Carpal Tunnel Syndrome – Everything You Need To Know

 

Imagine not being able to hold a pen and that you’re wrist feels like it’s about to explode just from attempting to hold it properly.

Painful and sad, right?

Now imagine not being able to play your favorite PC game anymore – no more LoL, or DoTA, or CS:GO.

I bet you’d go crazy. That’s Carpal Tunnel Syndrome for you.

Unfortunately, a lot of gamers – even professional ones – have their gaming lives and career cut short due to this incapacitating illness. This article aims to shed light on what is Carpal Tunnel Syndrome and how to avoid it.

What is Carpal Tunnel Syndrome?

In a tech-driven society, it is not shocking that you hear complains about wrist cramps or painful and repetitive jolts of pain from the wrist to the arm up. Especially when, most of the time, that person types, texts, or writes his/her day off. This painful sensation is called carpal tunnel syndrome.

The median nerve, located at the length of the wrist to the carpal tunnel, is compressed, or in layman terms, squashed. Basically, what alerts the pain is anything that would narrow the carpal tunnel, thus crushing the median nerve, notifying the pain receptors.

Since we live in a tech-driven society, carpal tunnel syndrome can certainly make you inefficient at types of work that are greatly demanded and required today. Fear not, because there are ways on how to prevent and cure this condition.

Causes of Carpal Tunnel Syndrome

The condition can be attributed to so many possible reasons that to pinpoint direct causes becomes impossible. From genetics to the nature of one’s work, the possible causes can be specified.

Unfortunately, some people are born with the genetic predisposition to acquire carpal tunnel syndrome. They are simply born with a naturally narrow carpal tunnel. Other causes can range from obesity, hypothyroidism, arthritis, diabetes, and trauma from arm injuries.

Repetitive extrinsic factors from pressure that is put on the part of the carpal tunnel can also be a cause of the condition, such as heavy workloads, sprains, and fractures. Intrinsic factors also play a role in the development of the syndrome.

An example would be benign tumors located near the carpal tunnel. Pregnancy and menopause also is a cause of the carpal tunnel syndrome, as the body experiences hormonal changes and swelling of the synovial.

Common Symptoms 

Carpal tunnel syndrome can be detected through various symptoms that gradually develop, more so if the condition is not immediately addressed.

General symptoms include tingling sensations in the hand or arm, localized numbness and pain, paresthesia or that pin and needle sensation.

Weakness of grip and inability to differentiate hot from cold can also be a symptom of this condition.

Pain sensations can mostly be felt in specific parts of the hand, namely the thumb, index and middle finger since these fingers directly receive their motor impulses from the median nerve.

Symptoms are usually worse at night. Patients often wake up just to shake their hands and arms to alleviate numbness and tingly sensations. Physical appearance of the lower thumb area can also worsen.

Muscles in this part deteriorate as a result of the condition. The skin in this part can look stretched and withered, especially when the patient’s carpal tunnel syndrome is left untreated.

Treatments

With the effects being unattractive and painful, carpal tunnel syndrome should be treated immediately to prevent worse conditions. Treatment options range from cheap medication alternatives to surgery.

Perhaps one of the cheapest medication would be staying away from the activities that worsen the condition. But if one’s work require the repetitive and damaging activity, proper exercises and add-ons that counter the effects are advised.

Physical remedies such as strains and wrist braces can be opted for, especially when the patient prefers a non-invasive treatment.

These aid patients when avoiding the damaging carpal tunnel activity is impossible. Physical therapy is also a non-invasive option, such as that of acupuncture.

Drugs can also be used for treatment. Cortico steroid injections, although immediately effective, should only be used temporarily. Oral medications such as “water pills” can also be administered.

For severe cases, surgery provides a longer period of relief, if not permanent. Carpal tunnel release is one of the most common surgery option. Open release surgery is one type that involves cutting 2 inches of skin to widen the carpal tunnel.

Endoscopic surgery, on the other hand, only requires a half-inch incision which allows for lesser scars and faster healing.

How To Prevent CTS?

