carpal tunnel and tendonitis and what to do?

August 18, 2009 11:16 AM

Arm/wrist problems and no health insurance: what to do?

John got (diagnosed) tendonitis last summer. It was a work related injury and he received workers comp for it (including doctors visits and physical therapy). It slowly got better. In December/January John was spending too much time typing and got (diagnosed) carpal tunnel. He was in a country with public health insurance then so was able to see a doctor. He got some sort of injections in his wrists/arms (not cortisone injections), which didn't really seem to help.

Returning to the USA, John stopped having any sort of health insurance (and has a part-time job, which does not offer him health insurance but pays enough that it disqualifies him from Medicare), but went to several free clinics asking what he should do. They told him to take NSAIDs and wear wrist braces all the time. John has been doing this for the last three weeks, but the wrist braces have aggravated the previously-mentioned tendonitis in his elbows.

Right now he has weak and tingling wrists and hands, opening jars and turning on sticky faucets causes pain and tingling. In the winter (when it was really cold), his fingers were going numbish/turning white. After wearing wrist braces for over an hour, his elbows start feeling like they did back when he first got tendonitis (pain near funny bone, pain down forearm).

He doesn't know what to do. He doesn't want to make either of his arm injuries worse, he doesn't want to ruin his arms for life, he does not have savings or enough money to be in a position to negotiate a flat rate with a doctor. Right now he is doing yoga, has just started taking vitamin B-6 (thanks to advice from the internet), isn't typing or using a computer, but is at a loss as to what his other options are (other than living with weak and tingling and weird-feeling arms for the rest of his life).

What should he do? What can he do? What are his options? (Also, this is being typed by his girlfriend Jane, who would also like advice on how she can best be supportive and help John feel better during this.) If it matters, we are in the central New York area.

posted by anonymous to health & fitness (17 comments total)

I was getting tingling and pains for more than 6 months due to too much typing, I thought. I found this guy's web site helpful. Main point being to properly align the rest of the body, which supports the arms, and get bloodflow happening by pushing the muscles (not in the injured area, but the supporting area). Circulation then seems to heal the injured area and keep it supported well. I haven't had further problems. Similarly, sometimes I get similar tingling and pain in a foot and I find floor pilates are good for getting bloodflow to the area and easing the symptoms over the next day or days.
posted by Listener at 11:50 AM on August 18

I've had 3 major bouts with wrist problems, doctors, NSAIDS, etc. Nothing worked. I am a software developer. pianist and music producer (mostly on the computer). I did so much research on this topic that I went crazy. He will not "ruin his arms for life". The human body can heal very well. The fear of making it worse does actually makes the problem worse.

3 things eventually helped me in this particular order:

1. Dr. Sarno's books. This one in particular:
http://www.amazon.com/Mindbody-Prescription-Healing-Body-Pain/dp/0446675156/ref=sr_1_2?ie=UTF8&s=books&qid=1250622397&sr=1-2

2. Resistance band exercises.

3. Exersizes and information in "It's Not Carpal Tunnel Syndrome! RSI Theory & Therapy for Computer Professionals"
http://www.amazon.com/Carpal-Syndrome-Therapy-Computer-Professionals/dp/0965510999/ref=sr_1_1?ie=UTF8&s=books&qid=1250622542&sr=1-1

Good luck to him. I was at my wits end, but other then a little soreness once and a while I'm fine. (got a gig on Friday).
posted by distrakted at 12:14 PM on August 18 [1 favorite has favorites]

opps, i meant: The fear of making it worse does actually MAKE the problem worse.
posted by distrakted at 12:25 PM on August 18

I almost hamburgered my right arm from mousing too much in my 20s- Apple, I love you, but your mice are crimes against nature.

I've had a lot of luck customizing my desk to reduce pressure and started using an egronomic mouse. I've got an Evoluent that I picked up off Amazon and have gone from "arm in a brace and constantly taking breaks" to "can make it through most days with very minor discomfort."

http://www.evoluent.com/
posted by clango at 12:39 PM on August 18

In the short term, he should get rid of his mouse! (That is, the electronic mouse attached to his computer.) My tendinitis completely went away after I switched to using a trackball, and I type a lot, all the time.
posted by whimsicalnymph at 1:02 PM on August 18

I used to get terrible pain in my right shoulder from using the mouse too much. I started taking fish oil and within a few weeks I noticed it was better.

