Carpal Tunnel Syndrome As an Occupational Disease

I was talking with India today. There was a mention about Carpal Tunnel Syndrome as an occupational disease. I still can't figure out why the testing hasn't been taken to the very heart of the problem. Big manufacturing units and office complexes could have a Mediracer field team visiting them. This would even be a functional business model for private service providers. We need to work more on this subject.

Carpal Tunnel Syndrome As an Occupational Disease: "Carpal tunnel syndrome (CTS) is the most well known nerve entrapment syndrome. Involving the median nerve, it is often described as an occupational disease and claimed as a basis for worker's compensation. To provide a perspective helpful in understanding the issues central to occupational CTS, this review will focus on the history of and aspects of epidemiologic research relating to occupational CTS. Armed with such knowledge, physicians will be better prepared to establish guidelines useful in determining whether CTS is directly and solely attributable to a patient's occupation."

Below is additional information from a web page relating to conditions in USA.

Methods: The English medical literature was reviewed on the relationship between CTS and occupational ergonomic risk factors. Recent legislative initiatives are discussed. Guidelines of diagnosing and managing occupational CTS are outlined.

Helge: Mediracer provides a reliable diagnostic method that features mobility and telemedical options. Screening and testing could be made at a big manufacturing unit for maximal flexibility and speed.

Results: Many studies are divided regarding whether CTS is associated with highly repetitive/forceful/vibration work. However, a subset of patients presenting with symptoms related to CTS probably has occupational CTS. These patients can be objectively diagnosed and successfully treated and are able to return to work.

Helge: This subset of patients could be screened and tested at an early stage.

Conclusions: By being armed with knowledge regarding the background of CTS and by following simple diagnosis and treatment guidelines, the family practitioner should be able to manage many patients presenting with work-related CTS.

Helge: Field tests and CTS-diagnosis could even be made by an occupational health nurse trained in the use of Mediracer. Read also about Santa Clara.

Professor Ulrich Mennen, South Africa, about hand and related injuries

I got an interesting email from Editorial Director Marita Kritzinger. I'll send this posting to her and she can forward it to Professor Ulrich Mennen for approval.

Dear Helge,

Since we last spoke about carpal tunnel syndrome and dentists, I interviewed a South African hand surgeon, Prof Ulrich Mennen, who had some interesting points about the definition of CTS and brings a South African perspective to diagnosis and treatment of it. I’ve attached the article for your interest. If you’d like to publish any of it on your blog, I’ll check with him if he’s ok with that – but I don’t think he would mind.

Kind regards

Marita

In your hands

The ability to practice dentistry is reliant on a number of factors, not least the physical presence of your hands. In line with the approach of dental ergonomics, which encourages a deeper awareness and respect for your hands and spine, renowned hand surgeon, Professor Ulrich Mennen (South Africa), talks about the hand and related injuries.

Question: What makes the human hand unique, compared with other animals such as primates?

Ulrich Mennen: The human hand is by far the most developed prehensile organ among all living creatures. The sense of touch in all modalities (light touch, deep touch, pain awareness, proprioception, temperature appreciation, two-point discrimination, stereognosis, vibration) is better developed in the human than in any other mammal. Touch, combined with the highly developed extrinsic and especially the intrinsic muscle function, enables the human hand to perform a wide spectrum of highly sophisticated activities.

This highly developed effector, and at the same time affector, organ further serves to communicate with the surrounding world. Hand language, as part of body language, is a powerful tool for interacting in various ways: it ‘speaks’, it ‘sees’, it ‘hears’, it ‘expresses’, it ‘conveys’ and it ‘receives’. The hand also has a significant emotional dimension which reflects much of ‘me’.

The opposable thumb, unique to humans, preceded the development of the cognitive brain by a few million years. It allows precision and power grips. The combination of the dexterous hand and the brain with its ability of conceptual thought inaugurated modern technology.

Question: What are the most common workplace-related injuries of the hand that you see in your practice?

Ulrich Mennen: It is difficult to single out one or two most common injuries. One sees and deals with all types. Injury, by definition, refers to tissue damage. The cause of an injury may be mechanical, thermal, chemical, electrical, an auto-immune reaction, degenerative lesions, overuse, etc. The body’s response to these insults is always the same: inflammation. Inflammation is the first step towards healing. The aim of wound/tissue healing is to restore structural and functional integrity to damaged tissues. Tissue healing may be divided into three phases: the inflammatory phase, the fibroblastic (proliferative) phase and the scar maturation (remodeling) phase. Treatment should always match the phase of tissue healing as this ensures the most beneficial treatment outcome.

The most severe injuries are caused by a failure to adhere to safety measures as well as (in South Africa) unskilled or untrained workers who handle sophisticated and dangerous equipment e.g. presses, angle grinders.

Question: Do you have any general advice you could give to a person whose profession can make him/her prone to repetitive strain injury, particularly in the arm and hand?

Ulrich Mennen: The concept ‘Repetitive Strain Injury’ should be clarified first.

An article which I published in the South African Orthopaedic Journal in November 2000 setting out the viewpoint of the South African Society for Surgery of the Hand, lists some of the terminology that is used for this so-called condition. The debate about the usage of the term has been raging in industrialized countries, especially Britain, USA and Australia for quite some time.

Our stance in South Africa is:

• Work related injuries naturally do happen. The clearest form is an injury on duty. These conditions should obviously be prevented and compensated.

• Certain work activities aggravate symptoms. Any type of activity such as sport, home activities and work could aggravate an underlying condition or disease, which is not necessarily related to the work situation.

• Most of the aggravated symptoms could be relieved by conservative management, hand therapy and custom-made splints, as well as improvement in the ergonomics of workstations and the work environment. [Helge: I agree]
  

• The emphasis should therefore be to prevent the aggravation of symptoms, rather than the compensation of symptoms, which is based on a vague diagnosis.
  
  
• Since prevention involves inspection of workstations and work environment, occupational therapists and especially hand therapists with an occupational therapy background, could do the necessary changes and recommendations. [Helge: I've spoken about this with physiotherapists and they agree based on practical experience]
  

As an example let us look at the common carpal tunnel syndrome. If the propensity exists for the carpal tunnel to be restricted in size (and there may be many causes for this e.g. gout , previous injury , hormonal changes , rheumatoid arthritis , normal age related wear-and-tear), then any repetitive activity such as typing may cause some swelling , which will result in median nerve compression , in turn causing ischemia (reduced blood flow) which then produces the typical symptomatology. Add to this the unphysiological functional position of wrist flexion while typing, and you have the perfect recipe for median nerve ischemia.

