Repetitive Strain Injuries

Way back in February 1996, I was hard at work for MindSpring Enterprises as a technical writer, authoring a software manual, creating web pages, and collaborating on a knowledge base. I was working from home because we’d run out of space at the office, and that suited me just fine. I would hyperfocus and sit for 10–12 hours without consciousness of any time passing. I was annoyed that my left hand kept going numb, but if I stopped typing and moved around, the feeling returned, so I didn’t think much of it.

I didn’t think much of it, that is, until the day that I realized that the numbness wasn’t going away anymore. My left hand had been numb for a week, and sometimes my right hand was going numb, too. I mentioned it while being treated for something else at my family doctor’s office. The doctor did take it seriously. He sent me to a neurologist. The neurologist did some tests and informed me that I’d damaged the nerves in my left arm and that only about 10% of the normal nerve impulses were getting through to my fingers!

Verdict

Next, I saw Dr. McBride, the hand specialist. The official diagnosis was “left ulnar compression neuropathy.” What that means for the non-medical majority: the nerves that control the hand have to run down behind the elbow before reaching the hand, bundled together like a phone cable before it splits off to the houses in your neighborhood. That bundle of nerves was being squeezed at the elbow, making the outer half of my left hand stay constantly numb (pinky to middle finger). The rest of the hand varied from numb to painful, but it was always relatively weak and clumsy. The more common name for this problem is cubital tunnel syndrome.¹I’m told that if you’re having pain and numbness starting from the inside of the hand (thumb first), you probably have carpal tunnel syndrome. If it starts from the outside of the hand, it is more likely to be cubital tunnel syndrome.

Treatment

Dr. McBride insisted that I stop typing at all with my left hand. (One-handed typing²I heard that snigger! was a real nuisance.) He said I could have surgery right away or try "traditional therapies," which meant a brace, rest, and anti-inflammatory medication. I chose not to have the surgery right away, hoping it would never come to that. The damage to the right arm wasn’t too bad yet, so I simply changed my work habits hoping to keep it fairly healthy.

Unfortunately, the non-invasive procedures didn’t work at all. In April 1996 Dr. McBride did a surgery he called a "release" to avoid further nerve damage. (There is no way to repair the existing nerve damage.) The surgery involved cutting my arm open from about halfway between my shoulder and elbow to just below my elbow and embedding that nerve bundle into the large muscle of my arm.

Aftermath

I was left with an ugly scar and permanent numbness in my left hand. My right hand continued to go numb from time to time for a few years, but eventually it healed. Still, both arms and hands ache like the dickens for no particular reason much of the time. I’m told the pain comes from a combination of arthritis and fibromyalgia. It is fairly normal for the site of any injury or surgery, and there’s not really anything to be done about it.

Dr. McBride prescribed occupational therapy for a while, but I found the formal therapy less helpful than something I did on my own. I picked up needlework again after a hiatus of several years. That allowed me to regain a great deal of fine motor control and some strength in the left hand.³If you experience a similar issue, I recommend finding some activity that forces you to use your hand(s). Try painting miniatures, playing a musical instrument, or working on small items.

Today

In February 1997, I was finally released to return to work. I’m still very careful about varying my movements through my workday, and I used voice control software as much as possible for a few years. Over time, I’ve learned to deal with my left hand’s numbness and weakness without anyone else being aware of them most of the time.⁴I think forcing anyone to listen to me play the piano might be a violation of the Geneva conventions, but I’ve still got my voice for making music. The 100+ words-per-minute typing speeds I once had are out of reach, but I’m no slouch at the computer keyboard.

Takeaways

1. Don’t spend 14 hours at a time at the keyboard. At the very least, move around and stretch and change positions, go get some more coffee, whatever, ok? Switch hands with the pointing device. If you normally mouse with your right hand, put the mouse on the left side for a while. (Feels weird, doesn’t it? You’ll adjust.)
2. Get serious about ergonomics. Your keyboard, monitor, chair, and typing surface all need to be adjusted properly to fit you.
3. Practicing proper ergonomics is good but not enough to avoid problems if you abuse your body. There are far more enjoyable ways to abuse your body, so at least introduce some variety into your life.
4. Do not lean on your elbows. Ever. This is much more important than keeping Mom from fussing about your table manners. Dr. McBride says that leaning on your elbows is one of the worst things to do to the nerves in your arms.

Resources

• Typing Injury FAQ
• Break Timer is a marvelous bit of software (for macOS, Windows, or Linux) that reminds you to stop and rest periodically.
• Dragon Speech Recognition Software is the best/most thorough application for hands-free control of your computer. It’s very pricey, unfortunately. There are specialty editions for legal and medical professionals.