1. Proper Posture

Maintaining proper posture is a simple and an effective way of preventing carpal tunnel syndrome, but this is undeniably taken for granted. Due to heavy workloads, that do not only pressure people, they also have no more time to double check this simple but significant exercise.

Improper posture can result to nerve compression in the neck, which then reflect to other nerves in the long term as well, specifically the median nerve. Being cautious of your arm postures can also be of great help. Leveling your arms and wrists while typing can aid in this exercise technique.

For people suffering from carpal tunnel syndrome, yoga can also be of help. This exercise program directly address posture, as well as joint stretching and strengthening. Whole body yoga exercise is advisable since good posture has a tendency to trickle down to other specific mobile parts of the body.

2. Use of Ergonomic Gear

Workers are the majority of carpal tunnel syndrome sufferers. That is why ergonomics, or the leveling of working conditions to the abilities of workers, should be tapped by employers.

Ergonomics mainly include devices and techniques that aid in the prevention and cure of carpal tunnel syndrome. One of which would be switching from QWERTY keyboards to a Dvorak keyboard layout.

There are also ergonomic qwerty keyboards that split in half to allow users better and comfortable access. Ergonomic mouse are also available in the market that give off a warm feel to it. Wrist rests with cushion parts and strategically placing chairs are also other ways to prevent carpal tunnel syndrome development.

3. Exercise

One of the best ways of preventing carpal tunnel syndrome is through exercise. Simple stretches can do just the thing, but they have to be strategically placed in patients’ daily schedule.

You can never be too busy for your health and comfort, so taking breaks every 45 minutes of work is advisable.

Isometric exercises are one of the many advisable and helpful techniques. Also, fanning out fingers on a flat surface is a short but effective technique.

Grips should also be monitored as people usually hold onto things tighter than what is needed.

Lessening tight grips can be aided by pens with soft grips when writing, or hitting the keys on a keyboard softly since too much force can, not only damage your carpal tunnel, but also damage the keyboard itself.

You may also like to read more articles in our blog section Gamers Health where we have written article, “5 Common Gaming Injuries” and “The Spirit is Willing but The Wrist Is Weak“.

5 Common Gaming Injuries

During my research into common gaming injuries, I came across several articles where the author actually made fun of these illnesses.

I wouldn’t link out to those articles as I don’t want to point fingers, in particular, one article lists Carpal Tunnel Syndrome despite it being a legitimate injury caused by improper hand use during work or play – together with something called “World of Warcraft Malnutrition” and “Gamer’s Rage”.

That would actually be pretty funny if the author at least recognizes the fact that these injuries are very real, instead, he or she did not.

In an effort to provide a good information about the reality of gaming injuries, we deliver an info-graphic about 5 common gaming injuries.

 

Nintendinitis

Obtained through the overuse of the D-Pad, Nintendinitis is also called “Gamer’s Grip”. Symptoms include blistering, swelling of fingers, and tingling or prickling sensation.

 

PlayStation Thumb

Caused by excessive use of thumb-operated controllers, it is characterized by swelling, blistering, and numbness of the thumb.

 

Wiiitis

A variation of Nintendinitis, Wiiitis is obtained through excessive use of Wii. Characterized by isolated, intense pain on the affected shoulder.

 

Carpal Tunnel Syndrome

Occurs when tendons swell and put pressure on the median nerve. It is usually caused by improper hand use. Symptoms include  swelling, numbness, and sharp pain.

 

Back Pain

Caused by improper sitting posture, back pain is usually felt on the lumbar (lower back) area after long periods of sitting. Invest in an ergonomic gaming chair to avoid potential back injuries.

You may also like to read more articles in our blog section Gamers Health where we have written article, “The Spirit is Willing but The Wrist Is Weak“.

The Spirit Is Willing But The Wrist Is Weak

Confined in a room while sitting on a couch or a gaming chair with cokes or beers on the side (and some slices of pizza boot!), as well as a keyboard and a mouse at hand – this is just but the life of an average gamer who’s at home living the leisurely lifestyle of gaming.

