My bilateral carpal tunnel syndrome recurred in mid-November 2021 and worsened in the ensuing weeks. The symptoms in my hands and fingers eventually came under control in mid-January 2022 with conservative treatment and addition of an Apple Magic Trackpad 2 to my desktop setup.
In this article, I recount the development of carpal tunnel syndrome in both hands in 2014. In addition, I describe the steps I took to successfully manage a recent flare-up.
History of My Bilateral Carpal Tunnel Syndrome
I first noticed persistent numbness and tingling in my left hand and fingers, in particular the palmar aspect of my distal palm and fingers, in October of 2014, i.e. more than 7 years ago. These symptoms progressed to include episodes of pain, especially on hyperextension or hyperflexion.
About a month after the onset of symptoms in the left palm and fingers, I experienced the same symptoms, but to a much lesser degree of severity, on the right side.
I did not perceive any weakness or loss of dexterity in either hand.
After about a week of persistent symptoms in both hands, i.e. in mid-November 2014, I suspected median neuropathy, in particular bilateral carpal tunnel syndrome.
The precipitant of my symptoms was quite obvious – the manual labor involved in relocating to our current residence. In Q4 of 2014, there was much cleaning to be done after the renovation work. I also painted the kitchen, two bathrooms, and two bedrooms myself. Moreover, I physically moved small pieces of furniture and boxes containing household goods. The books were especially heavy. Other than for the large furniture, I lifted objects unassisted, most often after office hours, especially the dead of night. We moved house on December 15, 2014.
I believe the repetitive nature of the interior house painting and the heavy weight of some objects I manually carried, possibly in unergonomic ways, caused repetitive strain injury and, ultimately, carpal tunnel syndrome.
When my symptoms became unbearable, I made an appointment to see a consultant neurologist, Dr PESE.
When I saw Dr PESE on December 18, 2014, there was no objective sensory or motor deficit. Phalen’s and Tinel’s tests were positive. Dr PESE prescribed a course of methylcobalamin and physiotherapy. I attended three short sessions of physiotherapy during the remainder of the month. The physiotherapy department issued me a wrist brace/splint – an Ossur Exoform Carpal Tunnel Wrist – for my left wrist, but not my right one, presumably because my symptoms were a lot worse on the left side.
I saw Dr PESE again in the second week of January 2015, at which time my symptoms had not changed, neither for the worse nor for the better.
Electrodiagnostic testing with nerve conduction studies was done on January 22, 2015. Below are the results documented in the printed report.
Dr PESE’s conclusion of the nerve conduction studies read, “These findings are suggestive of moderately severe median nerve lesions at both wrists, worse on the left, which would be consistent with the clinical diagnosis of bilateral carpal tunnel syndrome.”
In view of my persistent symptoms, he recommended I sought a surgical opinion with a view to bilateral carpal tunnel releases.
In the subsequent months, I avoided any activity that might have aggravated my carpal tunnel syndrome as much as possible, including lifting heavy objects and painting. I also made the effort to wear my wrist brace as much as possible, both day and night, including while sleeping.
My work schedule only allowed me to fix an appointment with my preferred hand surgeon, Dr MEP, in June 2015. A complicating factor was that Dr MEP was based at National University Hospital, Singapore – seeing him meant having to make arrangements for travel and accommodation. I planned for an extended stay in Singapore because I expected to undergo surgery to both my wrists and to receive post-operative follow-up care in Singapore.
Between the time I was discharged from Dr PESE’s care (January 23, 2015) and my appointment with Dr MEP (June 13, 2015), my symptoms improved to such an extent that I was completely asymptomatic.
During my appointment with Dr MEP, I had no symptoms and no clinical sign could be elicited. Not surprisingly, the surgeon was reluctant to operate on my wrists in spite of Dr PESE’s nerve conduction studies report. I was delighted with this outcome and treated the rest of the time I spent in Singapore as vacation.