The same person will also develop Carpal Tunnel Syndrome if she were to knit or sleep with her wrists in flexion. Her work has only aggravated the condition. Surely the employer cannot be held responsible for the narrow carpal tunnel. Unfortunately, many interest groups (such as lawyers, trade unions etc) insist that the employers compensate these diseases. In South Africa fortunately we have resisted the demand by these interest groups to label our patients with unscientific diagnoses and subsequently force employers to pay compensation.

Question: What advances in hand surgery and hand therapy make it possible for people suffering from RSI to recover from their injuries and rehabilitate fully.

Ulrich Mennen: It is most important that a firm diagnosis is not made on vague symptoms or signs. Once the patient has been labeled with a diagnosis, it is virtually impossible to get rid of this diagnosis. The diagnosis should be based on firm clear scientific evidence. Furthermore, it is also important not to blame the work situation for an ailment if a direct link cannot be proven, for example such as an acute injury. Having said this, it is well recognized that certain conditions can be aggravated by inappropriate working conditions, and for this reason it is important that a survey should be done of the work situation and ergonomic recommendations be made by a qualified hand therapist with an occupation therapy background. Hand therapy has made huge strides in managing the symptoms and signs of work related disorders. The biomechanical understanding, as well as physiological basis of the tissue response to injury, is much better understood nowadays. Many effective modalities are available to address these conditions. Patients should be referred only to qualified hand therapists and not indiscriminately to ‘physiotherapy’.

Professor Ulrich Mennen has a private hand surgery practice in Pretoria, South Africa. He is head of departments of orthopaedic surgery and hand and micro-surgery at the Medical University of South Africa, MEDUNSA. He is a member of the SA Society for Surgery of the Hand, SA Orthopaedic Association, SA Society for Hand Therapy, SA Assocaition for Occupational Therapy and executive council member of the International Federation of Societies for Surgery of the Hand. His research areas of interest include bone healing and internal fixation, nerve suture (end-to-side-technique), moist wound management and tendon transfer.

Added this by the request of professor Ulrich Mennen:

“Nerve conduction studies may be helpful only in certain cases of nerve compression syndromes eg. Carpal tunnel syndromes. This is because it has been shown that this type of special investigation unfortunately is not very sensitive and can result in false positive or false negative values. We rely more on high definition sonar , which shows the exact area of compression and it can measure the exact diameter of the nerve as well . Furthermore, sonar can be done ‘dynamically’ ie. by flexing muscles through which a nerve passes, or flexing joints eg. the wrist, kinking of the nerve can be observed accurately.”

HELGE: Very interesting! I'd like to add all necessary links and references to this blog posting. What could we at Mediracer do to provide a focused occupational health service to dentists. My understanding is that the high-frequency vibration is one of the causes to "Hand Arm Vibration Syndrome" (HAVS) and carpal tunnel syndrome (CTS). I'd also like to suggest that someone from Mediracer vists you, Marita Kritzinger, to provide an hands-on demonstration of how easy to use the Mediracer is.

Background about Dental Learning Hub: Editorial Director Marita Kritzinger wrote me an email about a group of "crafts people" that have the potential to develop RSI and or CTS. I'd not written about dentists and carpal tunnel syndrome a single time before her email. Now there are several postings about this subject.

Please, send your comments. I'd like to see you folks discussing this posting.

Cindy McCain Sustains Minor Hand Sprain - Politics News Story - WDIV Detroit

Cindy McCain Sustains Minor Hand Sprain - Politics News Story - WDIV Detroit: "Cindy McCain Sustains Minor Hand Sprain."

Supporter Squeezed McCain's Hand Too Much, Spokeswoman Says. Politics is hard work.

• [NEWSVINE: Cindy McCain Sustains Minor Hand Sprain]
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• [RSS] [PRINT: Cindy McCain Sustains Minor Hand Sprain]
• [EMAIL: Cindy McCain Sustains Minor Hand Sprain]

Republican Sen. John McCain's wife has been treated for a 'minor sprain' after someone at a campaign event in Michigan shook her hand firmly.

A campaign spokeswoman said Cindy McCain left the West Bloomfield, Mich., campaign event Wednesday for X-rays at a local hospital after an enthusiastic supporter squeezed too much.

McCain's wife has had previous surgeries for carpal tunnel syndrome and the handshake exacerbated the condition.

Cindy McCain was traveling with her husband as he planned to attend three Oakland County fundraising events Wednesday, reported WDIV-TV in Detroit. He'll also meet with reporters at the Townsend Hotel in Birmingham, a site of one of his fundraisers."

Helge: I've been writing about work ergonomics as a way to avoid hand sprain, carpal tunnel syndrome, and / or RSI (Repetetive Strain Injoury). The supporters should bow in front of the candidates like in Japan ;)

Wikipedia about RSI:

A repetitive strain injury (RSI), also called cumulative trauma disorder (CTD), occupational overuse syndrome, or work related upper limb disorder (WRULD), is any of a loose group of conditions resulting from overuse of a tool, eg. computer, guitar or knife, or other activity that requires repeated movements. It is a syndrome that affects muscles, tendons and nerves in the hands, arms and upper back. The medically accepted condition in which it occurs is when muscles in these areas are kept tense for very long periods of time, due to poor posture and/or repetitive motions.

It is most common among assembly line and computer workers. Good posture, ergonomics and limiting time in stressful working conditions can help prevent or halt the progress of the disorder. It is also a problem for guitarists who play with very tensed muscles.^{[citation needed]} Stretches, strengthening exercises, and biofeedback training to reduce neck and shoulder muscle tension can help heal existing disorders.

Mediracer is an alternative method for CTS diagnosis.

Hand Surgery Carpal Tunnel Release

Here is a YouTube video about carpal tunnel surgery and comments from people and patients.

guthixclauus (3 months ago)
my hand is feeling number, and its hard to bend my fingers. My mom says its carpal tunnel. Will I get surgery? And can I stop it from happening before my hand gets bad? Msg me someone...

Helge: We should talk more about early diagnosis and also about alternative treatments.

swtgal125 (3 months ago)
Wow, my hand does feel numb at times, do you think i have this? Please reply...

Helge: Did you visit a doctor? How about nerve conductivity testing?

o2demand (3 months ago)
Excellent clinical audio and video lectures.

Helge: The video is good, yes!

BIGmuzza46 (3 months ago)
CTS does not need surgery in most cases - what is effective is deep tissue massage releasing inflammation from muscle and tendons of the forearm and hand.

