April 16, 2020
Written by Xavier Simcock, MD
Recently given the COVID pandemic there has been a dramatic increase in people working from home. Working from home often provides an added level of comfort during the workday. However, this is not always the case. 60% of people who primarily work at a computer or desk work will experience pain in their arms during their career. This is especially true for people who have not considered the ergonomics of their workplace. The majority of people suffering from aches and pains in their arm can find some relief with simple ergonomic modifications and limiting overuse patterns of activity. Specifically in the following article we will review the most common causes of pain associated with overuse patterns when working from home. This article is to be used as an early guide and initial steps for treatment for your symptoms. If the symptoms persist or if they do not fit easily into one of the categories we are always happy to make time to evaluate you with a telehealth appointment.
Pain in the hand and wrist
There are many reasons for pain in the hand and wrist. The easiest way to identify and diagnose the cause is to carefully observe where you are having pain and where the pain is coming from. Most commonly there are 3 areas around the hand and wrist that have pain:
- Pain on the palm side of the wrist.
- Pain on the backside of the wrist close to the base of the thumb.
- Pain on the small finger side of the wrist.
Pain on the palm side of the wrist
If you are suffering from pain on the palm side of the wrist after repeated use it is common that this pain will radiate. Oftentimes this pain will move along the thumb or along the index and long finger. Sometimes after prolonged use you can potentially have numbness and tingling as well as pain. There are multiple potential causes for this pain including carpal tunnel syndrome, tendinitis, and arthritis. However, the initial treatment for all the above diagnoses is similar. It is key to limit the motion of the wrist. Extremes of motion, and prolonged repetitive activity will worsen the symptoms. So the first step in treating these is to start by avoiding significant flexion or extension at the wrist. If you are working on your computer or at your desk it is essential to maintain your wrist in a neutral position. A neutral position is having your wrist straight out from your forearm. The easiest way to maintain this at your desk is making sure that your laptop or keyboard is centered in the middle of the desk so your wrist and forearm can lay flat on the desk while typing. If you have a large keyboard sometimes it is necessary to place a gel pad underneath your wrist for support to maintain a neutral position. Finally, after a long day of work wearing a resting night brace to avoid prolonged flexion while sleeping can allow for significant pain relief. It is very natural for us to sleep with our wrist flexed just like we did in a fetal position. Thus, wearing a brace overnight can be beneficial in preventing this while we are asleep.
Pain on the backside of the wrist close to the base of the thumb
The pain in this area often is caused by 1 of 2 different pathologies. If you are having consistent pain directly at the base of the thumb that feels most acute in the hand this can be caused by arthritis or synovitis at the base of your thumb. This pain is often worse when doing pinching activities and is worse after doing a long day of gripping and holding objects. If the pain on the backside of your wrist localizes more towards the wrist than the hand, this pain is often made worse when moving your wrist from side to side. This pain is often associated with an inflammation of the tendon. Classically it is associated with new mothers when lifting small infants. The first step in treating pain that localizes at the base your thumb is to start wearing a brace that limits thumb motion. These braces are called thumb spica braces. These braces can be both soft and also rigid in order to accommodate the needs of your workplace environment.
Pain on the small finger side of your wrist
Pain on the small finger side of your wrist and hand can be much more complicated. In the medical profession we call this the ulnar side of your wrist. If it is associated with numbness then this can be can be caused by compression on the ulnar nerve. Changing position of both your wrist and elbow may relieve the numbness. Specifically flexion of the elbow for prolonged periods of time can lead to numbness in the small finger. If the numbness persists or it happens more frequently I would suggest being evaluated in order to prevent any persistent nerve damage. Pain directly at the ulnar aspect of the wrist of the wrist can be caused by numerous reasons. Most commonly they relate to inflammation of tendons or ligaments. The specific diagnosis of these pain often requires a more thorough examination with a hand professional. The for step in treating this pain is to limit repeated flexion and ulnar deviation at the wrist. This can be accomplished with a rigid brace.
