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A Surprisingly Common Office Injury That Is Often Misdiagnosed

Between writing emails, texting and word processing, wrist pain has become one of those annoyingly painful facts of office life. But the twinges of pain are often misunderstood -- and poorly treated.

Doctors sometimes wrongly interpret wrist pain as carpal tunnel syndrome (CTS) when more often than not, it's caused by an overuse injury like tendinitis. "Many people who have hand pain have been diagnosed improperly with carpal tunnel," says Dr. David Rempel, professor in the division of occupational and environmental medicine at the University of California, at San Francisco. An estimated 2 % of people have CTS and the prevalence of wrist tendinitis ranges from about 4 to 14%, depending on the criteria used in the studies.

True CTS occurs when there's swelling inside the small tunnel that runs between the wrist and heel of the palm and protects a major nerve and nine tendons. The symptoms are actually quite specific. The swelling compresses the nerve, causing numbness, tingling or weakness in the first three fingers. The numbness often wakes you up in the middle of the night. Lastly, it may cause pain, but not always. Tendinitis, on the other hand, causes pain in your forearm or hand, usually without any numbness or tingling. If there is numbness, it affects the whole hand, not just the three fingers. Tendinitis is an inflammation of the tendons around the wrist joint.

The causes

  • CTS: Contrary to what many believe, keyboarding and using a mouse has not been definitively linked to CTS. Studies have found mixed results. CTS is more commonly caused by repetitive forceful motions, like using a jack hammer or assembly line work with tools. Pregnant women, diabetics, and people who are obese have a greater risk of CTS.
  • Tendinitis: Keyboarding has, however, been shown to cause tendinitis. Long hours tapping at the keyboard combined with poor ergonomics and poor posture can cause muscular tension starting as high as the shoulders and can irritate the tendons.
The treatment
Both conditions respond to:
  • icing the wrist
  • anti-inflammatory medications
  • frequent breaks from work
  • wearing a brace to stabilize your wrist
While physical or occupational therapy can help with tendinitis, it hasn't been shown to help CTS. If you have CTS, steriod injections may be helpful, and if symptoms don't improve, surgery may be recommended. You may want to have your CTS confirmed with a nerve conduction test. Studies have found that using only a physical exam and symptom history may not accurately diagnose the problem.

To prevent tendinitis, make sure your keyboard is just above the lap, with wrists are straight, not flexed. Take a one second break every minute, dropping your hands to your lap or shrugging your shoulders. We tend to tense up when typing or concentrating (even while texting), and this gives muscles a tension break, says Erik Peper, Ph.D., professor at the Institute for Holistic Health Studies at San Francisco State University.

Less is known about how to prevent CTS. If you have a job that stresses your hands, take frequent breaks. If you have a computer job, make sure your office is ergonomically correct with an elbow-level keyboard, but whether this helps prevent carpal tunnel is unknown.

Do you have wrist pain? What have you found that works?


Laurie Tarkan is an award-winning health journalist who writes for the New York Times, national magazines and websites including Health, Prevention, iVillage and the Huffington Post. Follow her on twitter.
Photo courtesy flickr user Chika
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