Ergoweb has a clipart package that contains many images of various industrial workers using various machines and fixtures. They usually show two or three images showing different awkward postures, etc and how engineering controls can help. I use it, and find it very helpful. I’d recommend checking it out.
Yes, I think that it is scar tissue and adhesions about the ulnar nerve that Dennis is dealing with. While I cannot disagree with your assessment that muscle tension and the effects of static posturing, etc., I think that, at this point, the best thing that Dennis could do is seek qualified treatment. It is probably more confusing and frustrating just getting information from folks like us over the Internet. Also, don’t overlook the workstation, and get an ergonomist to look at that, too!
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.
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