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wrist pain

Wrist Problems

Some Anatomy

The wrist is a complex joint and can perform many different movements. These include:

  • Flexion: bending the palm surface towards the wrist.
  • Extension: raising the back of the hand.
  • Supination: turning the wrist into a palm up position.
  • Pronation: turning the wrist into a palm down position.
  • Ulnar deviation (flexion): bending the wrist to the little finger, or ulnar bone, side. With the right hand this is the movement you use when hitting the Enter key.
  • Radial deviation (flexion): bending the wrist to the thumb, or radial bone, side.

Go to the Wrist Movements Page for more details on these wrist movements.

How do Computers Contribute to Wrist Pain and Repetitive Strain Disorders?

Keyboarding or typing requires that the wrists be held in the following positions:

  • Pronation: In order to type the wrists are held at the extreme range of pronation.
  • Extension: In order for the fingers to reach the keys the wrists must be held in extension.
  • Ulnar/Radial Deciation (Flexion): In order to press the Enter or Backspace key the operator must ulnar deviate the right wrist. To press the Escape or Tab key they must ulnar deviate the left wrist.

These postures are maintained for long periods of time while the fingers make rapid movements around the keyboard.

Carpal Tunnel syndrome

The carpal tunnel is formed by a ligament (called the transverse carpal ligament) that attaches to the carpal bones of the wrist. This tunnel is important because many nerves, blood vessels, and tendons pass through it on the way to the hand. Irritation, due to excessive, repetitive, or awkward movements, can result in swelling of the tendons within the carpal tunnel. This swelling puts pressure on the nerves, as they squeeze through the tunnel, causing a number of problems. This is known as the Carpal Tunnel Syndrome.

Problems caused within this carpal tunnel are often felt in the hand and fingers, rather than the wrist itself. Symptoms of problems within the carpal tunnel, known as Carpal Tunnel Syndrome can include:

  • Tingling in the fingers.
  • Clumsiness, such as dropping things.
  • Weakness, such as difficulty picking up and holding things.
  • Numbness in the fingers or palm.
  • Pain in the fingers, hand or wrist.

While Carpal Tunnel Syndrome gets the most press it is by no means the only repetitive strain syndrome associated with the wrist. Other syndromes include:

Intersection Syndrome

  • Intersection Syndrome is a painful condition that affects the thumb side of the forearm.
  • This is where two muscles cross over - or intersect - two underlying wrist tendons.
  • The upper muscle group tendons connect with the thumb to pull it away from the hand - and the lower set of tendons bends back, or extends, the wrist.
  • Cause: Irritation of the two tendons (tenosynovitis).
  • Symptoms: Swelling and redness may occur over the area where the two tendons rub against one another - at the intersection point. Pain can spread down to the thumb or back up along the thumb side of the forearm. Movement may be restricted. Intersection Syndrome can be confused with DeQuervain’s Tenosynovitis.

DeQuervain’s Tenosynovitis

  • Pain on the side of the wrist and forearm just above the thumb
  • Cause: The two tendons that pull the thumb out and back from the hand are causing this discomfort. These two tendons run in a tunnel on the side of the wrist just above the thumb. When these tendons become inflammed they have difficulty moving through the tunnel, which causes pain.
  • Symptoms: Pain at the base of the thumb that may also radiate up towards the elbow.

Guyon’s Canal Syndrome

  • As it crosses the wrist, the ulnar nerve and artery run through the tunnel known as Guyon's canal. This tunnel is formed by two bones, the pisiform and hamate, and the ligament that connects them.
  • Cause: Nerve compression affecting the ulnar nerve as it passes through Guyon’s canal. Similar to carpal tunnel syndrome, but involves a completely different nerve. Sometimes both conditions can be causing a problem in the same hand. The hamate bone has a small spur that sticks out for attachment of ligaments in the wrist. This spur is called the hook of the hamate bone and can be broken off, which could cause Guyon’s Canal Syndrome.
  • Symptoms: A feeling of pins and needles in the ring and little finger, starting in the early morning before waking. This progresses to a burning pain of the wrist and hand, followed by decreased sensation and eventually clumsiness in the hand.

Important Note: Sleeping Position

How you sleep can be a contributing factor to wrist discomfort. Some people sleep with their wrist flexed (bent) which contributes to compression of the carpal tunnel.

sleeping with wrist flexed
The subject in this image is sleeping on their left hand, with the wrist flexed. The contents of the carpal tunnel are subjected to prolonged compression.

Solutions to Consider

Position and Posture

Before proceding to change your keyboard and mouse, consider your posture. Making improvements in posture can help you deal with problems in other areas, such as your wrist.

  • How are you sitting; what is the height of your desk?
  • Do you have to perch on the edge of your chair, or are you slouching?
  • Are you twisting your neck to read a document?
  • Are you twising your neck to hold the telephone while you type?

These and other issues should be considered when addressing wrist problems.

When it comes to wrist problems, it is very important to consider the position of your wrists and forearms while typing adn mousing.

  • With your elbows resting comfortably at your sides, the angle of the elbows should be ~90°.
  • The wrists should be straight (not a lot of bending up or down).

Arm/Wrist Supports

Supports come in many shapes and sizes, but the most common support is the wrist (or palm) rest that is placed in front of the keyboard.

Keyboard Gel Palm Rest
Keyboard Gel Palm Rest

There is a lot of debate on the advantages and disadvantages of this style of wrist rest. Some rules of thumb include:

  • Use them for resting only (during breaks between typing).
  • When typing there should be no contact between your wrist and the wrist rest. This will eliminate skin irritation due to rubbing the top of the rest.
  • Do not lean into them. This puts a lot of pressure on the carpal tunnel area.

Some keyboards come with built-in wrist rests, which may be removeable.

Natural Ergo Keyboard 4000
Natural Ergo Keyboard 4000

Some mice come with built-in wrist rests, which may be removeable.

RollerMouse Red

Some supports are articulating, giving full support throughout the typing/mousing range and eliminating rubbing.

ErgoRest Forearm Support
Ergorest Forearm Support

Keyboard/Mouse Considerations