edgecase
Adapt or perish, now as ever, is Nature's inexorable imperative.
~ H. G. Wells
Author: StJohn Piano
Published: 2018-03-19
Datafeed Article 43
This article has been digitally signed by Edgecase Datafeed.
1391 words - 269 lines - 7 pages



STATUS



I can do a small-to-medium amount of work without triggering RSI symptoms.





SUMMARY



RSI stands for Repetitive Strain Injury.

The long-term causes of my RSI:
- Bad posture
- Long periods of programming/typing without breaks
- Use of a laptop as my main computer
- Low-quality equipment

The immediate cause of my RSI:
- A six-week period of intense work and high stress

Condition timeline:
- December 2015: Onset of symptoms.
- January-June 2016: Steady increase in symptoms.
- June 2016: Worst point.
- July 2016 - March 2018: Slow improvement. Symptoms stop occurring by default.

Symptom descriptions:
- Mild: Sensation of heat/swelling/tingling in wrists and hands.
- Medium: Aching/pain/numbness/heat/swelling in wrists and hands. Slight pain can occur in forearms and elbows. Pain points can occur in biceps.
- Severe: Aching/pain/numbness/burning/cold in wrists, hands, and forearms. Medium pain can occur in elbows and biceps.

Current symptoms:
- If I do household chores and a little computer work: Usually none, occasionally mild.
- If I do a small amount of work: Mostly none, sometimes mild, occasionally medium.
- If I do a medium amount of work: Often mild, sometimes medium.
- If I do a normal workload: Severe.

Current work ability: I can usually do a small-to-medium amount of work if I combine a small amount of typing with the use of a dictation system.





CASE HISTORY



Some of the long-term causes of my RSI:
- Bad posture
- Long periods of programming/typing without breaks
- Use of a laptop as one's main computer (neck is angled downwards, body tends to hunch forward)
- Bad equipment (low-quality keyboard and chair).


November 2015 - January 2016:

The immediate cause of my RSI:
- A six-week period of intense work and high stress, during which I:
-- Worked nearly constantly
-- Did not sleep enough
-- Did not maintain a regular sleep pattern
-- Was highly stressed
-- Typed constantly
-- Did not exercise enough


December 2015:

I began to feel some aching and slight numbness in my wrists (I didn't feel any sharp pain).


January 2016:

During the last few days of the intense work period, the aching/numbness became stronger and began to persist even after I had stopped typing.

I rested for several weeks before beginning to work again.


February - June 2016:

The aching/numbness in my wrists became pain/numbness/burning/cold, and spread out into my hands and forearms. I typed less and less, but over time the symptoms increased in severity and regularity.


June 2016:

10 minutes of typing could cause several hours of severe pain. An hour of typing would produce two days of severe pain.

I saw Dr MG at Orchard House Surgery, who diagnosed me with carpal tunnel syndrome.


July 2016:

Several people volunteered to take turns to do my typing. This allowed me to produce just enough code to navigate certain data processing chokepoints in several projects.

At one point, I became frustrated with the slow speed of dictating code to another person and wrote a script myself. I then experienced extraordinarily severe pain that lasted until I saw Dr M the next day at Orchard House Surgery, who diagnosed me with peripheral neuropathy and prescribed amitriptyline.

Amitriptyline quickly and drastically reduced my perception of the pain. I still felt it, but as a remote, dull ache - unpleasant but not particularly painful. It also made me drowsy, although this decreased rapidly with repeated exposure. This drug was extremely useful - if I triggered RSI symptoms, I could stop whatever I was doing, take amitriptyline, and ride out the storm.

Dr M also prescribed splints, to be worn while sleeping. These were also very useful. They prevent the normal compression of the wrists while sleeping, which will aggravate the situation if there is already inflammation within the carpal tunnel.


