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Look, Ma, no hands! Coping with Repetitive Strain Injury

Look, Ma, no hands! Coping with Repetitive Strain Injury. Trey Harris Mail.com tharris@staff.mail.com http://metalab.unc.edu/~harris/rsi. A disclaimer. I’m not a medical practitioner

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Look, Ma, no hands! Coping with Repetitive Strain Injury

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  1. Look, Ma, no hands! Coping with Repetitive Strain Injury Trey Harris Mail.com tharris@staff.mail.com http://metalab.unc.edu/~harris/rsi Harris RSI -- LISA '99

  2. A disclaimer • I’m not a medical practitioner • This talk is for informational purposes only, and is not intended to diagnose or treat any illness or disease • Follow my suggestions at your own risk Harris RSI -- LISA '99

  3. Myth #1 • “I don’t type a lot, so I can’t get RSI.” Harris RSI -- LISA '99

  4. Myth #1 • “I don’t type a lot, so I can’t get RSI.” • Fact: Anyone who types more than two hours a day is at risk for RSI Harris RSI -- LISA '99

  5. Myth #2 • RSI is mostly psychosomatic Harris RSI -- LISA '99

  6. Myth #2 • RSI is mostly psychosomatic • Fact: Though usually invisible, RSI is a soft tissue injury susceptible to medical diagnosis and treatment Harris RSI -- LISA '99

  7. Myth #3 • “I don’t touch type, so I can’t get RSI.” Harris RSI -- LISA '99

  8. Myth #3 • “I don’t touch type, so I can’t get RSI.” • Fact: though hunt-and-peckers are less likely to develop RSI, certain habits (such as holding up the thumbs or making a fist while typing) can cause serious ailments Harris RSI -- LISA '99

  9. Myth #4 • Carpal tunnel syndrome is the most common kind of RSI Harris RSI -- LISA '99

  10. Myth #4 • Carpal tunnel syndrome is the most common kind of RSI • Fact: CTS is actually one of the rarest forms of RSI, and its over-diagnosis and over-hyping can be a barrier to effective treatment for RSI patients Harris RSI -- LISA '99

  11. Myth #5 • “My symptoms have been like this for years, so I guess it won’t get any worse.” Harris RSI -- LISA '99

  12. Myth #5 • “My symptoms have been like this for years, so I guess it won’t get any worse.” • Fact: RSI is progressive, and even if the pain doesn’t get worse, permanent disability is possible if the injury gets bad enough Harris RSI -- LISA '99

  13. Myth #6 • “If my hands get really bad, I can always switch to voice dictation until it gets better.” Harris RSI -- LISA '99

  14. Myth #6 • “If my hands get really bad, I can always switch to voice dictation until it gets better.” • Fact: Current voice dictation systems are a poor substitute for the keyboard, especially for technical workers Harris RSI -- LISA '99

  15. My story • Binge typing • Poor posture and awful ergonomics • Years of incremental adjustments • Denial • Finally, a scare Harris RSI -- LISA '99

  16. A week of terror • inability to type • excruciating pain • soreness and heaviness • clumsiness • hyperawareness & an “injured feeling” Harris RSI -- LISA '99

  17. I’m going to fix this! • Appt. w/doctor • Braces • Voice dictation Harris RSI -- LISA '99

  18. Down and dirty with dictation • Training • and frustration • I don’t do Windows! • more frustration • How do you pronounce “s/^\S+([^:])*/$1.old/”? • even more frustration Harris RSI -- LISA '99

  19. A demonstration • Dragon NaturallySpeaking Professional • Only available from certain consulting vendors • Teen, Standard or Preferred won’t work • “conversational” speech system • This laptop • 300 MHz Intel Celeron • 96MB RAM • How it’ll work • (It’s going to be excruciating) Harris RSI -- LISA '99

  20. Troubles in voice-land • Passwords? • Curses/cbreak programs are dangerous • Many GUIs don’t work well with speech • The command line is doable, but hard • X is near impossible • Errors • Discrete systems are better except when they’re worse • Laryngitis is an RSI Harris RSI -- LISA '99

  21. A disturbing prognosis • Diagnostics • The Poking Test • The Prodding Test • The Shocking Test • The Numbing Test • So what is it, anyway? • Treatment: braces -- and maybe surgery • Did you say permanent??? Harris RSI -- LISA '99

  22. A friend steps in • Pascarelli & Quilter, Repetitive Strain Injury (John Wiley & Sons, 1994) • I do a lot of self-education Harris RSI -- LISA '99

  23. What is RSI? • Repetitive Strain Injury • RSI != Carpal Tunnel Syndrome • Umbrella term for Cumulative Trauma Disorders (CTD) stemming from hand movements that are: • prolonged • repetitive • forceful • awkward Harris RSI -- LISA '99

  24. What does RSI affect? • Involves damage to: • muscles • tendons • nerves • In the areas of: • neck • shoulder • arms • hand Harris RSI -- LISA '99

  25. What does RSI feel like? • Great variability between sufferers, but commonly reported symptoms include: • Pain • acute (stabbing) or chronic (soreness) • shooting or localized • brief or long-lasting • Weakness • Numbness or other neurological symptoms (referred pain, etc.) • Motor impairment (clumsiness, etc.) Harris RSI -- LISA '99

  26. Warning signs of RSI • Pain during typing • Difficulty with ordinary chores • Opening doors with shoulders or feet • Stiffness, weakness, or lack of endurance • Heaviness • Lack of coordination, dropping things • Cold hands • Hyperawareness of hands • Frequent self-massage or “cracking” Harris RSI -- LISA '99

  27. Causes of RSI • Repetition • Ignorance of proper use of the hand • Poor posture • Holding still • Being out of shape • Forced speed • Overwork • Excessive monitoring • Lack of job satisfaction Harris RSI -- LISA '99