Also, this book recommended an exercise for elbow pain that helped me a lot.
posted by Serene Empress Dork at 1:52 PM on August 18

this mouse really helped me a lot
posted by alkupe at 1:57 PM on August 18

Another vote for fish oil- helped me with some minor wrist pain awhile back.
posted by ThePinkSuperhero at 3:04 PM on August 18 [1 favorite has favorites]

IANAD, but have had tendonitis.

Stop whatever activity is causing this injury, and use proper chair/desk/mouse arrangement when necessary.

If he remembers the physical therapy exercises he was prescribed before, start them again. The tingling is caused by inflamed tendons swelling and pressing on nerves. Over the counter NSAIDS will reduce the swelling. Don't be afraid to take them at the max levels the bottle says. This may be 6-8 pills a day. One thing I really took away from physical therapy was the idea that your hands are supported by your arms, which are supported by your elbows, shoulders, down to your back. To get your arms wrists and hands strong you need to exercise and develop muscle in your shoulders and back as well. Weight lifting may be difficult right now if his grip is weakened, but start small, or go with resistance band training exercises.
posted by fontophilic at 3:13 PM on August 18

Over the counter NSAIDS will reduce the swelling. Don't be afraid to take them at the max levels the bottle says.

Overuse of NSAIDs can lead to gastrointestinal problems including ulcers.

I tried several different braces/supports. Unless I needed my hands and wrists completely immobile, the best thing was actually cheap tube bandages. And if needed at night (and/or watching TV before bed) Pil-O-Splint. I had varying amounts of success with a cheap TENS machine. In the US you might have to order from outside the country. At first it was great, later only moderately effective. Alternating 15-20 minutes with cold-packs and heat-packs sometimes worked very well. And if you go to Canada (or the UK or Spain) for any reason, you can get OTC painkillers that include codeine.

But, as I'm sure you're aware, quickly covering up the pain is not the same as tackling it at the source (physio-exercises, better posture, ergonomic mouse/keyboard, taking regular breaks from the keyboard, etc).
posted by K.P. at 4:05 PM on August 18

you need a strategy to treat tendinitis and RSI, the age old advice of rest, splinting and NSAIDs has serious limitions

step one: reduce inflammation

Ignore NSAIDs, across the board inhibition of prostanoid synthesis is silly. There really is no consensus that NSAIDs speed the healing of bone, tendon or ligament injuries.

Fish oils reduce inflammation by provding DHA and EPA, which directly compete with omega-6 fatty acids during prostanoid synthesis. As William Lands covers in his books, omega-3 based prostanoids are much less 'inflammatory' than their omega-6 counterparts.

Tumeric and bromelain are very powerful anti-inflammatories, I really like this product at iherb.

step two: self massage and strength training

If you can afford massage therapy, I would seek a few treatments with someone who knows one of the soft tissue techniques (active release, myofascial release, rolfing), and let them make you scream while breaking down the accumulated trauma in your forearms.

Otherwise, you can do it yourself. Most people with carpal tunnel have extensive knots and tension in the muscles that flex the wrist, as well as the muscles that extend the wrist, and the rotator cuff muscles.

I like to massage the muscles in my fingers, the fascia in my hand, and then use my elbows to dig into the forearm flexors and extensors of my opposing forearms. There are some good youtube tutorials on self forearm massage.

Eccentric training has long been known one of the most effective treatment for tendinitis, it works mainly by increasing the maximal strength of the muscles with tendinitis, requiring you to use a lower percentage of motor units during everyday activities. If you want to return to work and not redevelop RSI, you need to increase the strength of your hands and wrist muscles to more than what they were preinjury.
posted by zentrification at 4:40 PM on August 18

Keep up the vitamin B6 -- or he might want to take a B-complex vitamin, and thus no worries about what if some other B vitamin is better for it. Computer mice are bad news for RSI -- vertical mice, touchpads, trackballs, pen&tablets, anything else will probably be better. I progressed through several different kinds of wrist supports -- it might help for him to try, buy, and wear some non-metal-splint ones. SmartGlove and Imak are two brands of wrist supports I own and have used a lot. Also re: wearing those things: the fit/adjustment is really, really important. It sucks to be fussing with the wrist supports, but they can make the pain worse if they're not adjusted quite right.

