I really need help at this point and am pretty desperate for some solutions.
Background: I foobar’d my elbow last year and finally had surgery for a pinched nerve in my elbow that was causing me huge problems typing (cubital tunnel syndrome). oh by the way I work in IT with alot of typing all day every day. Surgery was in March and I *think* i was pain free up until last few weeks. I say “think” because I might have just learned to ignore any minor pain.
Now i am back to pain in my elbow while it is bent and my left pinkie gets sensitive then goes numb again. This is exactly why i had surgery and what they told me surgery would fix. Now i have a 12″ scar on my arm and back in the same pain and discomfort i was in. I have been using ergo keyboards for 10 years and i use the correct posture but I just cant stop the problems i am having. I need some solutions. I went back to the doctor, needless to say he was very suprised, and he suggested first taking anti-inflamatories for 2 weeks then possibly physical therapy. PT i find a joke because I have really good flexibility with no pain and can lift weights regularly pain-free. not sure what PT would do other than make me more mad.
I dont know why it sill hurts. I was thinking about getting forearm wrests to see if that would help other than that I am out of ideas and not happy with doctors.
Any and all suggestions are welcome.
Would the use of voice recognition software be a consideration? I don’t use it personally but have spoken to a few people who have. There was apparently some initial set up involved but after that they seem to like it as it minimizes the amount of keyboarding they do. Good luck.
I recomend Dragon Naturally Speaking for a variety of reasons, and it sounds like you should give it a try. Depending on your workstation, it may be the best solution for your longer text typing needs. I say depending on your workstation because usually I recomend it be used in a fairly quiet environment, and one where your dictating will not bother other workers. You may find that you can use it for just long text and to open/close programs in command mode, and then use the mouse and keyboard for everything else. You can operate the mouse by voice however it is a little tedious and usually folks with some hand function will opt to continue to use the mouse. There are definitely skills involved in dictating that some people just can’t seem to master, however with practice most folks can learn. The newest version of Dragon is 10, and you can get it online at http://www.nuance.com. The Standard Version is $99.00 and definitely worth every cent as far as I’m concerned. I just bought it for myself, loaded it up, put on the headphone microphone, did not do any training, and started dictating and it was 100% accurate.
The other most important thing is the mini breaks-stretching and alternating tasks every 30 minutes. I like the software that reminds me –www.stretchware.com. Check it out and good luck.
You mentioned ergo keyboards but not which ones. You might benefit from a larger spread to the alphabet keys or more extreme tenting, like with the newer Kinesis Freestyle. You also might benefit from a neutral posture mouse like the Evoluent.
In defense of PT: PT is not just about ROM and strenghening. An experienced PT will look at the entire arm, shoulder girdle and upper torso, not just the elbow. There may be scar tissue that needs to be broken up with deep tissue work or modalities. You may not experience pain when you work out, but that doesn’t mean your technique isn’t contributing to your problem. A PT can evaluate your work out methods and determine if changes would help. Find someone who specializes in body work and RSI.
You might benefit from an ergo evaluation where the evaluator watches you type. Static posture can be as damaging as repetitive motion. You may also hit the keys too hard. A light touch keyboard like the Goldtouch or Kinesis Freestyle might help.
And if you aren’t already, make sure you stop keying every 15 minutes and move your shoulders, arms and hands for 30 to 60 seconds.
The voice recognition software is also a good idea.
Do you have regular arm rests on your chair? I ask because I have had severe tennis elbow problems in the past which no longer bothers me, but when I briefly had arm rests on my office chair, my elbow got very sore almost immediately, then was fine shortly after removing the arm rest. Perhaps forearm rests would help you, but I would proceed cautiously.
