Carpal Tunnel Syndrome And Computer Use, Plus Arm and Wrist Glossary of Terms

Carpal Tunnel Syndrome And Computer Use,
Plus Arm and Wrist Glossary of Terms

For the person who spends time at the computer, as many of us medical transcriptionists do, here is an article to educate. Use many sources of information to properly make your station ergnomic. Labor and Industries has very useful booklets and helps.

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Carpal Tunnel Syndrome And Computer Use

While there are a lot of rumors about carpal tunnel syndrome and computer use, it is hard to find a definitive answer on what, if any, actual link there is between the development of carpal tunnel syndrome and the use of computers.

Does computer use increase one's chances of developing carpal tunnel syndrome? If you do a "search" on the internet, you can find several stories that say no, and just as many that say yes . . . sometimes even from the same source! While there are still some conflicting beliefs on how the use of computers affects a person's chance of getting carpal tunnel syndrome, the injury seems to be more prevalent than ever before.

There is a general belief that working for extended periods of time using a computer will lead to an increase in carpal tunnel syndrome, and that jobs such as data entry lead to higher risk of carpal tunnel syndrome. Since carpal tunnel syndrome is caused by constant repetitive or static motion of the hands and wrists, logically this would make sense. There are several studies that initially suggested that the repetitive motion and static flexion involved when using a computer causes irritation and swelling of the flexor tendon sheaths, resulting in the impingement of the median nerve and the diagnosis of carpal tunnel syndrome. Though this is not conclusively proven in studies, what is proven is that any task that involves excessive use of the hands in activities that require duration, repetition and force does in fact cause carpal tunnel syndrome.

Carpal tunnel syndrome can be caused by anything that involves excessive unidirectional movement patterns that require too much force, duration and repetition, as the overused muscles actually become stronger, shorter and tighter than their opposition, the extensor muscles. The stronger flexor muscles begin to compress the carpal tunnel and the median nerve within. The tendons that pass through the carpal tunnel (a small area between the carpal bones and the transverse carpal ligament in the wrist) can become swollen from doing the same movement over and over, like typing on a computer for extended periods of time.

Some people might think that carpal tunnel syndrome is a new condition of the information technology age, born from long hours of computer keyboarding, but carpal tunnel is not new, it just seems to appear more often because the nature of work has changed. More jobs are highly specialized and require the overuse of only a small number of muscles repeatedly, leading to a muscle imbalance. If one muscle group is overused, then the opposing muscle group must be underused. It is basic common sense.

Because of the underlying assumption that computer use contributes to carpal tunnel syndrome, concern from the government and employers continues to grow. Ironically, studies out of the Mayo Clinic released by the government seem to actually show that using a computer does not increase the risk of developing carpal tunnel syndrome. There are arguments over why this is.

The test showed that those who worked a long period of time every day with computers had the same percentage of becoming afflicted with carpal tunnel syndrome as everyone else. One of the suggestions for the reasoning is that the continued use of computers would only affect people who did not practice appropriate form. People who are employed to work with computers are generally better trained in how to type from home row, how to keep their wrists straight, use ergonomic keyboards, chairs, screens, mouse and know how to use good posture.

All of these factors can help decrease instances of carpal tunnel syndrome, which in turn can help keep the number of injuries down. On the other side of the equation, computer use by individuals who hold their wrists and fingers improperly, put unequal pressure on their hands, don't use ergonomic tools or proper posture may become afflicted with cause carpal tunnel syndrome more frequently than those using appropriate form and proper ergonomic tools.

This may certainly be the reason why the belief that computer use causes carpal tunnel syndrome remains strong, even when testing suggests otherwise. Individuals trained in how to properly use a computer will know what or what not to do in most cases. Computer users engaged in a good ergonomic prevention program at work will know which stretches and exercises to perform, know how to use good posture and utilize the latest ergonomic equipment, and hence not experience the same injuries and muscle imbalances as say someone who does not use appropriate form, ergonomic tools or perform muscle balancing exercises and stretches.

While the studies suggest that extensive use of a computer does not contribute to carpal tunnel syndrome, even that piece of information should come with its own caveat, that being that proper use of a computer appears to not increase the chances of carpal tunnel. But people certainly need to learn to use proper posture, use good ergonomic equipment and know appropriate stretches and exercises to perform because excessive use of the computer without proper hand positions or use of poor equipment leads to imbalances in the hands, wrists, forearms and shoulders that can contribute to the onset of carpal tunnel syndrome.

With carpal tunnel syndrome being so prevalent in the past decade, it is best to take all preventative methods available and implement them into one's daily work regimen. It is easier to prevent an injury than having to address it once it is already present. Prevention is the cure for carpal tunnel syndrome.

Terms for arm and wrist

Abduction

Abductor pollicis longus

Anconeus

Annular ligament

Annular ligament of radius

Anterior brachial compartment

Anterior interosseous - supplies deep structures in flexor compartment

Anterior ulnar recurrent

anterior, posterior and intermediate bands (ligament)

Articular disk - binds radius to ulna and carpal bones and separates distal ulna from carpal bones

Biceps brachii

Brachial artery

Brachialis

Brachioradialis

Branch from medial cord

Capitulum

Carpal tunnel - Space between carpal bones and flexor retinaculum – contains digital flexor tendons and median nerve.

