Touch my hand . . .

Computer Related Repetitive Strain Injury

Copyright © 1996-2013 Paul Marxhausen. THIS DOCUMENT IS NOT AN OFFICIAL PUBLICATION OF THE UNIVERSITY OF NEBRASKA-LINCOLN.

"We pray with our hands and often communicate with them. We use them to eat, work, and make love. We employ them as marvelously sophisticated instruments of flexibility and strength, and when they are damaged, we anguish."
- Keith L. Moore, Clinically Oriented Anatomy

As more and more work, education and recreation involves computers, everyone needs to be aware of the hazard of Repetitive Strain Injury to the hands and arms resulting from the use of computer keyboards and mice. This can be a serious and very painful condition that is far easier to prevent than to cure once contracted, and can occur even in young physically fit individuals. It is not uncommon for people to have to leave computer-dependent careers as a result, or even to be disabled and unable to perform tasks such as driving or dressing themselves.

I've faced this problem myself since March of 1994, and many friends are also affected to varying degrees. I am not a health care professional, but I hope on this page to provide a very brief introduction to RSI for the benefit of students who may not be aware of the potential for a life-altering injury. It includes book references and links to Internet resources that have been helpful in educating me about this. Don't hesitate to get in touch by e-mail, but because I have to limit my own computer use, please take the time to consult the entire page and the listed materials at length first. -Paul Marxhausen

[What's RSI?][Symptoms] [Prevention][What If?] [Books][Network Sites] [UN-L Info] [FindADoc] [Products] [Reviews] [Music]

DEAD LINK ALERT: This site is overdue for "weeding" expired links to external sites. I apologize for the inconvenience while this is in process.

What is RSI?

Repetitive Strain Injuries occur from repeated physical movements doing damage to tendons, nerves, muscles, and other soft body tissues. Occupations ranging from meatpackers to musicians have characteristic RSIs that can result from the typical tasks they perform. The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders. Use of pointing devices like mice and trackballs are as much a cause, if not more so. The thousands of repeated keystrokes and long periods of clutching and dragging with mice slowly accumulates damage to the body : another name for the condition is Cumulative Trauma Disorder. This can happen even more quickly as a result of typing technique and body positions that place unnecessary stress on the tendons and nerves in the hand, wrist, arms, and even the shoulders and neck. Lack of adequate rest and breaks and using excessive force almost guarantee trouble.

You may have heard the term Carpal Tunnel Syndrome in connection with these injuries, but in fact CTS is only a small and dangerous percentage of typing injuries. Tendinitis, Bursitis , Tenosynovitis / DeQuervain's Syndrome , Tendinosis , Thoracic Outlet Syndrome, Trigger Finger/Thumb , Myofascial Pain Syndrome, Cubital Tunnel Syndrome, and several other related conditions may also be involved. All of these are serious and in advanced cases can cause great pain and permanent disability. In addition, patients injured by repetitive strain sometimes develop Reflex Sympathetic Dystrophy (RSD), discussed here and here .


What are the Symptoms?

  • Tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows

  • Tingling, coldness, or numbness in the hands

  • Clumsiness or loss of strength and coordination in the hands

  • Pain that wakes you up at night

  • Feeling a need to massage your hands, wrists, and arms

  • Pain in the upper back, shoulders, or neck associated with using the computer.

How Do I Prevent It?

Correct typing technique and posture, the right equipment setup, and good work habits are much more important for prevention than ergonomic gadgets like split keyboards or palm rests.
Figure 1 shows proper posture at the computer. ( Some current thinking suggests that a monitor position lower and farther away may be better. In addition, there are other opinions about what is the "correct" position. ) Note that the chair and keyboard are set so that the thighs and forearms are level (or sloping slightly down away from the body), and that the wrists are straight and level - not bent far down or way back. If the table is too high to permit this, you may do better to put the keyboard in your lap. Also note that the typist is sitting straight, not slouching, and does not have to stretch forward to reach the keys or read the screen. Anything that creates awkward reaches or angles in the body will create problems. Please note that even a "perfect" posture may result in problems if it is held rigidly for long periods of time: relax, MOVE and shift positions frequently. This isn't just about your hands and arms, either: the use or misuse of your shoulders, back and neck may be even more important than what's happening down at your wrists.

More specifics:


More tips ...


...on preventative posture and correct technique are on the Typing Injury Frequently Asked Questions Archive, maintained by Dan Wallach & Scott Wright. A great starting place for learning healthy computing is, well . . . HealthyComputing.com

What If I Have Symptoms of RSI?