While some may think that gaming is a past time that is all chill and fun, there is a reality about gaming that only fellow heavy gamers would understand – it’s not all rainbows and butterflies every time.

Like having to work in an office, gaming can be as stressful, tedious, and prone to aches and nagging pains resulting from the repetitive nature of the activity (though the fun part overpowers all of these).

The toil is even truer for hardcore and professional gamers who spend countless hours mastering their craft – after several hours of adrenaline-filled, red bull-pumped gaming, the resulting outcome has always been same – it is tiring (both physical and mentally), if not something that results to sore pains which many gamers are familiar of but do not give a care about…until the pain is already excruciating, if not debilitating, like a Repetitive Strain Injury on their hands.

 

What are Repetitive Strain Injuries?

 

You may think that your spirit is willing but cant play more because your wrist is weak, its because of what is known as Repetitive Strain Injury (RSI). Put in both medical and computing terms, an RSI is a kind of injury arising from the overuse of hands for doing tasks in repetition like writing, clicking on the mouse, and typing on the keyboard.

At its mild cases, an RSI can be easily alleviated and fixes itself from the pain over time. However, more serious cases of RSI can be potentially debilitating as the pain is synonymous to a person having a serious case of arthritis, the latter of which is basically about the inflammation of the joints.

What makes an RSI different from any kind of arthritis, however, is that instead of the joints, RSI is more affecting towards the muscles and the nerves, if not the combination of both, each of which or both of which are the root cause of pain.

The two most common cases of RSI include the Carpal Tunnel Syndrome and the Guyon Canal Syndrome which are both pretty much the same, only differentiated by the affecting areas each is attributed to.

 

History of RSI

 

Not until the early 1980s, RSI was oblivious in the medical field, let alone for workers who do tedious office jobs. It was not until female office workers who had gone from the transition of using typewriters to computers that RSI, due to its now known symptoms, was identified as a medical condition rather than simple occurrences of pain.

Seeing how these female workers perform their duties with their typewriters and how they did after making the transition to using word processors on their computers, the root cause of the issue was blamed towards the workers’ increased efficiency at work due to continuous typing that is not entirely possible seen when they were using typewriters.

Yet the same clinical issue is also becoming a trend among people who play video games for a hobby for long durations of time, basically for the same nature of activity.

Professional and non-professional gamers alike are not immune to this health condition which likely affects a good portion of the population who play games as a hobby, if not for sports.

 

Pathophysiology of RSI

 

Since the discovery of RSI back in the early 1980s, continuous learning about this medical condition have found new insights of what makes RSI a case among people who do repetitive work with their hands such are the gamers who play several hours in succession or longer.

The pathophysiology is simple: Routinely doing a set of work involving the hands rapidly without much ceasing causes a microscopic-level tears to either or both our tendons and muscles which, in turn, affects the circulation of the blood in the affected area – commonly, as an RSI condition, the hands. As the blood supply is diminished, recovery time from the micro-level injury is thus lengthened.

Adding more to the problem of simply just having micro-level wear-and-tear are the byproducts of metabolism accumulating on the affected area which then calls for an inflammatory response from the body and hence the cause of inflammation among people afflicted of RSI.

As the swelling, resulting from inflammation, puts pressure on the nerves of the affected area, pain could escalate which then can be excruciating for some. With a likely pain on the upper extremities arising from the condition, RSI-afflicted individuals therefore experience a sense of weakness and restrictive movements as well.

Lastly, as there is a direct correlation between blood circulation and the level of synovial fluid in certain parts of the body—including the hands—people with RSI are also aggravated by the increased level of friction and pressure on their affected upper extremities, most likely resulting to increased level of pain.

 

The Gaming Life Chose Me

 

RSI is particularly common for MOBA or real-time strategy gamers whose actions-per-minute (APM) is associated with their skill. Furthermore, according to a Starcraft wikia, most proficient players can average from 150 to 200 actions per minute, but it’s not rare for professionals to reach up to 500 to 600 actions per minute – that’s 10 actions every second.

