Desk Setup That Protects Your Hands

Chapters

• 0:02 Host Intro And Episode Focus
• 0:15 Why Desk Setup Drives Hand Symptoms
• 0:49 Carpal Tunnel Anatomy Made Simple
• 3:05 Why Wrist Rests Make Pain Worse
• 3:36 Ideal Keyboard And Wrist Position
• 3:55 Guyon’s Canal And The Mouse
• 5:12 Two Key Tunnels, Core Takeaways
• 5:36 Closing And Website Mention

Transcript

SPEAKER_00: 0:02

Welcome back to the Hand to Shoulder Solution, Giving Pain the Middle Finger. I'm your host, Carl Petito. I'm an occupational therapist and a board certified hand therapist, along with being an ergonomic assessment specialist. I want to talk about the optimal setup for your desk. There's a couple of key details that I'd like to discuss that patients often ask me about. And patients will come in with carpal tunnel syndrome or they just had a carpal tunnel syndrome release surgery, yet the symptoms are coming back. And I always ask patients, what do they do for work? And folks that work at a desk, my next question always is, where is the keyboard and where is the mouse? So let's discuss a couple of things first. I want to talk about the carpal tunnel, let's do a brief review. The carpal tunnel is made up of the carpal bones. There's eight of them. And this is the palmer surface. So when you look at your palm and you look at the heel of your palm, you're looking at the carpal tunnel. The surface on the palm, there's a thick, heavy ligament that forms the top of the tunnel. And inside that tunnel, there are nine tendons. So there's two to each finger, one to the thumb that go through the tunnel, and a very thick wide nerve called the median MEDIAN nerve. That nerve gets compressed, and the nerve plugs into the thumb, the index finger, the long finger, and half the ring finger. And so when patients say they're having numbness and tingling on the thumb side of the hand, my first thought is the median nerve and what is causing this. So one cause can be resting on the heel of the palm while typing. What happens is the tendons that go through their carpal tunnel, they are passing through and moving, moving, moving. And that movement, if resting on their wrist, becomes it causes the tendons to swell up and get inflamed because of the friction of the tendons passing through the tunnel with some pressure on them. A key structure that goes through there, which you just mentioned, is the median nerve, and that nerve is pretty shallow, it's pretty pretty close to the surface. And it's big, it's about as wide as a pencil and thick like a noodle. So any pressure on that causes the numbness and tingling. And if the tendons are getting inflamed and irritated, swollen, it's taking up space in the tunnel and choking off the nerve. When you cross your legs and your foot goes to sleep, that's pressure on a nerve. That's not a blood flow problem. So that's pressure on a nerve. The surgery for a carpal tunnel syndrome is to go underneath the skin and cut that thick, heavy ligament on the top, which relieves the pressure. So that's called a carpal tunnel release surgery designed to release pressure off the nerve. Now, therefore, I never want to put pressure on the nerve. So what I see a lot of people doing is using a wrist rest in front of the keyboard, resting the heel of the palm or the carpal tunnel on the wrist rest while they're typing. So all day long, number one, there's pressure on the nerve, and number two, there's also pressure into the carpal tunnel, causing some friction, some extra friction on the tendons, which connect these muscles to these bones. And the tendons can get very inflamed and swollen, also putting pressure on the nerve internally. So the ideal position is to have that keyboard on the edge of the desk, typing with the wrist straight, the chair high enough so that it's the wrist is not up like this, and the chair low enough so the wrist isn't bent down. So the wrist should be straight, typing with nothing but air on the carpal tunnel. Now there's another key structure called Gion's canal. G-U-I-O-N apostrophe S. That canal is a little trough where the ulnar nerve slides through. So when you hit your funny bone, you're hitting the ulnar nerve, and that goes through cubital tunnel. There is such a thing as cubital tunnel syndrome. Cubital means elbow. And then the nerve passes down, it goes between a couple of muscles, and it goes through Gon's canal, and that plugs into or innervates a small finger and half the ring finger. Let's talk about the mouse. So when you're using your mouse, what a lot of people will do is use the mouse forward on their desk, way up here, and that puts pressure directly on Gion's canal right there. So if you feel your wrist and there's this little round bony area right there, and then you go toward your thumb, just the hair, that's where that ulnar nerve lives right there. So a lot of folks, including me, sometimes I forget and I'm here like this, and then this starts to go to sleep, and then I remind myself to just bring it back to the edge of the desk and use it. My shoulders are relaxed, I'm close enough, I'm positioned well, and I'm just using that mouse right here, like so. Alright. So two key tunnels is the carpal tunnel and Guian's canal. Carpal tunnel, median nerve, Guian's canal, ulnar nerve. Staying off of those, avoiding pressure makes all of the difference. Soon we'll talk about other ergonomic considerations for your desk, and we'll explain all the reasons why. But these two main points are very crucial. Thank you for watching, and check out my website, Carlpatito.com. Thank you.