Pain in the forearm and elbow
There are many reasons for pain in the forearm and elbow. Again we will focus on the most common types of pain. The easiest way to identify and diagnose the reason for the pain is to carefully observe where you are having pain and where the pain is coming from. Most commonly there are 3 areas around the hand and wrist that have pain:
1. Pain on the outside (or lateral) of the elbow
The most common cause of pain on the outside of your elbow in the setting of desk or computer work is tennis elbow. This pain tends to be worse after a long day of repetitive use. It gradually begins with an ache but can become very sharp and acute with time. The pain tends to radiate from the elbow down into the musculature of the forearm. It can even extend all the way down to the wrist. Tennis elbow is caused by inflammation within the tendon. All of the muscles that allow you to extend your fingers and extend your wrist begin at the same location on the outside of your elbow. Therefore it is easy to imagine that with prolonged typing and wrist extension and movement of the fingers that this site can become inflamed. The first ergonomic trick to treat tennis elbow is to change the position of your hand and wrist. First, try to attempt tasks by looking at the palm of your hand. If you are looking at the palm of your hand you are using your flexor muscles as opposed to your extensor muscles. Thus the extensor muscles get a break. Secondly, repetitive work like mouse work can be achieved with a vertical mouse. This can provide some relief from chronic overuse of the extensor tendons. In addition, wearing a night resting brace at the wrist can prevent you from stretching and straining your extensor muscles overnight.
2. Pain on the inside (or medial) of the elbow
There are two common causes of pain from the inside of your elbow. Pain that is associated with intermittent numbness is often a cause palm compression of the ulnar nerve. The ulnar nerve runs through a tight tunnel at the inside of your elbow. When the elbow is flexed at 90 degrees for prolonged periods of time this can lead to numbness developing in the small and ring finger. Associated this with this numbness can also be radiating pain in the forearm and fingers. Furthermore direct pressure on the inside of your elbow can lead to sharp pain and shock-like symptoms down your fingers if the nerve is already irritated. Another cause of pain on the inside of your elbow is associated with tendinitis. The muscles that allow you to flex your wrist and fingers originate from the inside of your elbow. A lot of repetitive use with flexion at the wrist and fingers can lead to inflammation at the site. If you are having “nerve-like” symptoms the first step is to evaluate the position of your elbow. Maintaining your elbow with only a slight degree of flexion can prevent extra strain on the nerve. For example working with your mouse or laptop further away from your body will keep your elbow in a more straight position. If you are working in cramped quarters you often find yourself with your elbow flexed at 90 degrees and potentially with pressure on the inside of your elbow. This is more likely to irritate the ulnar nerve. Again wearing a brace at night on your wrist can be significantly helpful in diminishing some of the symptoms. The brace prevents you from flexing at night and allowing the flexor muscles a chance to recover.
3. Pain on the back (or posterior) of the elbow
On the backside of your elbow you do not have a lot of soft tissue padding before you reach the bone. Pain on the backside of the elbow continue to be located directly over the bone. If this is directly over the bone it is often associated with swelling. Because you do not have muscle or tendons padding the backside of the bone this is an area that can often fill with a small sac of fluid if it becomes irritated. This is called olecranon bursitis. It can occur without any obvious trauma and can be quite shocking as it grows to the size of a golf ball or even a tennis ball at the backside of your elbow. There are 2 types of olecranon bursitis. The first is just caused by inflammation. The second is caused by infection. If you have had recent trauma where the skin was broken or cut and if the area is incredibly red and warm then this should be evaluated. If it is just swollen without significant warmth then it is safe to treat this with gentle compression wrapping. This can be in the form of an elbow sleeve or an Ace wrap. It is important to note did not put the sleeve on too tightly in order to prevent blood flow to the rest of the arm. The sleeve asked to put gentle pressure on the area of fluid so that it gets reabsorbed.
If the symptoms persist or if they do not fit easily into one of the categories we are always happy to make time to evaluate you with a telemedicine appointment. Midwest Orthopaedics at Rush is available for daily telemedicine appointments with specialists in the hand, wrist, elbow, and shoulder to help guide you with your pain.