We all have occasional aches and pains that go away in a day or two, especially when we overdo anything. But if you have the symptoms listed above regularly when you are using the computer, run, do not walk, to your doctor or health care provider RIGHT AWAY. Dealing with this early is critical to limiting the damage, and to spare you a world of hurt , trouble, and frustration. You are not overreacting: by the time you have symptoms there has already been some damage done, and if you try to ignore the pain you may sustain a serious injury. If your doctor doesn't seem to know much about RSI, find one who does. When you find one, listen to them and check with them about any changes you intend to make or therapy you want to try. (See UN-L RSI Resources about the Health Center.) In order to be an educated patient, take time to read the other resources linked to on this page, or the books below. (Note: Dealing with RSI means wading through a lot of confusing medical terminology. See these On-Line Medical Dictionary.)

Remember that "RSI" is a mechanism of injury, not a diagnosis. Where or how seriously you are injured, and how best to treat it, varies immensely from person to person. Also, many systemic disorders such as diabetes can mimic or exacerbate RSI, and these can be ruled out by medical tests, so don't go chasing a treatment you may have heard about UNTIL YOU'VE SEEN A DOCTOR.

THERE ARE NO QUICK FIXES.

No wrist splint, arm rest, split keyboard, spinal adjustment, etc. is going to let you go right back to work at full speed if you've been injured, and even carpal tunnel sufferers who undergo the release surgery on their wrists can be back in pain and trouble if they don't make the long term changes in technique and work habits that hurt them in the first place. Read this "Or else . . ." warning from someone who's been there.

Healing can happen but it may take months, even years. That's why it's important that you . . .

DON'T GIVE UP!!!

Many RSI patients do regain the ability to work and substantial freedom from pain, although they may find that they remain vulnerable to re-injury and flare-ups. DON'T GIVE UP. Recovery may take much longer than you think you can bear. DON'T GIVE UP. Almost everything in your life may turn upside down in the course of dealing with long-term recovery. DON'T GIVE UP. There are many, many resources listed on this page (see below), and if none of them is a fast "magic fix", taken together they can give you the tools to hang in there.

Don't give up.


What about TMS?

There has been a great deal of controversy and discussion about the mind/body pain theories of Dr. John Sarno and others, who attribute some common and intractable problems like back pain and RSI to something they refer to as "Tension Myositis Syndrome" or TMS. In brief, they posit that such chronic pains are real and have a physical cause: emotionally-mediated muscular tension causing oxygen starvation and pain in tissues. Consequently, it is claimed that counseling and psychological methods can bring relief to sufferers. The author of this web page himself found that understanding these concepts was an important part of recovery. Rather than expand this website to cover this huge topic, I suggest starting at the TMS Wiki where there are resources, links, and testimonials.


Learn More About It . . . Books!

Books on RSI contain a far greater depth of information than can be easily presented on-line. I strongly encourage you to read one or more of the following titles. I know this list has gotten really long, but your local library may have some of these titles or can get them for you through interlibrary loan. The publishing information and Web links to the publisher or distributor are included where they are known. In addition, in association with Amazon.com Books you can purchase many of these titles on-line by clicking the
Order from Amazon ... link after each listing, which will take you directly to that particular catalogue item. If you buy from Amazon, they will handle all billing, shipping, etc. and inquiries should be directed to them. Some of these books & others are also available from Micronite Inc.

By the way ... these books are pretty much listed in the order I became aware of them, not in order of quality or relevance. Some of the ones I personally consider indispensible are way down the page.


Internet Sites & Other Links

This is not an exhaustive list of sites, just a handful of starting points. In the current age of Google and Bing, I'm sure there are many many more. Keep in mind that RSI prevention products and books advertised on the Web are rarely magic bullets or sure-fire fixes and consider any such things as only part of an overall approach to prevention that must include a medical provider if you are already injured. Also, you may want to start by brushing up on
Tips For Savvy Medical Web Surfing first.


Questions?

With these pages I've tried to provide access to everything I've heard about RSI, but I'm not an "expert". Everything here has come to me from other people. If you have more good resources, corrections to what is here, or encounter dead links, please let me know so it benefits the unexpectedly large number of people who find this site when they are looking for help.

My own experiences with treatment are necessarily limited. If you have questions about RSI, in addition to seeing a doctor and reading the resources above I strongly suggest you tap into one of my main resources, the SOREHAND e-mail list. You can subscribe by sending mail with the line SUBSCRIBE SOREHAND firstname lastname in the body to listserv @ listsrv . ucsf . edu

Text content of this page is Copyright © 2013 Paul Marxhausen
No permission required for Web links to this page. All rights reserved for reproduction in print or other media. Print-outs of this page may be photocopied for NON-COMMERCIAL informational use. (1) Figure 1 reproduced with permission from "The Pocket Ergonomist", Copyright © 1986 David Brown and Robin Mitchell, occupational health and safety consultants, Airport Health Centre, Mascot NSW Australia; stretch GIFs reproduced with permission from "The Floppy Ergonomist", Copyright © 1987 David Brown. Figures 2 through 4 are public domain.


Univ. of Nebraska-Lincoln / Electronics Shop RSI Web Page / Paul Marxhausen