You also mentioned having used ergo keyboards for 10 years–can I ask what brand and model? I need to disclose that I am with Kinesis Corporation, a designer/manufacturer of ergo keyboards. Hopefully you will not take this post as self-promotion, but there are very large differences between different ergo keyboard designs and I am very familiar with most of them. Most use "splay" (which forms a triangle from the torso and arms) but some allow complete separation where the arms can point straight in front of the shoulders. The latter can make a big difference in arm, elbow, neck and shoulder attitudes and tension because the split design allows you to hold your hands more or less straight in front of your shoulders to type.
I work as the Safety/RM Coordinator (and whatever other hat needs wearing!) for a public entity on the Oregon Coast and when one of the data entry folks in our Assessor’s office had bi-lateral carpal tunnel surgery, I knew she would have a hard time with job re-entry if we didn’t make some changes. Luckily, the first thing I tried worked: I bought a Kenesis Keyboard with foot control for her to use. It would be a wonderful world if we could just discontinue the activities that cause us physical distress but that’s not always the case and this person really wanted to keep working.
We both believe that the keyboard saved her job and I think there was a couple of factors that made that possible: the first was that the keyboard has such a steep learning curve that she had to slow….way….down to learn to use it; the second was that the motions for her fingers were so drastically different compared to a standard keyboard that it reduced the impact from the CT "release" procedure. She’s been using a Kenesis keyboard exclusively for almost 15 years without any flare up from CT.
It may be one of the things you want to try.
The Kenesis and Goldtouch keyboards recommended in this discussion are both available in the Ergobuyer Store:
Let us know if you have any questions.
Only effective, reliable, ergonomically designed products, satisfaction guaranteed.
Another thought: Since you have more pain when your elbow is bent, can you lower the keyboard so that your elbow is significantly more straight? You will need to place the keyboard in a negative tilt (far side lower than front) to keep from extending your wrists. And if you are long armed and long legged it may be challenging to get the keyboard low enough without hitting your legs. IF that is the case, you might try a standing station or keyboard tray that allows you to stand up. (Be sure to raise the monitor, too). A sit-stand stool would give you some relief from the standing and still keep your legs out of the way. If the angle of the negative tilt is so extreme that the keyboard slides, add a Rubbermaid mat. C.Kelley
I note that C. Kelley had some good suggestions – I’d like to take them a step further. Perhaps you need to find an Occupational Therapist who specializes in ergonomics and hand problems. This person could give you ergo tips (like what is the position of your neck and shoulders while you type? I often find that people who sit at a level that is good to put their feet flat on the floor are either raising their shoulders to put arms on keyboard or are tilting their heads to see the computer screen clearly – especially if bifocals are involved). Where is your mouse? Is your elbow at your side with about a 120 degree angle from forearm to upper arm (preferable for someone with cubital tunnel). As previously mentioned, a therapist may need to work on scar tissue (were you instructed to do scar massage?) and nerve glides/neural tension stretches. Neck and shoulder stretches may help as well. Often when an extremity has been in pain, the rest of the upper quadrant has developed tension and problems due to compensations used.
I hope that helps! To find a Certified Hand Therapist, go to http://www.asht.org – then work the phone to see if you can find one who knows about ergonomics as well.
Good luck! Shirley, OTR/CHT
I have not had the chance to read all of the other post so if I am repeating I apologise. Have you looked at any forms of mysofascial treatment? Are the muscles compressing your ulnar nerve as a result of the muscles being wound up? This could involve a number of areas as highlighted immediately above. Keeping the body in a relatively static posture can contribute to this muscle wind up.
Well, a lot of advice has been offered. Have you found any relief as of yet? I hope so. If not, may I offer my perspective.
I would look at several things, but this advice is no substitute for a qualified ergonomics professional’s consultation directly at your workstation. I would suggest searching your local area for someone who is certified by the Board of Certification in Professional Ergonomics. You can go to http://www.bcpe.org and search for a consultant by locality. I would suggest someone with a background in rehabilitation as well as ergonomics, and the BCPE credentials help to ensure competence in ergonomics.