Helge: A masseur told me that we should watch our working style. Take a look in the mirror what positions you're taking during your working day. It's not possible for everybody, but computer freaks, barbers, office workers, assembly line workers, welders, etc. can check and adjust accordingly.

Haseeb2 (3 months ago)
The surgery is waste of money and time. Once the surgeon goes in and slices and dices, you'll never be the same. Your hand will never be at 100%.

Helge: The diagnosis should be made before it's too late.

zatch10013 (4 months ago)
Speak for yourself , I'm an advanced guitar player & just had the surgery on my fretting hand. Mine fucking hurt real bad! its getting better but now that i got the green light to start playing again my pinky and ring finger are quite sore & the pain medicine doesn't help. No numbness anymore but its going to take awhile for those two fingers to get solid again, I'm still fast but but when i do legato runs, that pinky feels like it did when i first started playing. But yeah, the surgery hurt bad to me.

Helge: Hope you will be able to play.

nicthekoch (4 months ago)
is it easy to get carpal tunnel for a person who uses a computer a lot a day? (3-4+ hours) and also, does age or gender(im 13, male) affect the risk of getting carpal tunnel? Plz reply :)

Helge: Research doesn't support this, but take care of your work site ergonomics. Take a look in the mirror, how you're positioned in front of your computer. There is a lot of good advice on Internet.

ShunShunRikka6 (3 months ago)
Yes, you will get carpel tunnel if you use the computer a lot. Females are most likely to get it because their carpel tunnel is smaller. I don't know anything about age though. I'm around that same age and I have CTS in both hands. If you value your hands cut down on your computer time!

Helge: It's true what you say about women, but we shouldn't generalize the computer as a cause for carpal tunnel. But I welcome more arguments about this matter.

SpraxIAKS (3 months ago)
Yeah. Though daily exercise and such will help prevent it. As I haven't been doing that, have been getting the symptoms lately. Though just normal things help prevent it. So don't play WoW. You'll get it then. :D

Helge: Good point that "daily exercise and such will help prevent it!"

Job safety in the fishing industry and CTS

Fishing is fun when you are doing it for leisure. But like any work, when you have to do it for work and to earn money, then fishing and fish processing does have its vulnerabilities.

Wrist and hand pain are common in the Fishing industry. Processing jobs tend to be far less dangerous than fishing jobs.

A found a web page explaining that in Alaska the most common problems were:

• cuts, fish and jellyfish poisoning,
• machinery-related injuries,
• exhaustion, flu and colds,
• carpal tunnel syndrome,
• and alcohol and drug-related problems

I guess, some of these the problems are similiar around the globe. There are lots of jobs in agriculture and the fishing industry where hand pains are a potential threat to the workers health.

Processing work often involves repetitive hand and wrist movements that can result in forearm and wrist pain. At its simplest, the processing industry involves gutting fish. Most industry employees use knives to do this; more than a few cut themselves. The best ways to avoid cuts are to pay close attention to what you're doing and to wear protective gloves.

If you do cut yourself, bring it to the attention of your supervisor immediately. The carpal tunnel syndrome is another matter. How well do employees and the management know about CTS? What could be done to avoid it? Are workers in the processing industry screened or tested to find hand and wrist problems at an early stage?


Diagnostics of CTS

There are no international golden standard criteria for diagnosing CTS. Typically, the diagnosis is made based on each patient’s typical symptoms, clinical findings, and neurophysiological tests.

In Finland, neurophysiological tests are always done before deciding on surgery. ENMG test for suspected CTS cases is the most common or the second most common single test in both public and private laboratories (20-40% of all EMG tests).

Agricultural Safety and Health Program

In United States, the Maine Agricultural Safety and Health Program performed a needs assessment to determine the health and safety concerns of Maine's fishing community.

Information for the assessment was obtained from clinicians, focus groups of wives of fishers, and government agencies. Recommendations include, in part,

• increasing surveillance,
• reducing barriers to access,
• increasing clinicians' knowledge about the fishing industry, and
• fostering collaboration between agencies providing health and safety information to fishers.

CTS

Hand and wrist problems and fatigues are common complaints among processing workers. For most people the discomfort is mild and only temporary, but for a few it can develop into a more persistent and painful malady called carpal tunnel syndrome.

The symptoms of carpal tunnel syndrome are pain in the wrist, which may seem to shoot up into the forearm or the palm of the hand, and numbness or tingling in the fingers and hand.

The pain is caused by swelling of the tendons and other tissue surrounding the main nerve serving the hand. Left untreated, it can become a serious problem. If you experience excessive pain in your wrists notify your supervisor.

Often people can use wrist braces which alleviate the strain on your hands, or you can be shifted to a job requiring less stress on their limbs. If the problem persists the employee should seek medical treatment, since left untreated carpal tunnel syndrome can cause permanent damage.

I found a Journal of Agromedicine

The Journal of Agromedicine examines evolving trends in emerging biotechnology and the globalization of agriculture, and the resulting political/economic effects of these trends upon the agricultural workforce and rural communities. Topics of special interest examined in the journal include:

• occupational health and safety issues in agriculture
• zoonotic and emerging diseases
• food safety
• health education strategies
• public health

The impact of these changes upon the health and safety of the agricultural workforce, rural communities, and consumers of agricultural products are discussed in this journal.

Don't Fish yourself a carpal tunnel during the vacation

It's summer time, vacation time, just when the living is easy.

Found this video showcasing how to avoid carpal tunnel syndrome while fishing.

This video includes the Turboset arm support to support your hand.

The music is also fun. I don't know if this is a serious problem. But if fishers can get it, how about golfers and tennis players?

The nick "FertilityStar" comments the video.

"This Turboset thing looks great!As soon as I start fishing again,I will be ordering one for myself and get one for my Dad. The hook set and pulling up big fish will be easy. My Dad always wanted something like this, but up until now it did not exist. Saw the web site and there is lots of cool stuff there. This old school rap is cool too!!! Made in US is good too."

Any comments to fishers getting carpal tunnel?

Carpal Tunnel Writing and Wellsphere

Thanks, Geoffrey W. Rutledge MD, PhD, It's always nice to know if someone is "reading" or "listening".

"Healthcare organizations face unprecedented financial pressure to reduce their costs of delivering care. At the same time, demand for improved quality and safety of patient care has never been greater. The Institute of Medicine reported that medical errors cause up to 98,000 deaths per year," writes Rutledge on this page (First Consulting Group).


