Even though the picks, short-handled shovels, and sweltering heat of yesterday’s workplace have been replaced with monitors, keyboards, and air-conditioning, work-related aches and pains are very real and very common. Much like the manual laborer or factory line-worker, today’s office-bound employee faces their own unique set of hand and wrist maladies.
These fall into three main categories:
- Neuropathies (nerve irritation)
- Tendinopathies (tendon irritation)
- Arthritis (long-term wear and tear or inflammation of joints)
While one’s work duties may not directly cause arthritis, tendonitis, or nerve compression, workplace posture or activities can contribute to or “un-mask” these problems if they already exist.
For example, a woman who has very mild cubital tunnel syndrome (compression of the ulnar nerve at the elbow causing numbness/tingling in the small and ring finger) may find that her symptoms worsen when she starts a job as a receptionist. Holding a phone to her ear for most of the day requires the elbow to be held in a flexed (bent) position which places tension and pressure on the ulnar nerve at the level of the elbow.
Symptoms of nerve irritation include decreased sensation, feeling “pins and needles,” and pain that is often described as burning, stabbing, or aching. Patients that experience worsening symptoms at night, particularly those that wake one from sleep requiring them to “shake out” the pain, likely have a nerve-related cause.
Conditions Affecting the Hand and Wrist
The most common nerve conditions affecting the hand and wrist are:
- Carpal tunnel syndrome (compression of the median nerve at the wrist)
- Cubital tunnel syndrome (compression of the ulnar nerve at the elbow)
It is important to keep in mind that compression of the same nerves at the level of the neck can closely mimic carpal and cubital tunnel syndrome, so being examined by a properly trained specialist is crucial to pinpoint the correct diagnosis.
In the early 90s, with the advent of the personal computer and its use in the workplace, fears arose that an epidemic of keyboard-related carpal tunnel syndrome was sweeping the nation. However, subsequent studies have failed to support the idea that keyboard use and other repetitive movements directly cause carpal tunnel syndrome.
There are several elements that have a much stronger association with carpal tunnel syndrome. These are:
- Being female
- Diagnosis of diabetes mellitus
How Are Nerve Syndromes Treated?
Treatments for nerve syndromes include splinting (especially at night), anti-inflammatories, and sometimes injections. Although sometimes helpful, these treatments are unlikely to solve the underlying problem and your surgeon may recommend surgical release or “decompression” of the nerve.
It is important to keep in mind that non-operative treatments for nerve compression is usually reserved for very mild cases, and “just living with” your symptoms or avoiding treatment can lead to unfortunate effects of permanent sensory loss, weakness, or loss of fine motor control.
The most common upper extremity tendinopathies affecting the office worker include flexor tendonitis or “trigger finger,” “deQuervain’s” tendonitis at the base of the thumb, and lateral epicondylitis, also called “tennis elbow.”
What is “Trigger Finger?”
Flexor tendonitis (trigger finger) most commonly causes pain and tenderness in the palm and a feeling of popping or catching with movement of the fingers. Symptoms can become so severe that patients may wake up in the morning with the involved finger stuck in a bent position, requiring them to open the finger with their other hand.
What Is deQuervain’s Tendonitis?
deQuervain’s tendonitis is actually irritation of an extensor tendon that wraps around the wrist and inserts onto the base of the thumb.
What Is “Tennis Elbow?”
Lateral epicondylitis is a very common but poorly understood condition causing pain and tenderness at the outside of the elbow. Despite its common name of “tennis elbow,” very few patients with this condition play tennis!
Again, common treatments for these conditions begin with:
- Steroid injections
- Avoidance of aggravating activities
Many tendon problems can be cured with these treatments, especially if inflammation or aggravating repetitive motions are the cause. However, if these treatments fail, your surgeon may recommend a procedure to “free up” the tendon to allow it to glide back and forth with less friction and less pain.
Help Through Ergonomics
Simple adjustments to one’s working environment and posture, also called ergonomic adjustments, can help prevent and alleviate painful upper extremity conditions. Certain specialists, including occupational therapists, are trained and specialize in ergonomic workplace optimization. These specialists evaluate a worker’s positioning, movements, and situation and make recommendations to optimize workplace ergonomics.
Recommendations include positioning the wrists in neutral (straight) position, the keyboard slightly lower than the level of the elbow, the shoulders held back, and the monitor at just below eye level. There are scores of commercially-available ergonomic mice and keyboards to position the hands and wrists in a more neutral position.
If simple ergonomic adjustments do not work to alleviate pain or symptoms, it may be time to schedule a visit with an orthopedic hand and upper extremity specialist. These physicians are specially trained in accurately diagnosing and effectively treating conditions of the hand and wrist using both surgical and non-surgical treatments.
Whatever might be keeping you from doing what you do best, know that The Bone & Joint Surgery Clinic is here for you!
- Meals C, Koenigsberg ES. Ergonomic Strategies for Computer Users With Upper Limb Problems. J Hand Surg Am. 2015;40(8):1688-1691.
- 1. Lozano-Calderón S, Anthony S, Ring D. The Quality and Strength of Evidence for Etiology: Example of Carpal Tunnel Syndrome. J Hand Surg Am. 2008;33(4):525-538.