Repetitive Motion Injuries: a primer - was ...excuses

[MarthaCowley -at- cexp -dot- com]

Hello listers.

To clarify in more generic terms: the carpal tunnel is the small hole
created by the floating and locked bones of your wonderfully articulated
wrists and through which flexor tendons pass through. Flexor tendons control
your hand and your fingers. The Median nerve  that is the control center for
the fine motor control of your hand resides just inside and to the front of
the carpal tunnel. Inflammation of this area can occur from injury, overuse
or even just retaining water because you are pregnant or have another
medical condition that is causing you not to process cell fluids adequately
(such as chemo). The inflammation and pressure can impact or trap the nerve
or nerve  endings. This can result in the nerve loosing functionality, or
loosing connectivity with tendons and surrounding tissues.

CTS is a specific diagnosis for the type of impaction: primarily the 9
flexor tendons that operate your thumb, pointer and index fingers and half
of your ring finger although sometimes all fingers are involved. Symptoms
include pain, weakness, fast muscle atrophy, loss of sensation, increased
sensitivity to sensation, imagined sensation, and sudden failure of the hand
to work.  There are other repetitive motion injuries that can occur
depending on where the nerve is trapped. For example: Thoracic outlet (in
the neck where nerves branch out from your spinal column to go to the
shoulder) or the ulnar nerve at the junction of the elbow. You can also
pinch a nerve anywhere else from a repetitive motion.

There is not much room in the narrow confines of the hand and wrist bones
for inflamed anything. Women are more susceptible to this because of the
smaller bone structure of the female skeleton. However the earliest cases of
CTS reported in the 1940s through 1960s were from meat packing plants from
men who gripped a meat hook in one hand all day long to reach and drag a
hunk of cow or pig down the line to be butchered and automotive assembly
lines. As work forces became more specialized and efficient, repetitive
injuries spread to just about any position that performs a repetitive task
to the exclusion of other movements which would "release" accumulated
tension. The advent of CTS in the IT world began making medical journal
headlines in the 1980s.
 
With a diagnosis of CTS, the median nerve function is measurably impacted.
Nerve function can be measures by providing an electrical impulse at one
point - say the shoulder, and measuring the power and arrival of the signal
at another point - the median nerve in the hand (this is the  EMG tests).
Losses in signal and strength and time to respond point to loss of the
nerve's ability to perceive signal. 

Before you have nerve function loss there are warning signals from your body
that are typically overlooked or ignored. You may have experienced fatigue,
tingling, swelling or even tendonitis.  Tendonitis is a frequent passenger
in full blown CTS. Tendonitis is the inflammation of the myelin sheath that
coats your tendons and allows them to slide and move. When the tendon gets
irritated or injured, that smooth surface becomes bumpy, like sand paper,
which can further aggravate the tendons. 

How do you get it? Depends. Generally we have enough variety of movement in
our day to alleviate conditions that could cause a repetitive motion injury.
But sometimes something comes into our lives that upsets the balance. A new
house, new stresses, an injury, a change in our body, etc. Your body will
give you some warning signs, but we are conditioned to ignore them. Feeling
tired is the sign of having put in a good day's work. And don't whine,
sissies and "nancy" boys are wimps. Sometimes the imbalance is temporary,
your body adapts or things return to normal and you are on your way without
really being or needing to be any wiser. Sometimes the imbalance slips
further out of balance. And by the time you realize it - you are hurt. The
realization of an injury may be sudden or even seem to appear "overnight."
In fact injury symptoms are more noticeable in the evening hours for a
number of reasons: 1)you aren't distracting yourself with the work or
situation that contributes to the injury, 2) your body's natural rhythm
slows down circulation for rest and so even less fluid is being transported
away from the irritated tissues, 3) your brain is more receptive to
listening to your body's woe because sleep time is restorative time. 

The bad news is you didn't get here overnight so don't expect to pop a pill
and wake up better in the morning. The good news is that for most people,
once you identify the issues and pay attention to your needs - however it is
you choose to pursue this, you will have a good recovery - in time.

OSHA states the following for prevention of repetitive motion injuries:
1. Avoid extreme motion.
2. Maintain correct posture.
3. Rotate job tasks.
4. Minimize repetition
5. Do your stretches and exercise regularly. Another lister gave you a
website for yoga exercises. You can do a search on repetitive motion injury,
ergonomics, or other keywords to find some additional resources.

If you are injured, OSHA advises the following basic first aid:
1. Use ice for the acute injury,
2. Then try heat. Alternating Ice and Heat does the following: Reduce
swelling and numb pain and increase circulation to transport fluids away.
3. Report symptoms early (to get faster treatment if needed). If you are
hurt, pay attention and do something about it. 
4. Treat your injuries. You got to the state of real pain you couldn't
ignore possibly by ignoring the early warnings. So don't ignore them. Early
treatment will get the best results.

And lastly, everyone is different and has different perceptions of pain and
resiliency in all manner of things. What may not bother you or someone else
may be intolerable for another. Sometimes repetitive motion injuries can
lead to a state of chronic pain or depression. Treatments that work for one
may not work for another. We are, by genetics and definition, different.
Please practice a little tolerance for your fellow man. 

Martha Cowley
Survivor since 92


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