tunnel syndrome x3
I have noticed that the topic of wrist/arm pain has become quite a hot topic amongst artists and illustrators alike over the past several weeks. As many of you already know, I was diagnosed with Carpal Tunnel in both my wrists and Ulnar Neuropathy (Cubital Tunnel) in my left arm. The past 3-4 weeks have been especially hard on me in terms of getting work done because of the pain. Maybe if I recount my story I can persuade people to be more careful with their work habits and take breaks more often. I was (and still am) notoriously bad about remembering to take breaks. Sometimes I would put in 18 hour stretches with only the occasional break to eat or use the restroom. I always had people tell me to take breaks, but once I start working I tend to keep my head down and work continuously. One of my problems is that if I encounter something that I can’t solve or can’t figure out, I will keep working on it until I do. It is extremely difficult to pry me away from something that is bothering me. So long story short, after working professionally for 6 years on the computer I developed problems in my wrists and arm. The funny thing is, I am right handed, yet I have Cubital Tunnel in my left arm.
About 2 years ago my wrists and arm started really bothering me at work. Me being me, I just shrugged it off and worked anyway. People kept telling me to go to the doctor, but I did the typical guy thing and said nah. I figured the only thing they would do is tell me that I have to cut back on my hours…which I can’t do because I have bills to pay. Now if someone wants to give me a huge raise to work less hours, I am all for it. Other people live in the real world and have to work their ass off in order to make a living. Sooooo, yeah, I just kept working through the pain. As the years passed, my art improved and I started getting more and more work…which didn’t help my situation at all. Then I started getting really crazy deadlines, which again didn’t help. I finally got to the point where I couldn’t take it anymore, so I made an appointment with a neurologist. For some reason my neurologist was backed up with appointments for another 2 months, so I had to wait. I finally go to the appointment and she says that I probably have carpal tunnel in both wrists and cubital tunnel in my left arm. She then schedules me for an EMG test the following day. I don’t know if you have ever had an EMG test, but they suck. You know when you shock someone after rubbing your feet on the carpet? Now imagine that feeling multiplied by 100 that lasts for almost 40 minutes straight. Oh, and the shocks are on your nerves, which causes your arm to jump and spasm every single time you are shocked. Now that is the easy part. After that they stick needles into your arms and hands, and I don’t mean they just put it in and take it out. They put it in, leave it there, and then continue to move and shove the needle around inside your muscles. The ones they put in the palm of our hands are just lovely. Oh, and they also put a needle into my neck and moved it around…that one was fun too. This goes on for probably 20 minutes…and they had to do this on both my arms. They will also ask you to flex your muscles while the needle is still inside. After the EMG test my hands and arms spasmed constantly for several hours straight. It also felt like I just worked out for 5 hours straight. Needless to say, I wasn’t able to work for the rest of the day. Oh, I also might have Fibromyalgia, so that might have exacerbated my pain. I also have never experienced any painful procedures or events in my life before (never had my face punched in, never broken a bone, never had cavities, never had major surgery, etc.), so this was the most pain I have ever felt in my life.
So what am I doing about it now? Well, I’ve been wearing these wrist braces on both wrists while I work…which can be extremely frustrating. The braces have palmar stays, which means I can’t bend my wrist. It also means they are pretty bulky and it is tough holding the stylus and pressing keys on my nostromo. My work speed has decreased significantly since I started wearing them. I am also supposed to avoid bending my arms while I sleep, easier said than done. I have had many people tell me to stop bending my arms while I sleep…but I can’t exactly remember to do that when I am asleep now can I? I tried putting pillows on both of my sides to try and prevent me from rolling on to my side –> fail. I wrapped bath towels around both of my arms to prevent me from bending them (I looked like Megatron) –> fail. I wore my wrist braces while sleeping –> fail.
I also started using one of those stress balls to try and increase my grip/wrist strength. I keep one with me at work and one at home. Squish squish. My good friend Tom Scholes also told me about a nifty little program called Workrave. Workrave is a free program for PCs that reminds you to take breaks. You can set the timer and specify how long the breaks are. I have mine set to remind me to take 30 second breaks every 15 minutes and 3 minute breaks every hour. Workrave also shows you some stretches you can do while you are taking your break. Now I need to find a good one for my Mac. There is one called Workpace, but it is $70.
Ahhh, medication time. After my diagnosis, my neurologist put me on Cymbalta to treat my nerve pain (even though Cymbalta is used to treat depression). Let me tell you, Cymbalta sucks, or at least it did for me. Let me preface this rant by saying that I was only on Cymbalta for a week and a half, which means I probably wasn’t on it long enough to receive any of the benefits because it didn’t help my nerve pain at all. Instead I was beat down by numerous side effects.