Hi Helge,

I was searching for the best medical bloggers when I discovered your blog at http://carpal-tunnel-syndrome-cts.blogspot.com/. I want to tell you I think your writing is fantastic -- I really liked your post on , “Scissor guards against carpal tunnel syndrome”. My name is Dr. Geoff Rutledge, and I've taught and practiced Internal and Emergency Medicine for over 25 years at Harvard and Stanford medical schools. I'm also the Chief Medical Information Officer at Wellsphere (www.wellsphere.com), where we are building a network of the web’s leading health bloggers, and I think you would be a great addition.

Wellsphere is a fast growing, next-generation online platform that is revolutionizing the way people find and share health and healthy living information and services. Our platform connects millions of users with the valuable insights and knowledge from health leaders and knowledgeable writers like you.

We are now launching a new health community on Carpal Tunnel Syndrome, and I would like to invite you to be a featured blogger for this community. By joining our network of hundreds of leading health and healthy living bloggers, you will be in great company, and will benefit from exposure to the expanded audience of the Wellsphere community. When you join, we also will feature you on our very popular WellBlog (http://www.wellsphere.com/blog.s), with a link back to your blog.

We will republish the postings you’ve already written for you (through your RSS feed), and feature them not only on the Carpal Tunnel Syndrome community pages of the site, but also within a new dynamic magazine-like Wellsphere360 section, where we give users a comprehensive view of expert information, news, videos, local resources, and member postings on topics you write about. Your profile page on the site will give you special status as a featured blogger in the Carpal Tunnel Syndrome community. If you are an active contributor, we also will feature you on our homepage at www.wellsphere.com.

By connecting to the Wellsphere platform, you will greatly expand the audience for your postings and attract additional readers to your blog. Also, your posts will link back to your blog, so you will benefit from Wellsphere's high ranking and large readership interested in your topic, which will give you more traffic, additional relevant audience, and a higher ranking for your blog.

If you would like to be a featured blogger in the Carpal Tunnel Syndrome community, just send me an email to Dr.Rutledge@wellsphere.com. You can see a sample of a Wellsphere360 special section at http://www.wellsphere.com/Wellsphere360/diabetes-type-2.htm

Good health,

Geoff

--

Geoffrey W. Rutledge MD, PhD

Chief Medical Information Officer

Wellsphere, Inc.

http://www.wellsphere.com

About

Dr. Rutledge joins FCG as vice president and leader of the Clinical Transformation practice. He served as vice president of Business Development and Clinical Informatics at WebMD, and executive director of WebMD, Canada. Previously, Dr. Rutledge co-founded the Emergency Medicine Program at Harvard Medical School's Beth Israel Deaconess Medical Center. He holds Doctorates in Medicine from McGill University and in Medical Information Sciences from Stanford University and is board certified in Internal Medicine and Emergency Medicine. "FCG's pioneering work in patient safety, evidence-based clinical practices, organizational redesign and systems implementation has given our team a unique skill set to deliver services that increase the efficiency of the care delivered by our client organizations. I am delighted to lead this FCG team in the creation and implementation of exceptional, custom-tailored clinical-transformation services," said Dr. Rutledge.

About First Consulting Group

FCG is a leading provider of consulting, technology, and outsourcing services for health-care, pharmaceutical, and other life-sciences organizations throughout North America and Europe. The firm's services increase clients' operations effectiveness, resulting in reduced costs, improved customer service, enhanced quality of patient care, and more rapid introduction of new pharmaceutical compounds. For more information about FCG, see www.fcg.com, or call 800-345-0957.

Carpal Tunnel Syndrome Treatment

Carpal Tunnel Syndrome Treatment: I came across"Non Surgical Treatments for Carpal Tunnel" and would like to ask Veijo Lesonen about alternative treatment and therapy methods.

"Muscular Skeletal Physiologists and Clinicians have been using massage therapy and specialty elastic tapping for decades to enhance the body’s natural healing process, relieve pain, swelling, inflammation and numbness caused by soft tissue injuries such as CTS to successfully avoid invasive surgical procedures."

There is a lot of information about alternative methods on the internet. At what stage of the CTS illness is massage therapy effective?

"People often ask, 'Why should I have surgery to solve a problem with inflammation in my joint?' This is a good question. There are so many well developed and effective alternative therapies that can solve the problem of inflammation without resorting to, for instance, Carpal Tunnel Surgery. These techniques improve blood circulation and lymphatic fluid exchange which results in more rapid regeneration of damaged tissue at the cellular level and dispersion of fluids contributing to swollen fascia tissue. These Carpal Tunnel Treatments have been proven to relieve pressure on the Median Nerve and eliminate the pain and symptoms of CTS."

1. Is surgery the only alternative?
2. What are the best alternative therapies?
3. How should inflammation then be treated?
4. What changes should be made to working conditions?
5. Rapid regeneration of damaged tissue at the cellular level?

Me and my operation: carpal tunnel syndrome | Mail Online

Me and my operation: carpal tunnel syndrome | Mail Online: "Me and my operation: carpal tunnel syndrome by ANGELA BROOKS, Daily Mail.

I've been looking at articles about carpal tunnel syndrome in press and other medias. Below is a story from the British Daily mail. I write my bulleted comments between the lines.

The NHS undertakes 37,000 operations a year to tackle carpal tunnel syndrome - a condition in which the wrist nerve becomes compressed.

Here, Julie Jewitt, 40, a hospital theatre sister who lives with her partner and two children in Dewsbury, West Yorkshire, tells us about her operation and her surgeon explains the procedure.

The patient says:

• Julie Jewitt found carpal
• carpal tunnel operation
• cured her hand discomfort

Strange sensations in my left hand started seven months into my first pregnancy seven years ago. I had pins and needles in my fingers which woke me up at night.

• Pregnancy
• Pins and needles in fingers "woke her up at night"
  

When I woke in the morning, my fingers would feel completely dead, but once I was up and about, that feeling would fade.

• Fingers feeling dead
• The feeling faded
  

I had a vague idea what it was, so I put off going to see my GP for two years. When I did finally go, he immediately told me he thought it was carpal tunnel syndrome and sent me for tests.

• Two years before visiting her GP (General Practitioner)
  

I knew a carpal tunnel release operation would combat the problem, but it was a matter of plucking up the courage. I decided I had to take action when it started to affect me at work, so I arranged an appointment with hand surgeon Douglas Campbell.

• Operation would cure
• Getting the courage
• Affecting work
  

He said it would be done as day surgery under local anaesthetic. They would wrap a tourniquet around my arm and then make an incision in my wrist, which would relieve the nerve under pressure.

• Surgery
• Local anaesthetic
• Incision in her wrist
  

I arrived at the hospital midmorning. Mr Campbell came along about 15 minutes before the operation and gave me an injection of local anaesthetic.

