Tuesday, 21 September 2010

Do you get wrist pain from typing or writing?

Q: "I get pain in my right hand near my wrist after long periods of typing and sometimes the area around my wrist (palm side) gets a bit swollen too.  What can I do to help the problem?"

A: This sounds like a case of "Occupational Overuse Syndrome" (OOS), or more commonly known as "Repetitive Strain Injury" (RSI). There is usually no discrete pathological cause for RSI - it is rather related to the overuse (and/or improper use) of particular areas of the body resulting in pain and/or other symptoms.

Common Causes of RSI:
  • Repetitive movements (eg. typing on computers and mobiles, writing, drawing, chopping, hitting, hammering, playing games with thumbs, etc)
  • Sustained poor postures (eg. sitting slouched at the computer, reading books looking down, looking up at ceiling or wall such as in painting, holding mobile against ear and leaning to one side, watching TV slumped or lying on the side, etc)
  • Awkward positions (eg. lifting heavy object from big boxes, handyman-type work, working in small confined areas, etc)
  • Vibrations (eg. holding heavy machinery, drilling holes, etc)
  • Mechanical compressions (eg. pressing against hard surfaces, hitting, hammering)
  • Forceful exertions (eg. pushing, pulling, lifting, throwing etc)
  • Psychosocial stressors
However, in some cases RSI may be the trigger for specific pathologies (tendinitis, tendinosis, tenosynovities) such as:
  • DeQuervain's tenosynovitis
  • Wrist tendinitis/tendinosis
  • Carpal tunnel syndrome, cubital tunnel syndrome 
  • Tennis elbow (lateral epicondylosis), Golfer's elbow (medial epicondylosis)
  • Trigger fingers/thumbs
  • Focal dystonia
  • Thoracic Outlet Syndrome

In these specific cases, the advice of a health professional such as a physiotherapist should be consulted for assessment and treatment. Click here if you would like further advice on your specific case or be referred to a specialist physiotherapist.

Typical Symptoms of RSI:
  • Pain in the area which has been overused (most common areas are wrists, hands, thumbs as well as larger joints such as shoulders and backs)
  • Diffuse symptoms
  • Aggravated by activity
  • May have weakness of the painful area
  • May have swelling around the painful area

Treatment of RSI:
Most work-related/occupational overuse conditions tend to resolve by itself over time, given adequate rest and addressing the cause of the problem. Some specific areas to address include:

1. Rest
Rest is crucial in the initial stages of recovery from any overuse injuries. Ensure plenty of stretch breaks during tasks which involve repetitive movements, sustained postures, awkward positions, etc.

2. Exercises
Especially in cases where overuse and poor posture are the main causes of RSI, some strengthening, stretching and postural exercises will facilitate recovery and alleviate symptoms.
  • Wrist/finger pain from typing:
    • Ensure adequate breaks from prolonged typing activities
    • Strengthen your wrist muscles (eg. hold light weight in your hand, and gently flex your wrist 10x, followed by extending your wrist 10x; hold light weight in hand and gently rotate your hand side to side 10x)
      Wrist flexor/extensor strengthening
    • Grip a squeeze ball to strengthen your finger/wrist muscles

    • Stretch your wrist/fingers
      • hold hand up like a stop sign, then pull fingers and hand back - hold 10-15s; followed by pressing hand downwards, palm towards forearm and hold 10-15s
      • Hold palms flat together in a prayer pose for 10-15s
      • Hold back of hands together and stretch 10-15s  
      • Stretch fingers by closing fingers into a tight fist, then opening hand and stretching fingers out as far as possible - repeat 10x
Wrist extensor stretch
Wrist flexors stretch in prayer pose

Finger stretch
  •  Neck/back pain from sitting at computer/reading/watching TV:
    • Stand up regularly to have frequent breaks, give a break to your eyes and look around/up and down
    • Stretch your neck muscles by looking up/down, left/right, tilt head side to side
    • Stretch your back muscles by standing up and extending your back gently, rotating your trunk, leaning downwards side to side
Neck stretches
Back extension stretch
Trunk rotation stretch
Back lateral flexion stretch
  • Posture care:
    • Ensure you sit upright at your workstation with a supportive chair
    • Use lumbar supports (eg. BackEze) to facilitate correct postures
    • Avoid slouching, slumping, leaning to one side (esp for sustained periods of time)
    • Ensure your hands are positioned and supported well on desk when typing, avoid uneven/crowded work areas

3. Ergonomics of your workstation
  • Ensure correct posture, adjust height of chair/desk/computer screen/keyboard/mouse

4. Computer Equipment Use:
  • Mouse - nowadays, you can purchase a specially designed ergonomic mouse which maintains the natural shape of your hand (eg. roller mouse), this may reduce the problems that may arise from using a small trackpoint ball (as per some laptop brands)
    • In some people, changing to a trackpad may also reduce problems with overtensing of arm muscles during the use of a mouse.
    • For jobs which require lots of clicking on the mouse, ensure frequent breaks from the activity and alternate your tasks to minimise overuse
  • Keyboards - ensure that the arrangement of the keys on your keyboard are appropriate for your typing technique and your hand size. Small keyboards may lead to problems with overtensing of muscles.
    • For jobs which require lots of manual data entry work, ensure frequent breaks and alternating your activities to minimise overuse and enable rest to your fingers
5. Writing Equipment
  • Pens/pencils - for people who need to write/draw for work, it is important to use pens and pencils with good grips that are appropriate for your particular hand grip and size. 
    • Note that pens and pencils come in all different sizes as well (in terms of width), so make sure that you are using ones that are comfortable in your hand. 
    • Some special ergonomic grips are available for purchase at Officeworks and other stationery outlets.
6. Pain relief:
In some cases of RSI, pain relief modalities may be necessary. These include:
  • Braces/splinting to support the overused joint (eg. wrist braces) and allow for recovery
  • Ice if necessary to alleviate pain from inflammation and also to reduce swelling
  • NSAIDs (non-steroidal anti-inflammatory drugs) (under the advice of Doctor)
  • Alternative therapies such as massage/mobilisation

For more information, advice or if you would like to be referred to a specialised physiotherapist, please click here to contact us.

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