As a starting point, be sure that you are comfortably supported in your chair. You should not have any contact with armrests or forearmrests given your history. Are your feet supported on the floor? Second, I would suggest looking at the worksurface height. Does it match the level of your elbow when the arm is comfortably relaxed at your side and your elbow bent to an "L" shape? Have someone measure and compare with the worksurface. Ideally, they should be equal. If not, can you adjust the worksurface or have it done by a maintenance engineer?
Be sure the chair is comfortably adjusted first, before measuring. A keyboard tray is a good idea, too, as you can adjust these into negative tilt, that is, angled away from you about 10-15 degrees so that you are able to hold your elbow in a more open posture, less greater than 90 degrees, which maximizes space around the ulnar nerve in the cubittal tunnel.
Of course, check to see that the monitor is adjusted so that you can comfortably view the screen without altering the neck or upper body posture. You may need an articulating monitor arm to adjust adequately for height and depth. Craning the head forward or into neck extension (looking up) is a bad posture and definintely affects the elbow, too.
In addition to the other advice you’ve received, I Hope this helps.
Mark Hank, OTR/L, CEA
I have been trying a great deal of things. I have a keyboard tray. All monitors are on swing arms that I can adjust for height. I use an ergo keyboard (8yrs) however i just cannot get comfortable and painless. I am not using any elbow rests at all. The pain starts from the outside of my palm on my left hand. Then i can feel dsicomfort in the back of my left elbow. Then left pinkie starts to feel funny (tingly and numb).
My arm does not feel comfortable at a bent 90 degree angle. that causes pain all over. i like my arm more open like at 160 degrees open (ie more extended arm). but this in turn makes it hard to see my monitors as they are now 2 feet away. I am working on getting them closer to the edge of my desk. THe other problem is I cannot get the keyboard tray correct because it wont lock at a down angle that feels comfortable and also at the best height the keyboard tray is pretty much wresting on my lap.
Basically this whole thing sucks and I feel like I cannot do much to fix it.
Hi Dennis, As you can see from the posts there are a lot of possibilities for you to consider. I’m an ortho PT with 26 years in the clinic and would like to suggest another possible reason. Many patients we see have primary or secondary problems with trigger points—a soft tissue anomly from various irritations such as overuse or trauma or actually any pain source. The muscle develops ischemia and resulting irritation that leads to pain. This often includes referred symptoms of pain and/or paresthesias in the upper or lower extremities. This is all documented well by Travell and Simons–google it and you’ll get plenty of info. I’d be happy to share more detail with you if you’d like. Because muscles react to any pain stimulus these symptoms can be a part of any trauma or overuse situation and the referred symptoms (according to Travell and Simons and my experience ) often mimic other diagnoses such as CTS,TOS, HNP, sciatica and many others. There’s a more complete list in the textbook. Need to find a therapist that can specidically evaluate trigger points.
Kurt Klemm PT Cert. MDT CEAS
I think that the suggestion of trigger points is a red herring and won’t be helpful to Dennis. He’s dealing with a nerve compression, and probably scar adheasions post surgery, so it doesn’t have anything to do with localized areas of muscle tenderness.
Dennis, I have to say, a keyboard set at 160 degress?!? That’s almost perpendicular to the floor?
It’s clear that some physical therapy with an upper extremity specialist is indicated, but I’d also get the workstation looked at by a qualified ergonomist, too. There’s only so much the well-meaning folks (myself included) can do via a blog like this. Call a few different clinic and ask if the therapists have expertise with nerve entrapment, especially post surgery. A PT or OTR with Certified Hand Therapist (CHT) credential may be the best person to treat.
Hope you’ll find relief.
The muscle wind up I am discussing is commonly known to result in issues such as brachial plexus compression etc resulting in change of sensation and loss of feeling etc. If it is not the muscles do you suggest bone?, scarring? etc. What do you believe is causing the entrapment? Is the surgical site presenting with keloid type tissue?etc
I think more information which would probably best achieved by as you say getting advise from a suitably qualified person.
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