the end of May.

My six month follow-up visit with the hand surgeon was approaching and I was starting to worry so I made an appointment with the physical therapist. She and I put together the time line above, she pointed out that nerve pain is often delayed: something you do Sunday may not cause pain until Wednesday. She also felt strongly that motorcycling was contributing to my increase in pain even though there was not a direct relationship. I left that day discouraged. I continued nerve glides 4-5 times a day.

Pain decreased little by little over a period of weeks. I did not ride motorcycles less, I did continue to type with correct posture but still typed full time.

I finally has my follow-up EMG at the end of July. The results show very close to normal in my left elbow and within normal level in my right. The surgeon released me!

Though the pain is reduced I am still in pain about half the time. The pain varies from 1-3/10 with a periodic 4/10 but it’s minimal. I asked the surgeon about the pain and she described it as the nerve is still irritated but no longer damaged.

The bottom line is that nerve glides and behavior modification works. I can’t thank my therapist at the Hand Center here in Philadelphia for correcting my bad habits and ultimately showing me how to correct this without surgery.

I ride motorcycles as much or as more as ever. I type on a computer 10-15 hours a day 5-6 days a week. I am by all measures healing and able to do my work and my hobby.

It may help others at an earlier stage of recovery from Cubital Tunnel Syndrome to know what I believe was the cause(s) and how I corrected each. I am not a doctor or therapist so this is my experience only.

Sleeping with my arms bent: I have always slept with my arms bent either under my head or under my torso. I have consciously taught myself to sleep with my arms straight. It took a few months until I could consistently sleep without waking up with my arm bent. Here’s what works best for me now: pile two pillows, rest your head in one direction and put the arm behind your head under the pillows straight up. Put the other arm in front of your face over the pillow straight up. You need to slide down so your feet are hanging off the end of the bed. It may sound odd but it works very well and is the one position I can sleep in comfortably every time.

Poor posture at the keyboard: your knees, hips and elbows should all be 90 degrees. Your elbows should be at your side. Put the keyboard at a height that you can type on it without hunching your shoulders: this means either a keyboard tray or just a low table. Arch your lower back and get your head over your torso. Your chair should provide some back support and be the correct height such that your feet rest on the floor with your knees bent 90 degrees.

Raise the monitor/laptop. I use a Rain designs stand on my Mac. I have an iFold for travel. Both are a little low but get the screen up so I’m not looking way down when in the right posture. This reduces your tendency to want to hunch to get your eyes lined up to the screen.

Split keyboard: this makes a surprising difference. It should be essentially two pieces and allow adjustment. Hold your arms in the position described above and put your hands over the keyboards but keep your wrists straight. your keyboards should line up such that you don’t have to angle your wrists. I have 2 Kineses Freestyles and just bought a Goldtouch Go! I can type all day on either the Goldtouch or the Kinesis. Just a few minutes typing on a standard keyboard is painful..

Do your nerve glides! No one does physical therapy generally.. but seriously nerves respond to these exercises. I noticed a huge difference when I first started doing them and when I forget my arms hurt.. I’m still doing them 4-5 times a day. If you use a Mac install this: http://www.dejal.com/timeout. It reminds me to stop every hour.

Get a rest for your mouse. I use a goldtouch gel pad with a 1/4″ piece of high density foam stuck underneath it. This allows me to wrest the base of my hand while I mouse and thus not bend my wrist. It’s little but it makes a huge difference. I use a regular mouse otherwise: usually cheap corded mouse or inexpensive wireless mouse.

One thought on “RSI update March-August

  1. Timm

    Congratulations, you are one of the lucky few who have avoided cubital tunnel surgery with conservative treatment. Perhaps you can serve as a model for others who don’t have severe CuTS and hope to avoid going under the knife.

    We have a U.S. Armed Forces physical therapist on our forums, and in his experience, very few people can avoid surgery once their CuTS symptoms become severe enough to seek medical attention. I tried conservative treatment for a couple years but eventually it was too much pain and numbness for me to bear, so I had decompression surgery last June. I was healed for about 4 months, but unfortunately another area of compression formed above my incision, and now the symptoms have returned, though not as bad as before. I am trying conservative treatment again, but it’s likely I will require a second surgery, transposition this time, likely later this fall.

    If you or any of your readers are interested, you may wish to visit our Cubital-Tunnel.com forums where you can share your experiences, ask questions and get answers about your condition. Good luck with your continued recovery!

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