• There is nothing about the diagnosis
• Did she go direct to the hand surgeon?
• How about ENMG or mediracing?
• How about ultrasound?
  

I was very nervous walking to theatre, partly because I was among colleagues and partly because, as a nurse, you feel as if you're there under false pretences. At the back of my mind was the fear that they might find something else.

• The patient is a nurse
• Fear for finding something else
  

Mr Campbell provided a running commentary of what he was doing and it took no more than ten minutes. I left theatre with my arm bandaged and in a sling.

• The operation took 10 minutes
  

The bandage was taken off a week after the operation and the stitches were removed four days later. The scar is so small, it's hardly visible. My sleep is back to normal - my only regret is not having the operation done sooner.

• Bandage was taken off a week after the operation

InterOpNurse

InterOpNurse: "InterOpNurse: A Nurse working in the field of Healthcare Information Technology. Chronicling my experiences as I go through the different stages and struggles of software maintenance and implementation. Technology tools for nurses must adapt to their workflow and be configurable and always available. Technology will continue to positively impact nurses, decreasing their workload, helping them deliver proactive care and supplying critical information by unit or hospital-wide. I hope to first hand go through this journey of change as I look for tools designed for and by nurses; a personal journey to see how technology can meets nurses' high needs and expectations."

Hello InterOpNurse, I see that we're connected through Jaiku. Let me tell about a new project where Educational Video has a central role. New things can be done in the blogosphere. Take a look at the open project launch at Digital Villages. More will be told in Jaiku, Twitter and Pownce.

@InterOpNurse, I blogged about you in CTS and would like to make you aware about the new video on-demand project. I made a decision about it today. It has been on my mind for quite some time but I guess this is the day when I finally came down to the decision. This is a long term project and we want to embrace global participants.

I'll ask more people to participate soon...This is an educational project. It's about knowledge transfer. Nothing complex, no rocket-science, but we can save a lot of time and money...

World Health Care Congress 2008

The 4th Annual World Health Care Congress 2008 is organized 10 - 12 March 2008 * Estrel Convention Cneter - Berlin, Germany.

1. The Who's Who in European Health Care
2. A three day networking opportunity
3. Practical information and actionable programs
4. Best practice presentations form
   - Germany
   - United Kingdom
   - Switzerland
   - Spain
   - Italy
   - France
   - The Netherlands
   - Sweden
   - Denmark
   - Belgium
   - Canada
   - United States
   - (nobody from Finland - How about Mediracer next time?)
   

Over 600 industry and governmental leaders from more than 50 countries reconvene to share the best practices for improved delivery and outcomes in Europe.

Four focused summits address critical issues in

• Chronic Disease Management: reengineering care, empowering patients, measuring and improving ROI, promoting health and preventing chronic disease
• Implementing Health IT: implementing eHR - challenges and applications, improving work flows and integrating care, Telehealth and remote monitoring
• Improving financial performance: cost-effective care, pay for performance, balancing public and private contributions, controlling costs
• Improving Quality and Patient Safety: designing implementation strategies, leveraging IT, closing the gap between evidence an practice

Participating thought leaders include:

1. health ministers
2. leading government officials
3. hospital directors
4. IT innovators
5. decision makers from private and public insurance funds
6. pharmaceutical and medical device companies
   
7. health care industry suppliers

With more than 28 hours of Summit sessions over 3 days, the 2008 Congress features even more practical information, actionable plans and implementation case studies.

Interactive Sessions are an unique opportunity for attendees to interact and to discuss specific challenges with Summit presenters. In 2008 over 8 hours of interactive Sessions were added to the programme to immediately follow every summit session. After their presentations, Summit speakers remain on stage to form a panel for 40 minutes of Q&A with the audience.

Facilitated networking sessions will take place in the networking/exhibit area, where coffee and refreshments will also be served. Delegates can request and schedule meetings with other attendees during the session.

The 2008 Congress launches a NEW Summit dedicated to public and private payers focusing on reforming health insurance and improving financial performance.

New executive seminars for:

1. Chronic care incentives for payers, providers and patients
2. Clinical transformation - Leveraging clinical information to improve outcomes
3. Pricing and reimbursement - Balancing freedom of choice and sustainable growth
4. Innovation vs Cost - Strategies for technology assessment
   

Chronic conditions can represent up to 70% of a country's total health expenditure. With ageing population and increasing number of chronic patients, European health systems are embracing chronic care as one of the most promising opportunities to improve clinical and financial results.

Organised under the high patronage of the European Commission, the European Leadership Summit of Chronic Care is the forum where government and industry leaders share successful initiatives and global best practices in implementation of chronic disease management programmes.

Mediracer is an innovative Diagnostic Method and could very well fit into this programme and context. I decided to blog about he WHCC 2008 to get a better understanding of what happens in the health care industry on an European / Global level. Mediracer could take a niche role in a Summit / Expo / Congress like this.

• CTS resulting from a chronic disease (diabetes)
• Carpal Tunnel Syndrome Diagnostic with Portable Mediracer combined with Telemedicin
• Mediracer as a cost-effective money saver
• Mediracer best practices in occupational health
• Telemedical support and remote diagnostic support of field working Mediracer teams

"Practical and relevant. The speakers go straight to the essential and the questions are concrete: what can we do with what we have?"
- Mike Leers, CEO, CZ, The Netherlands

Organizing Mediracer Occupational Health

I've been writing about CTS - Carpal Tunnel Syndrome diagnostics with Mediracer since late September 2007. A part of my blogging has been to search and digg for patients, health care professionals and occupational health personnel comments and advice about the syndrome.

It has been a learning process performed in English, Swedish and Finnish. Understanding the causes of the problem, reading health care blogs, looking into statements from medical professionals around the world.

1. The problem is global
2. The diagnostic methods are standardized
3. A remarkable amount of information is available
4. How can we communicate the idea that there is a faster and more economical diagnostic method?
5. How can we get health care professionals to take action?
6. Are we facing a top down organizational task to get enough mediracing points?
7. How about patient organizations?
   

However, for the individual patient, the knowledge about a mobile diagnostic service doesn't help much if we can't motivate e.g. health care professionals to organize the diagnostic service close to patients suffering from CTS and staying in line for months to get their hands diagnosed?

It's not enough to get out with the message. We've to get the Mediracer services to the clinics and health care organizations. Information alone isn't a solution to the problem. How can we accomplish it?

I think, we need to give specific advice on how mobile services have been arranged in Finland, Sweden, UK, Estonia, Denmark.

Building a budget for the Point of Care Mediracer CTS service...