August 2016 - January 2017:

I improved and expanded an off-the-shelf dictation system until it could be used for programming work. While dictating, I am perhaps 20 times slower than my original speed, especially when doing tasks that require switching between several windows or manipulating buttons/controls on GUI interfaces.


January 2017:

After a day spent mainly scrolling documents, I noticed that the tendon on the back of my right hand leading to the middle finger had become quite swollen.

I saw Dr B at Orchard House Surgery. He made some comments:
- The tendon is swollen due to repetitive use when scrolling using the scroll wheel on the mouse.
- RSI is still not completely understood. It's hard to see/analyse, compared to e.g. muscle damage.
- Any repetitive action can cause RSI.
- Swollen tendons can be a vicious cycle. The swelling within a confined space can cause feedback that makes the tendon swell more.
- The nerves themselves probably aren't damaged or are not damaged very much. When the tendons swell, they are in the same tunnel as the nerves, so the nerves experience compression, causing nerve irritation. Nerves can take a lot of irritation without permanent damage.
- Swollen tendons compress everything around them.
- The three nerves in the hand (radial, median, ulnar) branch and rejoin multiple times on their way from the neck. If I experience numbness and tingling only in the pinky finger and in the ring finger, which is symptomatic of irritation to the ulnar nerve, this indicates that the irritation is occurring at or below the elbow, where the ulnar nerve separates for the last time from the other two nerves.
- Parasthesia (nerves not feeling what they should feel normally) is much more common than actual nerve damage in cases of RSI etc.
- It's possible that my particular anatomical features (e.g. the bone structure around my elbow) put me at higher risk of developing RSI in general in my hand.
- It's possible that the ulnar nerve compression is occurring at the wrist rather than at the elbow.


March 2017:

Dr W at Orchard House Surgery referred me for occupational therapy at Newmarket Hospital.

I visited a physiotherapist for occupational therapy on these dates:
- 2017-04-07
- 2017-05-12
- 2017-06-09
- 2017-07-03

Advice and comments from physiotherapists:
- When you notice numbness, try these movements:
-- Scapula retraction for 5-10 seconds. Imagine you're trying to clench a coin between your shoulder blades.
-- Chin retraction.
-- Arms out to side and then back in.
-- Nerve glide (10-12 repetitions) for ulnar nerve: elbow out to side, touch earlobe with fingertips, palm facing upwards (or towards the head). Slowly move the hand (without changing the upward angle of the fingers) and forearm so that the arm is now pointing straight out to the side (fingers pointing upwards, palm facing outwards).
- Regular intake of amitriptyline. Body adapts: nerves calm down, easier for them to heal.
- Amitriptyline calms the feedback response.
- There probably isn't any scar tissue in the muscles.
- The problem is probably just postural. Pattern of pressure on nerves: fibres around tendons swell.
- Experiment - there's no right posture. Regularly change position.
- Q: Why did it take a decade to develop? Why did my body tolerate bad posture for a long time? What changed over time?
A: Static loading is the problem. Buildup of a behaviour (like smoking).
- Perform behavioural retraining - change posture.
- It is possible that the amitriptyline medication is masking a background level of pain. Try a 30-minute typing session, then wait a day. There is a lag in the swelling process.
- Probably not to do with the neck (i.e. thoracic outlet syndrome).
- Mobility and strength are fine. No deficits or muscle wasting.
- Exercise is important.


July 2016 - March 2018:

After this long period of recovery, my condition has improved. My symptoms, when they occur, are weaker, and I manage them better. I can detect the initial onset of symptoms much earlier and can thereby avoid triggering the worst responses. I rarely take amitriptyline, although sometimes I experience unpleasant periods during which I take it for several days. I use better equipment and have better posture while working. I can usually do a small amount of typing, if I am careful, and on some days I can do a larger amount. If any RSI symptoms begin, or if I have to produce a lot of code or text, I switch back to the dictation system.





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This article uses material from a previous article:
How I developed RSI and returned to a low but useful level of productivity


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