This is why for professional esports stars, the gaming life is a huge balancing act. Benjamin “deMuslim” Baker, who plays for Evil Geniuses told NBC news in a previous interview that he has to take vitamins, exercise, and manage his time properly in order to perform at his peak. And while Benjamin Baker did not develop any RSI, other players weren’t as lucky.

 

Cloud9’s Hai

 

North America’s most famous League of Legends shot caller, Hai Du Lam “Hai”, almost retired from the professional-scene due to his wrist injury, which kept him from keeping up with practices and scrims. Hai isn’t known for his mechanical prowess however, and he changed roles to jungle and finally to support where his superior in-game knowledge and leadership skill are better utilized, thus propelling a declining Butt9 to a Cinderella-esque gauntlet run and a shot at a World Title…though retirement doesn’t seem so bad:

Other players with RSI include Team Solo Mid’s “Bjergsen” and currently Hong Kong E-Sports’ “Toyz”. Toyz even had to retire in June 2013 when his Carpal Tunnel Syndrome did not permit him to play anymore. He finally returned as HKE’s mid laner in October 2014, saying that his wrist is finally better.

 

Risk Factors for RSI

 

Not all people get RSI and may likely explained by the differences in people’s lifestyles. However, here are the factors that may contribute to the development of RSI, especially amongst gamers:

  • Short interval (30 seconds or less), repetitive arm and hand movements
  • Improper sitting or body positioning
  • Underlying cardiovascular disease
  • Illnesses such as diabetes, arthritis, and gout
  • Pregnancy
  • Overweightness or obesity
  • Stress

There is Hope, But What To Do?

Will we be ever free from the threat of acquiring RSI as long as we keep playing games? Yes, we can – prevention is key! Here are some things that we can do.

 

Time Management and Gaming Efficiency

 

Luckily, for many people, Repetitive Strain Injuries are as optional as the choice we make on how long we play our games. Less time for gaming, less chances of acquiring RSI. More time for gaming, more chances of acquiring RSI – in the truest sense, this could be true, but telling this advice to gamers like us is futile – we’ll play the game as long as our wrist and fingers can move! Fortunately, most e-sports doctors say that it all boils down on playing the game as efficiently as possible – basically clicking less, but doing more (note that proper posture, exercise, and use of proper equipment still matter…). Totally unlike a guy who clicks for the sake of clicking.

 

Proper Posture and Exercise

 

Maintaining a proper posture is crucial to extending your gaming life. A few wrist exercises won’t hurt either and even promotes proper blood circulation to those often-abused areas. Good posture while sitting encompasses a variety of factors. You can identify proper posture by the following:

  • Your feet are flat while touching the ground or a foot stool.
  • Knees bent at a 45 degree angle directly above your feet.
  • Your chair supports your lower and upper back.
  • Seat should be slightly sloping forward.
  • Shoulders are relaxed and arms relaxed at sides or bent while resting flat on the armrests.
  • Don’t hunch.

Use Ergonomic Equipment

 

Ergonomics and engineers alike are now looking at creating better equipment for gamers – ergonomic chairs with multiple adjustment points are now in the market, as well as ergonomic mice, keyboards, and adjustable desks.

Plenty of doctors are also diving into the e-sports scene to recommend proper wrist exercises and posture that minimize the chances of developing RSI. Doctor Levi Harrison is one of the more well-known doctors in the e-sports industry that advocates the use of proper gaming equipment and following a healthy lifestyle. He even has an e-sports coaching page on his website and I’m quite surprised to see that he’s worked with NRG, one of the newer teams competing in the LCS.

 

Educate Yourself With These Resources

 

RSI is not a frequently discussed topic – after all, why discuss about injuries, health, and posture when you can talk about dank memes? However, educating yourself about the perils of gaming too much (however impossible that may be) is still a good thing. As such, I created an educational resource for you which I will update every time I come across a suitable site or link.

Your Call

 

In the end, how we defeat RSI is a matter of choice – we can live a healthy gaming lifestyle which reduces the risk of RSI or we can live a life of an irresponsible gamer and suffer on its consequences later on.

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