Side effect number 1 - Nausea. Nausea is supposed to be the most common side effect of Cymbalta, weighing in at 30%. From the time I woke up in the morning until the time I went to bed at night I felt like tossing my cookies. You don’t realize how debilitating nausea can be until you experience it for 12 hours straight, 7 days a week. Sitting down seemed to help some. I also tried taking the medication at night so that most of my symptoms would occur while I was asleep, nope…didn’t help.
Side effect number 2 – Drowsiness. Drowsiness is the second most common side effect at 21%. When I say drowsiness I don’t mean I felt a little sleepy, I mean by 3-4pm I was falling asleep and by 7-8pm I was completely passed out (many times I passed out on the floor). I was so out of it that I would wake up and not know where I was or how I got there, which I don’t remember happening. Imagine getting home from work at 6pm and by 7pm you were out for the rest of the night. I wasn’t able to work on any of my freelance work…unacceptable in my book. Oh, did I mention that most of the side effects of Cymbalta have opposite reactions? You could experience weight loss or weight gain, constipation or diarrhea, chills or sweating, extreme elation or thoughts of suicide, drowsiness or insomnia. Why oh why couldn’t I have had insomnia instead of drowsiness? Curse you Cymbalta!
Side effect number 3 – Dizziness. Yup, I had trouble walking from time to time.
Side effect number 4 – Yawning. Considering I was sleepy all day long, yes I yawned…a lot.
Side effect number 5 – Headaches. Yup, I had headaches. I seem to experience headaches a lot anyway, so I dunno if it was from the medicine or from something else.
Side effect number 6 – Sweating. I would start sweating even when it was cold or when I wasn’t even moving around.
Side effect number 7 – Weakness/fatigue. I felt like a walking zombie all day long but without the insatiable need to eat brains.
Add all of these side effects together and you get crap. I could’t wait around to see if my body would adjust to the side effects, it was completely destroying my ability to work. I contacted my neurologist to see if there was something else I could take ,like Gabapentin, or if there was something that I could take for the side effects, like Provigil. She said that Gabapentin is very good, but it will also make me sleepy. She also said putting me on Provigil was a bad idea, but didn’t explain why. Instead she suggested a new medication called Savella. Savella is used to treat Fibromyalgia and guess what, it has almost identical side effects as Cymbalta with the exception of drowsiness. I started out with a very low dose, 12.5mg. I am now up to 25mg. So far I haven’t noticed any adverse side effects, but I also haven’t noticed any improvement in my nerve pain.
If you have a full-time job and you develop carpal tunnel while on the job, be sure to file for workers comp. I filed for it a few weeks ago and they sent out an ergonomics expert to evaluate my workspace. Since many of you are freelancers and might not have the luxury of having an ergonomics expert pay you a personal visit, I figured I would share his input. He started out by taking my history and then measured various aspects of my workspace (chair height, monitor height, table height, etc.). The first change he made was on my chair. He moved the seat of my chair forward so that there were only 2 finger widths, instead of 4, between the back of my knees and the front of the seat. This change was to add more support and decrease the amount of pressure being put on the back of my legs. To the left you can see the awesome drawing I did of my workspace and the changes he made. My many years of art school training allowed me to create that awesome drawing. The first drawing is of my original workspace. I have one of those angled desks where my computer is in the little nook. Directly in front of me is my tablet with the keyboard in front of that. The mouse is next to the keyboard on the right and my Nostromo is to the left of the keyboard. In front of those are my three monitors. The arrows depict the angle of my arms when I am working. Since my tablet is in front of me, my arm is bent at an angle (maybe around 45 degrees). My Nostromo is pushed back pretty far, so in order to use it I have to extend my arm quite a bit. I also have to extend both my arms in order to type. These are all big no-nos. Extending my arms like that for significant periods of time puts stress on my ulnar and median nerve. In order to alleviate the stress, the PT pulled the Nostromo a lot closer to my body so that my arm is bent instead of extended. He also raised the arm of my chair so that my elbow rests comfortably while using the Nostromo (before my elbow wasn’t resting on anything). He then moved my tablet to the right so that my arm was resting straight out instead of at an angle. I then moved my monitors to their maximum height so that I wouldn’t have to look down (to avoid stress on my neck). 
Next he took a look at my stylus and suggested I use one of those squishy pencil grip things that were popular back in middle school. I think that is the technical term for it, squishy grip thing. Although I am not sure how that will work since I won’t be able to use the trigger on the stylus. He also suggested that I drink a lot of water during the day and he stressed that exercise is very important, cardio in particular. I know I know, I never exercise anymore, but the last thing I want to do after working 80-100 hours in a week is workout. I dunno, maybe I will start skating again.
