The Ergonomic Topic: Your Keyboard and Carpal Tunnel Syndrome!

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Keyboard choice is one of the most vital of your career. Choose the wrong keyboard and you may hate every keystroke; choose the right keyboard and you may love to type for years to come. In the medical transcription field, we know a good keyboard will help alleviate symptoms of carpal tunnel syndrome, a debilitating career-shortener. Let’s explore this connection and some options.

You wouldn’t think the tiny movements needed to type on a computer keyboard are dangerous, but we all know injury from small, repetitive movements is a real problem in today’s information-driven milieu. The first case of carpal tunnel syndrome was documented in 1854 in connection with factory workers who used a newly patented machine to make buttonholes all day long in an assembly line. The term “carpal tunnel syndrome” was coined in the 1930s, and became more well known in the 1960s. CTS diagnoses fairly hit the roof throughout the 1980s and 1990s, as computers transitioned from NASA labs and government-building basements to home and workplace desktops. Today, CTS is a consideration for anyone who uses a computer keyboard.

What is it, exactly? Well, first you need to understand that your body is meant to do a lot of things very easily and well, but it’s not really meant to do the same thing a zillion times in a row. Next, it’s important to realize that every movement causes stress; too much stress results in injury. Alternate activities and rest are needed so stressed muscles, ligaments, and tendons can heal. The cause of CTS, and any other repetitive stress injury, is performing the same motions too many times without enough rest and variation.

Let’s consider the natural angle of your hands and wrists as they hang at your sides. If you stand and take note, you’ll find that your thumbs are in close proximity to the sides of your thighs, with your palm angled slightly back. This is the position of least stress on your wrists and hands. Now let’s consider your typing stance: from this neutral position, without moving your wrists or hands, bend your elbows to a right angle. If you place your hands on a keyboard in this neutral position, only your pinkie finger and hypothenar eminence will contact the keyboard. You won’t get much typing done like that. In order to use a standard keyboard you have to rotate your wrists so all your fingers can touch the keys. This motion twists and scissors your radius and ulna, creating stress. Next, in order to reach all of the keys, you need to angle your hands outward—ulnar deviation—creating more stress. Next, you’ll probably notice the back of your hands are angled upward somewhat, so a drop of water on your knuckle would run toward your wrist. This is wrist extension, the third stressor. All three alter and compress the carpal tunnel, a narrow, crowded passageway at your wrist, surrounded
by your wrist bones (carpals) and flexor retinaculum (a strong band of connective tissue). Now, hold this position for hours while flexing your fingers thousands and thousands of times, working the tendons attached to each finger like pistons, irritating the tender little tissues and tendon sheaths by the incessant and unnatural movements inside a tiny little space. Irritation leads to inflammation, which further reduces the available space. Your hands become cold because the blood vessels are squeezed. They are numb and tingly because your median and ulnar nerves are squished. And they hurt.

At this point most doctors prescribe NSAIDs, stretches, splints, and ice, and blithely recommend we stop typing—for a long, long time, if not for good. Yeah, that’s like telling him to stop seeing patients. Whatever! Typing is a repetitive stressor, but this is how we make a living, so we have to take a look at other options. This brings us back to our discussion about keyboards.

Most of us know ergonomic keyboards look different from other keyboards, with curves and angles. Some swoop around; some are like a hill that peaks in the middle; others point your fingers down. They all have the same basic aim: to reduce the twists and turns in your joints between your elbows and fingertips in an effort to reduce stress and strain on your moneymakers (hands and wrists, people!).

Several ergonomic keyboards are popular choices. According to IntelliReview, the most popular ergonomic keyboard is the Microsoft Natural Ergo 4000. It has a slight curve with a large wrist rest. Many Career Step students and graduates use this keyboard and love it.

Other ergo keyboards have a more pronounced curve (to straighten out the degree of wrist deviation), like the Microsoft Natural Elite, with a split keyboard, or the Logitech Wave, which features a peak in the center of the keyboard to decrease the amount of rotation. For more reviews, visit www.intellireview.com and search “ergonomic keyboard.”

For a more dramatic difference, you might be interested in the Safetype keyboard. According to the manufacturers, this keyboard addresses all three of the positional strain problems in one, with a vertical keyboard. You orient your hands as if you were playing an accordion, with your palms facing each other on the keys. If you know how to touch type you will be able to use this keyboard right off the bat, although it may take a little while to get over the mental hurdle of using such an weird-looking thing. Take a look at the keyboards here: http://safetype.com/index.php

Sometimes, even a slight adjustment can make a big difference. If you are noticing numbness, tingling, weakness, or pain related to the amount of time you spend on your keyboard, keep in mind an ergonomically designed keyboard might help a lot.

What about typing speed? Old-fashioned typewriters were not really designed to be efficient or to support blitzkrieg typing speed. The most common keyboard arrangement then—and now—is called the QWERTY, because the first six keys on the top row spell QWERTY. It seems that this key arrangement was chosen almost capriciously, without much thought to efficiency. Some sources indicate that the QWERTY key arrangement was adopted exactly because it is inefficient (on manual typewriters, this array kept the keystrokes coming slowly enough that the keys wouldn’t get jammed). Although efficiency experts agree that the QWERTY key array is not a particularly efficient arrangement, most keyboards are still configured this way, and most of us learned to type on a QWERTY interface, so we’re used to it.

It’s not the only choice, however. August Dvorak developed a more efficient key arrangement after studying hand motions, finger strength and coordination, as well as letter frequencies in the English language. It’s been around for a long time—the patent was granted in 1936—but it has not replaced the QWERTY arrangement. You can purchase DVORAK keyboards, but you should also know most major operating systems allow you to switch your existing keyboard to respond to a DVORAK arrangement. See the following site for more information: http://www.powertyping.com/switch.html. For those willing to retrain in order to type more efficiently, with less wear-and-tear, learning DVORAK might be just the ticket.

The right keyboard holds the key to office-based as well as work from home medical transcription jobs. Make sure you choose yours wisely.

Jill McNitt
CS Student Support Team


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  1. Daria August 28, 2014

    Great article!


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