  28. RSI isn’t a fracture • RSI is a soft tissue injury, so: • it comes on very slowly • it takes a long time to heal • rest alone will not affect recovery • it rarely comes back to 100% • relapses are par for the course • endurance is the last thing to return • symptoms poorly differentiate—a successful treatment of one ailment often reveals other undiscovered ones Harris RSI -- LISA '99

  29. Types of RSI • Muscle & tendon disorders • Cervical radiculopathy • Epicondylitis & ganglion cysts • Tunnel syndromes • Nerve & circulatory disorders • Other associated disorders Harris RSI -- LISA '99

  30. Muscle & tendon disorders • Muscle and tendon disorders • Myofascial damage • Tenosynovitis • Stenosing tenosynovitis • DeQuervain’s disease • Flexor tenosynovitis (trigger finger) Harris RSI -- LISA '99

  31. Tendinitis • Shoulder tendinitis • Bicipital tendinitis • Rotator cuff tendinitis • Forearm tendinitis • Flexor carpi radialis tendinitis • Extensor tendinitis • Flexor tendinitis Harris RSI -- LISA '99

  32. Cervical radiculopathy • “phone shoulder syndrome” Harris RSI -- LISA '99

  33. Epicondylitis & ganglion cysts • Epicondylitis • lateral (tennis elbow, bowler’s elbow, pitcher’s elbow) • medial (golfer’s elbow) • Ganglion cysts (“bible bumps”) Harris RSI -- LISA '99

  34. Tunnel syndromes & CTS • Tunnel syndromes involve three nerves: • median (middle) • radial (thumb side) • ulnar (pinkie side) • Median nerve -- Carpal Tunnel Syndrome • Dynamic (RSI) • Passive (rheumatoid arthritis, gout, diabetes, hypothyroidism, etc.) Harris RSI -- LISA '99

  35. CTS is rare • Carpal tunnel syndrome is one of the rarest forms of RSI • 15% of office workers have some form of RSI • < 1% have CTS • So why is it so prevalent in discussion? • Obvious treatment options • Medically less controversial • Profitable for surgeons Harris RSI -- LISA '99

  36. Radial and ulnar tunnel syndromes • Radial Tunnel Syndrome • Ulnar Nerve Disorders • Sulcus Ulnaris Syndrome • Cubital Tunnel Syndrome • Guyon’s Canal Syndrome Harris RSI -- LISA '99

  37. Nerve & circulatory disorders • Thoracic Outlet Syndrome • Raynaud’s Phenomenon Harris RSI -- LISA '99

  38. Other associated disorders • Reflex Sympathetic Dysfunction or Dystrophy (RSD) • Focal Dystonia (writer’s cramp) • Osteoarthritis • Fibromyalgia • Dupuytren’s Contracture Harris RSI -- LISA '99

  39. I take control • Get rid of the braces • Insist on a better diagnosis • Abort the path towards surgery • Start aggressive physical therapy and bodywork Harris RSI -- LISA '99

  40. The traditional medical team • General, family or adult practitioner • Physical therapist(s) • Specialists: • Orthopedist • Hand surgeon • Neurologist • Occupational/sports medicine doctor • Physiatrist • Rheumatologist • Pain management specialist Harris RSI -- LISA '99

  41. The alternative medical team • Massage therapist(s) • neuromuscular therapy • Swedish or shiatsu • Rolfing or Hellerwork • Feldenkrais • Osteopath or chiropractor • Acupuncturist • Naturopath • Yoga instructor Harris RSI -- LISA '99

  42. Medication • Non-steroidal anti-inflammatories (NSAIDs) • ibuprofen or fenoprofen • Butazolidin, Indocin, Voltaren • Pain medication • OTC: aspirin, acetaminophen • Painkillers: codeine, Perkocet, hydrocodone • Cortisone Harris RSI -- LISA '99

  43. Splinting • Splints are controversial • Often indicated for CTS or DeQuervain’s syndrome • NEVER use them while typing!!! • “Braces” aren’t much better Harris RSI -- LISA '99

  44. Surgery • Is it really necessary? • Is surgery efficacious for this condition? • Have all nonoperative techniques been eliminated? • Is it a quick fix? • Get a second opinion (and a third, and a fourth…) Harris RSI -- LISA '99

  45. Physical Therapy • Deep-tissue massage • Phonophoresis • Iontophoresis • Ultrasound • Transcutaneous electrical nerve stimulation (TENS) • Upper body exerciser (UBE) machine • Neuromuscular stretches Harris RSI -- LISA '99

  46. Occupational Therapy • Work hardening is a no-no for RSI • Posture retraining • Preventative exercise • Stretching • Strengthening Harris RSI -- LISA '99

  47. Alternative therapies • Acupuncture • Spinal manipulation • Massage therapy • Vitamins • Yoga Harris RSI -- LISA '99

  48. What not to do • Don’t self-diagnose! • Don’t exercise without the advice and consent of your practitioner • Don’t rush to surgery • Don’t look for an easy way out • Don’t let your doctor talk you into treatment options you don’t want • Don’t fall for “ergonomic” gimmicks Harris RSI -- LISA '99

  49. Your recovery • Stop (or at least reduce) the injurious behavior • See a doctor trained in soft-tissue injuries • Start medical treatment • Investigate alternative care, if appropriate • Develop new long-term work and living habits • Develop a maintenance plan (exercise and massage) Harris RSI -- LISA '99

  50. First step: stop hurting yourself • Take a break • Take the day off • Take vacation • Take disability leave • Take unemployment • Whatever it takes -- don’t let RSI become something worse • Permanent disability can set in within weeks or months if you don’t do something now Harris RSI -- LISA '99

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