Anyway, I hope this wall of text helped inform some of you of the severity of carptal/cubital tunnel. I know when I was younger I didn’t really care about it because I had that teenager mentality that nothing bad could happen to me. All you have to do is take breaks every so often and stretch/exercise. It may seem like a lot for your busy schedule, but it is worth it. You definitely do not want to end up in my position. If you have any questions or comments, please let me know. Thanks!
Wow…I had no idea of the kinds of tests they have to do to diagnose Carpel Tunnel Syndrome. Sounds absolutely medieval. Sorry about your pain Mike, and thank you for helping spread the word. I’ve been trying to give people the heads up, but it carries so much more impact hearing from someone who’s actually going through this condition.
Re: the Fibromyalgia; I’m a firm believer in embracing all forms of healing, both conventional and alternative, and I’ve heard some really good results are being had with Colostrum in treating and even reversing the effects of Fibromyalgia. My sister has FM, and takes Colostrum religiously, and she swears by it. Maybe you could find some benefit from it as well.
I suggest the Colostrum from Symbiotics, if you’re interested. It’s made in New Zealand, and they have much healthier regulations regarding cattle and milk industry.
-Lu
I found this osx application. Not sure how well it works thought:
http://tech.inhelsinki.nl/antirsi/
Your informative wall of texts is helping many. About getting the arm to stay mostly straight during the hour that i sleep, i slide into the sleeping bag and sleep on the floor. I haven’t experience the wrist problem yet, but the nerve on my elbow on the ulna side is in pain. So i thought of using the sleeping bag. This also kept me from turning and put weight on one side.
Oh man! I’m so sorry to hear all this. I don’t know what to say besides I hope everything works out for ya somehow where you can get payed more and still get to do what you love. As an artist I look up to, I hope you’ll get through.
Best wishes,
Yajmon
I hate you’re going through all of this. I’ve working with the wacom in my day job and freelance for about 8-9 years now and I’m actually relieved to see my desk is already set up like your diagram number 2. I’m like you in that I’ll got for hours without breaking once I get into something. I’m going to give that timer program a try.
I also can’t recommend exercise and good diet enough. Soft drinks and pizza may help in the short term when you’re working long hours in front of the computer but it’s not worth the sugar crashes and long term health problems. Only a few weeks after sticking to a clean diet and good exercise and I felt like a new person. One without aches and pains and triple the energy I used to have.
Good luck to figuring all this out.
I’m very sorry to hear you’ve been diagnosed with these conditions. At the very least I can draw some information for myself from your experience, because my workspace is not that much different from yours.
As for the medications, the Savella drug your neurologist prescribed last may need some time for its effects to become evident. I’m not intimately familiar with how its effects change in the long term, however, quite a few neurotropic drugs have pharmacokinetics and dynamics that prevent immediate effects. I suppose you should start noticing an improvement in two-three weeks after the initial dosing.
I hope this helps somewhat. Oh, and EMG is supposed to be a bitch. Be glad your neurologist went through the trouble of doing it. As bothersome as it is for both patients and examiners, it does provide very useful information.
Best wishes!
I’m so sorry to hear about this. After having some work friends of my own who suffer like you do, I’ve been making changes in my life.
I really hope things get better for you.
Bryan – Thanks for the link, it works great!
can’t help but think writing the wall of text couldn’t have helped, thanks for the sacrifice.
I know you’re not an expert, but would love any insight you might have:
My left wrist gets stiff, and doesn’t seem very strong, no pain yet but I’m really scared about it coming. I’m an animator so similar using the left hand for hotkeys. I don’t know how to improve things, I only use my left hand on the keyboard, so I can have the keyboard at whatever angle, I have one of those little wrist pads to rest on. I don’t really work long chunks of time already. Can your wrist be tired from use at the end of the day or if it’s tired it means damage is being done?
Have they talked to you about shoulder stuff? (correct posture and stuff?) I keep hearing it starts in your shoulders, but that’s coming from yoga people who are all about shoulders, I’m curious what the RSI specialists say.
When I try and sit ergonomically I am uncomfortable, (more comfortable all coiled up) does that mean I’m doing it wrong, or is it like vegetables and exercise, you do it because you should not because you like it?
Is that the recommended break schedule?
I have a friend who has fibromyalgia and she has controlled it a lot through diet. I think she cut out foods from the nightshade family (like tomatoes and potatoes) and greatly improved. I think when the fybromyalgia was strong it would lead to lots of other health compromises.
Good luck.
Ok…so this is gonna sound crazy. Let me know if it does because I’m putting together an article for my own blog about ergonomics and how much things have changed since artists have gone digital.
I’m an aspiring matte painter. Matte painters used to work on large pieces of glass all day, typically standing, sometimes sitting on a high stool, and didn’t have the wrist and arm problems associated with the short, small, repetitive movements that we have now. Artists had a variety of methods for holding brushes and working comfortably.
It doesn’t take an ergonomics expert to see where the differences are in our working methods.
