Maintaining Healthy Hands

Keeping your hands healthy and pain free is something every programmer should be thinking about, minor hand injuries will affect your productivity, a major injury could threaten you livelihood. Hand injury is common problem amongst programmers, so it’s not surprising that the question “How do you keep your hands in good condition?” was asked here on Programmers (though closed as off topic).

Dr. Alan Gotesman an orthopedic surgeon with training in hand, microvascular & upper extremity surgery and friend to the Programmers Community has agreed to answer this question for us.

By: Dr. Alan Gotesman

Repetitive Strain Injuries of the Hand

Prolonged repetitive hand movements, particularly in awkward positions, can lead to strain injuries. It is important to be aware of these injuries and prevent them as well as treat them when appropriate. Some of the conditions may not necessarily be caused by repetitive stress, but many can be aggravated by it.  The following are some of the more common hand conditions encountered by hand surgeons in the setting of repetitive stress.

Carpal Tunnel Syndrome

The carpal tunnel is a narrow, tunnel-like structure in the wrist. The bottom and sides of this tunnel are formed by wrist (carpal) bones. The top of the tunnel is covered by a strong band of connective tissue called the transverse carpal ligament.

The median nerve travels from the forearm into the hand through this tunnel in the wrist. The median nerve controls feeling in the palm side of the thumb, index finger, and long fingers. The nerve also controls the muscles around the base of the thumb. The tendons that bend the fingers and thumb also travel through the carpal tunnel. These tendons are called flexor tendons

Carpal tunnel syndrome occurs when the tissues surrounding the flexor tendons in the wrist swell and put pressure on the median nerve. These tissues are called the synovium. The synovium lubricates the tendons and makes it easier to move the fingers. This swelling of the synovium narrows the confined space of the carpal tunnel, and over time, crowds the nerve. The synovial swelling can be caused or aggravated by repetitive motion. Direct compression of the carpal tunnel as well as extreme positions can also aggravate the condition.

Symptoms of carpal tunnel consist of:

• Numbness, tingling, and pain in the hand
• An electric shock-like feeling mostly in the thumb, index, and long fingers
• Strange sensations and pain traveling up the arm toward the shoulder

Prevention:

Prevention of symptoms should focus on proper hand positioning when performing activities, in particular typing. The wrist should be in a neutral position (not bent up or down) which is best done by a forearm rest. There should also be no direct compression on the wrist which can increase the pressure in the carpal tunnel. Occasionally, braces may be required to rest the wrist and if symptoms become severe enough, surgery may be necessary.

Tendonitis

Tendons are the connection between muscle and bones which allow us to move our joints. The wrist tendons slide through smooth sheaths as they pass by the wrist joint. These tendon sheaths, called the tenosynovium, allow the tendons to glide smoothly in a low-friction manner. When wrist tendonitis becomes a problem, the tendon sheath or tenosynovium, becomes thickened and constricts the gliding motion of the tendons. The inflammation also makes movements of the tendon painful and difficult.

The most common and consistent complaint of patients diagnosed with wrist tendonitis is pain over the area of inflammation. Swelling of the surrounding soft-tissues is also quite common. Repetitive stress can cause tendonitis by putting too much strain on the tendons.

Prevention:

Taking frequent breaks and not putting the wrist/hand in awkward positions can prevent these injuries. If symptoms appear, anti-inflammatories can be helpful as well as short periods of immobilization. Swelling can be brought down with ice and elevation. Cortisone injections can be helpful for symptoms that are not improving and surgery may be necessary if conservative modalities are failing.

Sprains

A sprain is an injury to a joint caused by a tearing/stretching of the ligaments. These are frequently acute injuries caused by trauma, however they can be chronic from repetitive stress across the joint causing stretching. Any joint can be affected, but the thumb can be particularly vulnerable as the ligament is often being stressed with daily activities. The increased frequency of texting, with the thumb primarily being used to depress the keys, has increased the incidence of this problem.

Symptoms consist of discomfort around the joint, particularly with any stress applied. There can be swelling in the area as well as tenderness directly over the affected joint. Extremes of motion can be painful as well.

Prevention:

Repeated stress across the joint, especially in one particular direction, should be avoided. If symptoms appear, alternative positions should be used and if possible, decrease the amount of activity. Custom splints can be helpful to support the particular ligament involved and decrease the stress across it. Anti-inflammatories can alleviate the pain and swelling. Infrequently, if symptoms persist, the ligament may need to be repaired or reconstructed.

Repetitive stress injuries of the hand can be disabling and appropriate measures to prevent them should be instituted. If symptoms persist, they should be evaluated further by a qualified hand surgeon for further treatment.

About The Author

Dr. Alan Gotesman is a board certified orthopedic surgeon with fellowship training in hand, microvascular & upper extremity surgery. He has a special interest in minimally invasive and arthroscopic surgery. He is in private practice in Rockland County.

Alan Gotesman MD
http://www.alangotesmanmd.com
Orangetown Orthopedics
99 Dutch Hill Road
Orangeburg, NY 10962
845-359-1877