1. The price of Mediracer
2. Price of electrodes and consumables
3. Salary of nurse doing the mediracing
4. How many CTS diagnostics per hour? and a working day?
5. How many potential patients should be in the service area?
6. Telemedical diagnostic support
7. How is the telemedical diagnostic support organized abroad?

I'll build examples starting from occupational health services... What is your advice? Should we create a small business plan for a regional Mediracer CTS Center?

• I need new pictures
• I want to do an on-lien interview
• Move from the general CTS profiling to specific presentation of Mediracer
• Blogging about the Features - Advantages - Benefits
  

Kid inventors get creative with Bubble Wrap - Innovation- msnbc.com

Kid inventors get creative with Bubble Wrap - Innovation- msnbc.com: "TRENTON, N.J. - It's the stuff that many people find addictively fun to pop after opening a fragile package.

Max Wallack, 11, works his computer in Natick, Mass., while he wears wrist cushions for carpal tunnel syndrome sufferers that he made from Bubble Wrap. Wallack said he spent months creating Bubble Wrap-filled socks with elastic and fabric fastener to tie around the wrists of people with carpal tunnel syndrome. He asked his grandmother to try out his prototypes.

Helge: Nice to see young inventors working with CTS supporting devices.

"I wanted to help her because she had all these cumbersome splints, things that didn't help at all," Wallack said. "Before she had surgery, she was wearing it and it usually helped."

Helge: Helping grandmother.

But for a group of young inventors, Bubble Wrap is more than something to stomp on, it's a source of inspiration. To 11-year-old Kayla Weston, it's a building material for shock-absorbing flooring for dancers; 11-year-old Max Wallack used it to create wrist cushions for carpal tunnel syndrome sufferers.

Helge: Young inventor!

'What's better than resting on air?' asked Wallack, of Natick, Mass.

Wallack is among 15 semifinalists competing in the second year of the Bubble Wrap Competition for Young Inventors, sponsored by Sealed Air Corp., the Elmwood Park, N.J.-based creator of the packaging material. More than 1,400 entries were received from students in 39 states.

The contest, administered by the Akron, Ohio-based National Museum of Education, was promoted in schools across the country, and was limited to students in grades five through eight. Contest entries had to be original inventions that incorporated the use of clear Bubble Wrap brand cushioning. Company officials say it's possible some of the student inventions could be used to create new products."

Helge: Congratulations Max Wallac, 11 years, for a great work! Innovators of all ages are needed to help and cure people with Carpal Tunnel Syndrome.

Overview Leicester Carpal Tunnel Service

Sunday, September 16, 2007

This was one of the first blog post concerning Mediracer. Wanted to take it up and back to the front page.

Three and a half years ago the Carpal Tunnel Service at Leicester was approached by the Finnish Government via the Department of Health seeking help with a new piece of Neuro physiology equipment that it was hoped would speed up access to NCS and would reduce waiting times and cost less to perform.

The equipment was easy to use and could be operated by a nurse or any healthcare worker trained in its use. More information can be obtained by contacting:

malcolm.clarke@uhl-tr.nhs.uk
Phone UK 07894 833310

The University Hospitals of Leicester

A study made in Leicester in February 2007 . I'll write more about this when I've a chat with Veijo Lesonen. Details to be found in powerpoint presentation. Download ppt.

Delivering the 18 week Patient Pathway

• 17th July 2007 by Malcolm Clarke
• Can it be done?
• By whom?
• When?
• How?

The Leicester Experience

• Overview Leicester Carpal Tunnel Service
• Traditional ways of working
• The Leicester Experience
• Traditional NCS in U.K.
• New Method of NCS
• Anglo-Finnish Collaboration
• Results /Audit
• Nurse Operating

Overview Leicester C.T.Service

• Nurse Led service
• 850 Operations per year
• 1100 New patients
• 1200 Follow-ups
• Average back to work post op 4 Days
• 12wks from referral to discharge

Traditional Ways of working

• Totally Ineffective
• Costly (wasteful Tax payers Money)
• Overkill on Resource (Theatre, Day Bed)
• Overuse of Manpower (Doctors, Nurses,Admin)
• Not Patient Friendly (Intimidating not Natural)
• Time Consuming ( Too Many Handoffs)

The Leicester Experience

• Highly Effective
• Value for Money (No Bed, No Theatre)
• Minimum Resource (Treatment Room )
• Small Manpower Resource (3People)start to finish
• Extremely Patient Friendly (Non Threatening)
• Time Effective ( Fast, Efficient Patient Pathway)

Savings to be Made being Effective

• No Bed £250 per half day
• Theatre £400 per half hour
• N.C.S £160 per Test

Traditional N.C.S. U.K.

• 16-20 Week Wait and can be much longer
• Cost between £120-£400 per test
• Referral to different hospital
• Not nice test for patient
• Long Referral to Discharge
• Totally Unacceptable

Anglo-Finnish Collaboration

• Leicester-Oulu
• 65 Patients
• All Traditional and Mediracer Tests
• 61 Operations for CTD
• 6mth Follow-up Mediracer (Sept 2006)

Results submitted for Publication

• Results/Audit Nurse Operating
• 3500 Operations
• 6000 New Referrals
• 8000 Follow-ups
• 97.8% Success Rate
• 2% Complication Rate
• High Patient and GP satisfaction rate

New Method of NCS

• No Wait (Test at 1st Appointment)
• Costs about £25-£30 for disposables
• No Referral to other Hospital required
• Comfortable for patient
• Results at 1st Appointment
• Treatment Discussed

Outcome

• Completion of Whole Treatment inside the 18 week timeframe.
• Guaranteed For all Patients
• Happy Patients/Relatives/Clinicians
• Shorter Waiting Lists
• Quality deliverance of care
• Hospitals able to tick the box
• Government achieve projected goals and claims

Early return to work

• £76.40 per day CBI Figures
• Sick pay, Lost Productivity,Loss of Tax
• 100 patients/ 75 working age
• 6 weeks off work/ 2 weeks off work
• £240,660 / £80,220
• 42,000 Ctd per year = Savings
• £67,384,800.00 one condition
• Smarter Thinking + Early return to work
• = Savings of £91,114,800.00 Minimum for the condition of Carpal Tunnels alone

The Future

• Patients treated in a one-stop Pathway
• No limit on patients treated
• No making patients wait 18 weeks
• Money saved invested back into services
• Safe guarding the NHS

Summary

• Clinically Led -Patient focussed services
• Nurse Led/Others from referral to discharge
• Large input on patient Comfort/Satisfaction
• Do use Cost Effective methods for Tests and Surgery
• Do not use theatres ( Usually £800 per hour)
• Do not use beds ( Usually £250 per half Day)
• Early Return to Work+Change of Practice could save a minimum of £100 Million

Carpal Tunnel Syndrome Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com

Helge: I wanted to find a podcast about Carpal Tunnel as an example for future podcasts. Take your time and listen to this one. Her is one.