Now as artists, we sit on our asses for 12 hour days(causing compression in our backs, and gaining weight because we don’t get the fidgets that we get when even standing still), painting on smaller canvases, using what is the equivelant of a marker, and causing our eyes strain by staring at monitors for too long.
I’m working to make my work process more analog feeling. Office environments today are based off of the office environments created by corporate industry and match the idealized workstation of early computer programmers. We are artists and should work like it. I’m working towards getting a cintiq, a height adjustable desk (geekdesk.com) and generally have my workstation at home setup like a classic matte painter would.
I’m also using alternative medicine to benefit my health. A friend introduced me to a chiropractor, and my health has dramatically changed for the better. I’m from a rural town in the midwest so alternative medicine is typically looked down upon out there. I go to the chiro 3 times a week and have for about 1 year, and just continue to see results. The Chiropractor I go to is the exact opposite of the typical scrubs wearing hippy that most people expect. He wears business clothes, acts very average, and has an awesome demeanor. We talk shop and shoot the breeze while he’s popping my back, wrists and fingers. The WIERDEST thing he believes in is retracing. That’s it. He’s never recommemended anything wierd, not even accupunture. I tell you all of this because I would highly recommend seeing a chiropractor. See a good one with good bedside manner. A good chiro will work totally different on every person. I’ve watched my chiro work on my wife (who has carpal tunnel syndrom in both wrists), and give her totally different adjustments. My chiro has done wonders for my wife and she hates the weeks that she can’t come to the chiro office with me.
The ease that this guy works kinda reminds me of my own.
http://www.youtube.com/watch?v=lDXxlPo4dMg
It’s important to find a good one, so many people I know don’t like Chiropractors because so many of them are snake oil salesmen. Some will even claim they can cure blindness. Mine has never claimed that he could fix anything except giving my back the proper curve, but I have had multiple benefits (NO MORE DAILY HEADACHES!) from visiting him.
My next thing to try is accupuncture. A lot of people say they don’t believe in it or accupressure, but will rub the temples of their foreheads when they get a headache…
A friend recommended one and claimed it cleared up his sinuses with one needle. Sounds fishy but we’ll see.
I also do alot of wrist exercises:
http://www.youtube.com/watch?v=hUyMNyrOHJQ
My chiro recommends all of them except the one where you basically push the fingers back. You can overextend that one and hurt too easily.
Regarding wrist braces, two doctors I’ve talked to are against them, unless the person is in the position you’re in, if you’re no longer in pain because you need to put MORE motion into the wrist. I was thinking about “protecting my wrists with braces but my doctor told me to strengthen mine instead.
Hope you get better man!
Forgot to mention. When my wife can’t get to the chiro and has wrist pain, she uses this instead of a standard brace.
http://www.kinesiotaping.com/arms.php
Although the taping method she uses is an X with it looping around the bottom of her hand and crossining over the thumb.
oh no, poor poo! Yuck..I can’t believe they stuck a needle in your neck too! Maybe you need some kind of heated wrist wraps, I should make you some super awesome ones with aromatherapy/heated gel:)
It has been proven that ten-fifteen minute break in an hour does not
– I repeat –
DOES NOT
affect your productivity.
Please remember to rest, and do exercise of the wrist in between works, Mr Daarken, hate to see you not able to draw in the future (knock wood). Should take care of yourself better ! a fan of your artwork.
Oh man,
As I enjoy your artworks and as I’m a graphist I really hope you will be better.
For those who don’t take some rest, keep in mind that when you take a good rest you refresh your mind, then you will work faster and better.
Add that when you will come back to the artwork, you will find mistakes easier.
For sure I would work like you because I’m young, but you warn me that this type of syndromes can come really fast ( less than 6 years / 30 is really fast for me ).
Take care of yourself,
RakDos
I have somewhat similar problems, not really pain (well some sometimes) but mostly lack of strength and endurance, my doctor sent me to a occupational therapist which only works with “Mindfulness” (some sort of meditation) and it really helps but takes time to get into.
I also do a lot of stretches and exercises that I found on youtube (remember be careful if you choose to try these exercises, you don’t have to stretch as much as they do in the videos if you can’t, don’t overdo)
Exercises for tendinitis and carpal tunnel
———————————————————-
http://www.youtube.com/watch?v=hUyMNyrOHJQ
RSI – Wrist Stretches
—————————–
Part1 – http://www.youtube.com/watch?v=DTnHpsK024Y
Part2 – http://www.youtube.com/watch?v=YpRq8QOT2io
Part3 – http://www.youtube.com/watch?v=rAep7ffqhsA
Also check out this program that allows you to modify all sensitivity curve control points with your Wacom. It allows you to use your pen lighter, protect your pen tip, tablet surface and your hand.
http://cghub.com/forum/showthread.php?t=3179