Carpometacarpal joints

Common interosseous

Coracobrachialis

Coracobrachialis

Cutaneous innervation

Deep (profunda) brachial

Deep (profunda) brachial artery

Digital flexor tendons

Distal radius

Dorsal radiocarpal ligament

Elbow (anastomosis)

Extension

Extensor carpi radialis brevis

Extensor carpi radialis longus

Extensor carpi ulnaris

Extensor digiti minimi

Extensor digitorum

Extensor indicis

Extensor pollicis brevis

Extensor pollicis longus

Finger extensors

Flexion

Flexor carpi radialis

Flexor carpi ulnaris

Flexor digitorum profundus

Flexor digitorum superficialis

Flexor pollicis longus

Hamate bone

Head

Humerus

Inferior ulnar collateral

Intercarpal joints

Interosseous membrane

Interosseous recurrent

Lateral antebrachial cutaneous

Lateral epicondyle

Lateral side

lunate - proximal carpal bone

Medial antebrachial cutaneous

Medial epicondyle

Medial side

Median nerve

Midcarpal joint - Between proximal and distal rows of carpal bones

Middle collateral

Motor to all muscles except Flexor carpi ulnaris and ulnar half of Flexor digitorum profundus

Musculocutaneous

Olecranon

Palm in prone position

Palmar radiocarpal ligament

Palmaris longus

Pisiform bone & hook of hamate bone medially

Pisohamate ligament - Insertion of the carpi ulnaris tendon on pisiform bone and hook of hamate bone

Posterior interosseous - supplies deep structures in extensor compartment

Posterior Interosseous Artery

Posterior ulnar recurrent

Pronation - Radius rotates on ulna allowing the palm to face downward

Pronator quadratus

Pronator teres

Radial

Radial (Lateral) Collateral ligament

Radial Artery

Radial collateral

Radial collateral ligament -Passes from styloid process of radius to scaphoid bone

Radial recurrent

Radiocarpal joint

Radius

Recurrent branch

scaphoid - proximal carpal bone

Scaphoid and trapezium bones laterally

"Snuff Box" - Thumb Muscles

Superior ulnar collateral

Supination - Radius moves on ulna enabling palm to face upwards

Supinator

Triceps brachii

triquetrum - proximal carpal bone

Trochlea

Ulna

Ulna head

Ulnar

Ulnar (medial) collateral ligament

Ulnar artery

Ulnar collateral ligament - Passes from styloid process of ulna to triquetral and pisiform bones

Wrist Extensors

OTHER DISORDERS

Dislocation of elbow in children - occurs as a result of a forearm being pulled away from arm. The head of the radius is held against the ulna by the annular ligament. The head and shaft of the radius do not fuse with each other until about 16 years of age. Traction applied to the forearm can result in the head of the radius being separated from the shaft.

Epicondylitis - is an inflammation of either the lateral or medial epicondyle of the humerus. Inflammation is usually brought about from overuse of the muscles attached to either of these bony prominence. The area around the epicondyle becomes very painful especially after performing resisted movements using the appropriate muscles . Most of the forearm flexors arise from the medial epicondyle while lateral epicondylitis ( tennis elbow) comes from over use of the wrist extensors.

Nerve lesions - resulting from trauma, entrapment or disease. Trauma to a peripheral nerve could result in loss of nerve function and paralysis of the affected muscles. Entrapment and nerve root damage usually leads to muscle weakness especially when trying to perform resisted movements.

Musculocutaneous Nerve - the most common type of injury to this nerve is entrapment within the coracobrachialis muscle. Symptoms include pain along the lateral aspect of the forearm and weak elbow flexion and supination of the forearm. Traumatic lesion of the musculocutaneous nerve would result in loss of sensation from the radial portion of the forearm and a pronounced weakness of ability elbow flexion and supination of the forearm.

Radial Nerve - can be affected by trauma such as compression within the axilla "Saturday Night Palsy", fracture of the shaft of the humerus or entrapment as the deep branch passes through the supinator muscle.

"Saturday Night Palsy" results from compression of the radial nerve in the axilla. The patient experiences paraesthesia along the posterior lateral arm and dorsum of hand. There is also a pronounced drop wrist when the forearm is in the supine position because of weakness of the wrist extensors.

Fractures of the humerus, especially the shaft, can damage the radial nerve. Elbow extension is usually not affected because the triceps brachii is innervated before the nerve winds around the humeral shaft. Again, drop wrist results because of the loss of function of the wrist extensors. There is also loss of sensation from the dorsum of the hand.

Entrapment of the deep branch of the radial nerve can occur as it passes through the supinator muscle. No sensory loss accompanies this condition because the deep branch is a pure motor nerve. Drop writs is the primary symptom.

Lesions of the medial and ulnar will be studied in the Hand section.

Chart I -PRIME MOVERS OF THE ELBOW, RADIOULNAR and WRIST JOINTS

JOINT	ACTION	MUSCLES	NERVE	SEGMENT
Elbow	Flexion	Brachialis	Musculocutaneous	C 5,6
		Biceps brachii	Musculocutaneous	C 5,6
		Brachioradialis	Radial	C 5,6
	Extension	Anconeus	Radial	C 7 ,8
	Extension	Triceps brachii	Radial	C 6, 7 ,8
Radioulnar	Supination	Biceps brachii	Musculocutaneous	C 5,6
	Supination	Supinator	Radial	C 5,6
	Pronation	Pronator teres	Median	C 6,7
		Pronator quadratus	Median( Anterior Interosseous)	C 8, T 1
Wrist	Flexion	Flexor carpi radialis	Median	C 6,7
		Palmaris longus	Median	C 7,8
		Flexor carpi ulnaris	Ulnar	C 8, T 1
	Extension	Extensor carpi radialis longus	Radial	C 6, 7
		Extensor carpi radialisbrevis	Radial	C 6, 7
		Extensor carpi ulnaris	Radial	C 7, 8
	Abduction	Abductor pollicis longus	Radial	C 6, 7
	Abduction	Extensor pollicis brevis	Radial	C 6, 7
	Adduction	Flexor carpi ulnaris	Ulnar	C 8, T 1
	Adduction	Extensor carpi ulnaris	Radial	C 7, 8

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