Talk to the hand

from Financial Mail

Hand pain and strain are at a record high because of the time we now spend in front of a computer. But there is much we can do to avoid surgery, writes Sue Grant-Marshall

Robbers shout "hands up" in a hold-up for a reason. That's the part of your body you use first in any crisis situation, in this case reaching for your own gun, pepper spray or the panic button. When you trip, your hands shoot out instinctively to cushion the fall. If you're hijacked, it's your right hand you raise protectively. In spite of their obvious importance, it's extraordinary how little attention we pay to our hands. One of SA's few hand therapists, Nicola Fellowes, describes them as the most functionally important and bio mechanically complex part of our body.


Our hands are, literally, an extension of the brain, more of which is reserved for hand movement than for control of any other part of the body. Today, they are being subjected to increasing strain, due to our computer use, as more of us sit for hours on end, only twitching our mouse hand. Using a mouse is, for many compromised people (diabetics, anyone aged over 40), the last straw. That twisting motion as you manoeuvre it from side to side on your mousepad can spell disaster if you don't heed warning signs.


Conditions ranging from trigger finger to tennis elbow and carpal tunnel syndrome could be around the corner unless you recognise hand strain symptoms. Carpal tunnel syndrome usually manifests in numbness or tingling in your hand, which may sometimes wake you up at night. You might experience clumsiness in handling objects or feel a pain that goes up the arm as high as your shoulder.


The symptoms occur when your median nerve, which travels from your forearm into your hand through a "tunnel" in your wrist, presses against a ligament as a result of swelling or inflammation. Carpal tunnel syndrome is common among those who use their hands for extended periods, for instance in computer data capture, writing reports, in journalism, or in textile manufacturing, upholstering or assembly-line work.


Cubital tunnel syndrome or inflammation of your funny bone is caused by your ulnar nerve being trapped at the elbow because you lean on it too often on a hard surface. You may feel tingling in your little finger or weakness in your hand. These symptoms may wake you at night.


Trigger finger or thumb is a form of tendonitis and can be caused by repeatedly grasping something. When a swollen tendon can't slide through its tendon sheath, it locks, hence the term. You feel a catching sensation and your finger or thumb remain bent. There is a range of treatments that a hand therapist can use when pain finally drives you to seek help. Hand therapists, like Fellowes, can minimise symptoms in various ways such as putting splints on your finger, thumb or wrist to prevent you flexing them.


Anti-inflammatory medication is used, too, either orally or by injecting cortisone into the painful area. But many people leave it too late and surgery becomes the only option. "People in the workplace are far more aware now of conditions like repetitive strain injury, which can cause trigger fingers or thumb," says Fellowes, who is increasingly seeing data capturers suffering from those conditions and simultaneously from tennis elbow. Some are only in their late 20s.


If a therapist sees a patient early on then she can intervene with treatment. "But so often people let their condition get so bad that their rehabilitation time is much longer," says Fellowes. Though in America patients can claim under the Workman's Compensation Act for computer strain, "we are not able to get coverage for white collar workers in SA," says Fellowes. "This is because [cases] are so difficult to prove."


Fellowes is increasingly seeing dentists, surgeons, physiotherapists, podiatrists and occupational therapists whose hands cannot cope with the demands their owners put on them. Sport, particularly golf and cycling, brings people in their droves to her rooms. The repeated wrist action in golf can cause a condition called lateral epicondylitis.


Cyclists are prone to nerve entrapments like carpal tunnel syndrome because of the position of their upper limbs (arms and shoulders) on the bike for long periods. Inflammation caused by jarring and vibration is a problem, too. People go for an X-ray and are often sent home though they have a wrist sprain which hasn't been diagnosed. Three months later, they are still in pain because conventional X-rays often don't show up wrist sprains.


Fellowes did gunshot research at three Johannesburg hospitals before doing her fellowship at Texas in America and stunned her fellow students over there with her research sample. "Nobody there had seen gunshot wounds." She also sees people who've been attacked for their rings, "with bites on their fingers, which are sometimes dislocated or broken in the process. They go horribly septic as human bites are far worse than those of animals."