Doctors answers to viewer questions | vol. #2

Causes Of Carpal Tunnel Syndrome

Dr. William Shiel, Chief Medical Editor of Medicinenet.com, discusses Causes Of Carpal Tunnel Syndrome

Listen now to Dr. William Shiel discuss Causes of Carpal Tunnel Syndrome (MP3 1:59min 947KB)

The following is a partial transcript taken from this audio broadcast. A MedicineNet viewer asks: Dr. Shiel, can carpal tunnel syndrome be caused from typing on my keyboard all day? Well, the answer to that would be 'yes'. Carpal tunnel syndrome is an irritation of a nerve that passes through the wrist...

Listen to the entire audio segment of Checking Your Pulse on Causes of Carpal Tunnel Syndrome in this edition of / Doctors on Health /.

Carpal Tunnel Syndrome Causes, Diagnosis, Symptoms, and Treatment on MedicineNet.com: "Carpus is a word derived from the Greek word 'karpos' which means 'wrist.' The wrist is surrounded by a band of fibrous tissue which normally functions as a support for the joint.

The tight space between this fibrous band and the wrist bone is called the carpal tunnel. The median nerve passes through the carpal tunnel to receive sensations from the thumb, index, and middle fingers of the hand.

Any condition that causes swelling or a change in position of the tissue within the carpal tunnel can squeeze and irritate the median nerve. Irritation of the median nerve in this manner causes tingling and numbness of the thumb, index, and the middle fingers, a condition known as 'carpal tunnel syndrome."

New York Carpal Tunnel Lawsuit Attorney New York City Cubital Tunnel Injury Lawyer NY Court Typing Butcher Accident Back

New York Carpal Tunnel Lawsuit Attorney New York City Cubital Tunnel Injury Lawyer NY Court Typing Butcher Accident Back: "Any injury caused by repeating the same motion a high number of times is a repetitive stress injury.

Carpal tunnel syndrome and arthritis are not only common problems in office environments, but also are experienced by butchers and electricians. An office worker may experience a computer injury caused by hours of typing at the keyboard or using a mouse.

If a desk chair is not supportive or adjustable it may cause back strain or a neck injury. In addition to workers' compensation benefits you may be entitled to a personal injury claim against a manufacturer."

Helge: Early detection is important.

Mediracer Point of Care for Carpal Tunnel Syndrome Diagnostic

Veijo, Thanks for the new broschure. To see the English version click the picture. The pdf-format is about 1 Mb. You can read it with an Acrobat reader.

Collaborative Research Begins

During the meeting in November 2005 we demonstrated the possibilities of Mediracer to our English guests as well as Malcom and and Orthopaedic Consultant Timothy Green. They wanted to familiarize themselves in more detail with the suitability of Mediracer in their operations.

This is why we founded the Anglo-Finnish CTS Study Group and convinced the ethical board of Leicester hospital to approve our research plan. The first part of the research was carried out in February 2006 and the follow-up in September 2006.

Helge: Have a great trip to UK. I wish you luck with the new NHS-project! The Bluetooth Mediracer is great. You're really moving into wireless. Mediracer NCS Device (Nerve conduction study), first in the world using BT-technology! Great!

Mediracer training at Orthopedic Clinic in Tarto, Estonia

Thanks Veijo Lesonen for your message and pictures from Tarto, Estonia: Orthopedic professionals from the university town of Tarto are in training to learn the use of Mediracer point of care instrument.

Medircacer is a small hand-held unit. General practitioners', nurses, occupational health professionals can use the carpal tunnel diagnostic instrument after a short training.

It's not big like an refrigerator and doesn't cost 40 000 to 50 000 dollars what you have to pay for an ENMG instrument.

Mediracer comes with a much smaller price tag. Telemedical support is available to users who don't have a Specialist in Clinical Neurophysiology to analyze the results. For details, consult the Mediracer home page http://www.mediracer.com


Det är ingen stor apparat. Vi är ju vana vid at en ENMG utrustning har en volym av ett kylskåp och kosta 40 000 - 50 000 €. Medan Mediracer är ett bärbart instrument som kan användas bl.a. ut på fältet.

Tack Veijo Lesonen för bilder från universitetsstaden Tarto, Estland: Specialister från ortopedisk klinik utbildas i användningen av Mediracer "Point of Care" för diagnostik av karpaltunnelsyndromet.

Tervehdys Helge, Virossa Tarton yliopistokaupungissa totuutellaan Mediracerin käyttöön. t. Veijo

From: Lesonen Veijo | Subject: Mediracer

Dear Mare and Peeter, thank you for your time in Tarto. It was very nice to meet you. And Peeter, thank your for the lunch in a charming restaurant. I attach a couple of photos. I hope that we shall have an opportunity to meet again.

Best wishes, Veijo



Veijo Lesonen
Specialist in Clinical Neurophysiology

Managing Director
Mediracer Ltd.
Mobile:+358 40 5535917
Fax:+358 10 400 5011
www.mediracer.com

Massage by Jan » Need a massage?

Helge: Wanted to write about massage therapy in the context of Carpal Tunnel Syndrome, diagnostics, operation, healing and treatment.

I will also talk with a local occupational health nurse that works in Loviisa. Trying to figure out the need for Mediracer in a small town with a surrounding 20 000 population.

Massage by Jan is following me on Twitter and I'd like to ask if she came in contact with CTS-patients or clients in her work. She is recently graduated and might give an insight to how she as a therapist faces people with potential CTS.

I'll write more to this post when I've twittered about it with her. Congratulations for the massage license.

Massage by Jan » Need a massage?: "Jan: Licensed Massage Therapist 5:18 am It’s official! After waiting four long weeks, I received my New York State Massage Therapy Licensure Examination results yesterday in the mail.

I actually scored higher than I predicted as well, which was a pleasant surprise. I called all my friends and relatives to tell them the good news and got in touch with a few of my classmates who passed as well.

It’s a very exciting time for everyone, especially those of us who’ve been waiting to get our massage licenses since we graduated back in January.

Jan Wopperer, LMT.
I’m so proud."

• Name Jan Wopperer
• Location Buffalo, NY
• Web http://www.jannyg...
• Bio I'm a licensed massage therapist with a BA in Print Journalism. I drive a WRX when I feel like an American. Life is good.