He might also want to make a short arm/wrist stretch and exercise routine for himself. (For example, there were 8 exercises in mine, and I gave each one a nickname and wrote it down as a full list and committed it to memory. made it a little more bearable.)
posted by oldtimey at 6:14 PM on August 18

He might have the wrist braces strapped on too tight. Mine hurt me like that when I don't leave enough give.
posted by Jacqueline at 6:31 PM on August 18

I know people that have been helped by acupuncture for various RSI-related ailments, so he might give that a try.
posted by ch1x0r at 7:33 PM on August 18

I'm not a doctor but I had a long bout with tendonitis. I went to see a physical therapist at Mass General Hospital and was told to do forearm stretches and take ibuprofen. I would also ice my forearms at the end of the day. All these things seemed to help. Eventually, the problem will get better. The big problem I had was that I was afraid to use my arms at all. Don't be afraid to do minor things like brush your teeth. I doubt that brushing your teeth twice a day is going to aggravate the condition. Eventually, the condition will get better. Remember that. It just takes a long time. It took me about three years to recover fully. Here are some resources: Harvard RSI action and Cornell University Ergonomics Web (for setting up computers to be ergonomic). For the computer, I also recommend using break timer software like Work Rave. If the condition is severe, some RSI sufferers use speech recognition software to avoid typing. For now, just minimize any repetitive movements like typing, factory work, playing musical instruments, even innocent stuff like stapling 100 sets of paper, etc. In terms of being supportive, one should make John feel that it's not the end of the world and that he will get better be able to do normal things eventually (unless he has a really severe case like a few people I know).
posted by qmechanic at 11:28 PM on August 18

I've had recurring tendinitis in both elbows and wrists for almost 14 years. I had to quit taking ibuprofen because it was causing enough gastric bleeding that I became anemic for the first time in my life 4 years ago. A re-diagnosis showed osteoarthritis in both wrists, with no cartilage remaining in my right wrist and 2/3 erosion in left wrist - no wonder they were so painful! All this was from many years of improper ergonomic computer use and one summer of short-order cooking at a local cafe. I now wear comfort cool arthritis thumb support splints for the wrist pain and no ibuprofen.

I also have been suffering elbow pain, (lateral epicondylitis) for which I wear elbow bands. John would maybe do better if he wore both sets of splints, as that seemed to help me so much more than just the wrist bands. I also got the evoluent mouse someone mentioned above, an ergonomic keyboard for both home and work, and a proper alignment of desk and keyboard at work. I was also lucky enough to have the services of a great physical therapist during the acute stage of my pain. I am not entirely pain-free but it has lessened a great deal since I began this aggressive management regime. I wish John the best of luck with a speedy recovery.
posted by Lynsey at 4:07 PM on August 19

I had pretty bad tendonitis (thankfully only minimal nerve damage, so I didn't get actual Carpal Tunnel) for several years when I was doing heavy computer work at the day job + more computer work at night.

Taking NSAIDs for a number of years can mess up your stomach and hearing - others have posted this already, but it's worth noting that they're really not that good for you in the long term. I have a significant amount of tinnitus in my right ear that now gets aggravated if I get sinus congestion or take more than a couple Advil at a time. Most likely from years of taking ibuprofen/voltaren/relafen and others for the tendonitis.

The tendonitis faded away when I started spending less time on the computer - significantly limited my email/AIM use, begged off the heavier data-entry at work, etc. and now, about six-seven years after the worst period, it only crops up when I spend too much time typing in a weird position (like on a laptop or weirdly-elevated table/etc.) and I keep it under control by not aggravating it when it does flare up.
posted by rubadub at 11:06 AM on August 21