She writes, "Many massage therapists bring their chairs into businesses and give massages for a morning or afternoon because it’s a good hands-on way to advertise themselves. Chair massage is a great way to introduce and educate people about massage, and it’s ideal for those who just need to relax and get some quick pain relief in their necks, backs, shoulders and arms. People who are uncomfortable with table massage often enjoy chair massage- it really is a treat, especially at the office!"

Helge: We've a friend in Rovaniemi who is doing this. I've to call him about work related muscle tension and how a therapist might spot a carpal tunnel syndrome.

Massage Techniques

Massage therapy can be a safe and highly beneficial approach for clients with CTS. At the least, massage is an excellent preventive measure that could reduce the advancement of CTS to a more severe stage.

Greetings! My name is Jan Wopperer, and I’m a Licensed Massage Therapist.

My schedule is very flexible. I’m available for massage appointments seven days a week between the hours of 8am and 8pm.

Please complete a client form and I will contact you.

My Training

I received my training at The New York Institute of Massage
in Williamsville, NY.

Courses Taken
Swedish Massage: 108.0 hours
Medical Massage: 108.0 hours
Modalities: 108.0 hours
Shiatsu: 108.0 hours
Anatomy & Physiology: 153.0 hours
Business Management: 18.0 hours
NY State Law: 4.5 hours
Heath & Hygiene: 76.5 hours
Upper Myology: 99.0 hours
Lower Myology: 99.0 hours
Neurology: 54.0 hours
Pathology 1: 54.0 hours
Pathology 2: 54.0 hours
Clinic Terms 1-4: 64 massages, 60 hours awarded

Overall Average: 95.353

Helge: I like the idea of Massage by Jan promoting her new practice with her own blog, using Twitter, Facebook and many other modern and interactive Social Media tools. How about therapists and private clinics in Finland? Scandinavia? Europe?

Her response: Hi this is an automatic email from TwitterMail with some new replies: @digitalvillages of course I'm familiar with CTS. I love to help people who have it as well- it's actually a very simple to treat with MT. jannygirl at 24-10-2007 23:56

Another response: wow, thanks for blogging about my blog! :c ) looks great on there too. my mom is so proud. Jan Wopperer / jannygirl.

Official Google Blog: Avoiding RSI and CTS

Digital Villages: Google takes RSI and Carpal Tunnel Syndrome seriously. It's a potential occupational health issue for companies where people do a lot of keyboard related tasks.

1. Programmers
2. Call Center personnel
3. Office personnel
4. Designers and innovators
5. Bloggers and Social Media users
6. Digital and Print Journalists
7. You name it...
   

Official Google Blog: Avoiding RSI: "Avoiding RSI 4/21/2006 02:05:00 PM Posted by Dr. Taraneh Razavi, M.D., Staff Doctor From time to time, a resident physician at Google headquarters weighs in with her thoughts on healthy living.

This is not medical advice, and you should check with your own doctor before pursuing any particular course of action. There is a Chinese saying that 'To go beyond is as wrong as to fall short.' In other words, how long can you tap on that keyboard or sit in that chair before you hurt yourself.

We’re not designed to remain as sedentary or perform the fine motor movements for the long uninterrupted hours that we have to do in so many of our jobs.

Evidence suggests that prolonged abnormal posture and repetitive movements contribute to neck, limb and back pain. These conditions are collectively known as overuse syndromes, or repetitive stress injury (RSI). RSI is no small matter.

It accounts for 34% of all lost-workday injury and illness — and costs almost $20 billion annually, according to the Bureau of Labor Statistics.

The National Academy of Sciences has concluded that an estimated $50 billion is lost by businesses every year from sick leave, decreased productivity and medical costs linked to repetitive stress disorders.

The Academy has published two reports since 1998 which directly link repetitive motion to workplace injury.

The damage sustained from RSI is due to structural changes in the muscle fiber as well as due to decreased blood flow. Nerves can also be involved.

The immobile tissue and surrounding inflammation compress the nerve which can cause numbness or tingling and eventually weakness if the nerve is damaged severely.

For those of you who need evidence, see this study on "Overuse Syndrome." In this study, biopsies were taken from hand muscles of injured and normal subjects, which demonstrated the structural damage in the muscle fibers and correlated the damage with the severity of the injury.

In another study, biopsies were taken from neck muscles, and reduced local blood flow was found in the injured areas. The greater the pain difference, the greater the reduction in blood flow.

Some of the most common RSI injuries are tendonitis and carpal tunnel syndrome (CTS). Work-related carpal tunnel syndrome now accounts for more than 41% of all repetitive motion disorders in the United States, says this study. And here's a telling title: "Hard work never hurt anyone: or did it?" -- it's a review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb.

So what should you do? The key to treatment is prevention. Research shows that injuries decrease and productivity increases when employers encourage stretch breaks and stress the importance of ergonomics. See for example this one at at Ergonomics Now.

Here are a few tips:

1. Breaks should be taken every 30-45 minutes for at least 5 minutes. If you need assistance there are free downloadable timers that will help remind you to do so.
   
   
2. Stretch your arms, hands, neck, and back during breaks. This yoga site demonstrates some exercises. Other sites are listed below.
   
   
3. Maintain posture alignment. Don't slouch on the couch with the laptop.
   
   
4. Work stations should be reviewed initially and with each office move. Adjust your chair, monitor, keyboard, mouse, laptop. Alternate keyboards and mice periodically.
   
   
5. Shift your gaze from the computer screen to the distance. And don't forget to blink!
   
   
6. Limit non-essential computer use. This may be heresy -- but do give the surfing, gaming, emailing, and text messaging a rest.
   
   
7. If pain occurs or persists, see your doctor, who may recommend wrist brace, ice packs, anti-inflammatory medication such as ibuprofen, cortisone injections, physical therapy, and most importantly, rest to allow healing. Don't procrastinate in addressing your symptoms -- the sooner you tend to them, the better off you are.

And finally, here are more sites that may be helpful:

• Safe Computing Tips
• Alternative Pointing Devices
• Alternative and Ergonomic Keyboards
• Harvard RSI Action
• RSI exercises
• RSI Page

Update: One more: Boston U.'s Ergonomics Self-Help Guide (Flash)."

Digital Villages: How are other high-tech and keyboard intensive companies viewing CTS? Do you know about:

1. Nokia
2. Microsoft
3. Yahoo
4. Forrester Research
5. SonyEricsson
6. Samsung
7. Apple
8. Cisco
9. And all the big Call Centers
10. Just to mention a few...