Since then, I’ve had infrequent and brief episodes, lasting no more than a few days, in which I experienced mild to moderate numbness and paresthesia in my distal palms and fingers. These episodes often coincided with periods of psychological stress and/or travel (during which the lifting of bags might have been a provoking factor). My symptoms would usually go away by resting my hands, but there were a few episodes in which I used my left wrist brace to control the symptoms in my left palm and fingers.
Recurrence of Carpal Tunnel Syndrome in November 2021
Symptoms and Signs
Around the middle of November 2021, I experienced mild carpal tunnel syndrome in the palm and fingers on both sides. The unusual thing was that my symptoms – mainly numbness and paresthesia, but sometimes pain – were much worse on the right side. Unlike what you might have read on the Internet, my symptoms during this episode have almost never occurred while I’m in bed at night. Instead, they have been most prominent while I am using my hands and fingers during the day, especially when working in front of the keyboard and mouse.
Phalen’s and Tinel’s test have been positive from mid-December to date.
For the record, I have felt no loss of power or dexterity in my hands or fingers. There is no suggestion of wasting (atrophy) of the thenar muscles.
Presumed Cause of Recurrence
Identifying the activity that precipitated this recurrence was not difficult – reviewing the content of two websites and migrating them to a new webhosting service provider. This created plenty of stress because:
- I was trying to beat a self-imposed December 31 deadline, and
- I was using my keyboard and computer mouse more than usual. I suspected use of my mouse exclusively with my right hand contributed to the symptoms being worse on that side on this recurrence.
Steps I Took to Alleviate My Symptoms
When I realized the carpal tunnel syndrome in my hands and fingers were not going away on their own, I tried the following maneuvers (not every step listed below was executed as I had wanted and not every step helped my symptoms)
- Limiting the amount of repetitive hand and wrist movements, especially on the right side since it was giving me the most angst
- Avoiding any activity that might aggravate carpal tunnel syndrome, namely lifting heavy objects and cycling
- Covering the front edge of my desk with a desk pad
- Adding a mouse bungee to my desktop setup
- Wearing wrist braces
- Using a trackpad
Limiting the amount of repetitive hand and wrist movements
I did my best to minimize use of the keyboard and mouse. However, given the amount of work that had piled up, a substantial amount of repetitive hand and wrist movements from typing and moving the mouse was not only unavoidable but necessary.
While working with the keyboard and mouse, I made an effort to take regular breaks.
Avoiding any activity that might aggravate carpal tunnel syndrome
I refrained from carrying heavy objects. I also avoided cycling because the road buzz through the handlebar would almost certainly provoke symptoms in my hands and fingers, especially numbness and paresthesia. (I often experience these symptoms even at the best of times.)
Covering the front edge of my desk with a desk pad
The front edge of my desk is smooth and rounded. But I wondered if the bare wooden edge might be causing undue pressure on my right wrist as I move the mouse. After experimenting with several methods to soften the edge, I decided on moving the desk pad about an inch back (towards me), such that its stitched edge protrudes a little over the edge.
With this small change of desk pad placement, the 3 millimeters of neoprene-like material provides sufficient padding of my right wrist against the desk’s edge when it holds the computer mouse. The silky texture of the desk pad’s texture is an added bonus.
Adding a mouse bungee to my desktop setup
Thinking my aging right wrist might be strained from dragging the mouse repeatedly and after confirming the mouse skates were still virtually frictionless, I bought a Zowie Camade II mouse bungee on November 24, 2021. Although the mouse bungee made the mouse glide on my Mionix Alioth gaming desk pad more easily, I experienced no improvement in the symptoms in my right palm and fingers.
Wearing wrist braces
I started wearing the old left wrist brace again from mid-November and searched for one for my right wrist. Staff at the physiotherapy department, where I received the left wrist brace seven years ago, told me they could order the same brand and model for my right wrist. However, on December 16, they told me their supplier had run out of stock and was no longer importing the product into the country. Therefore, I purchased the Ossur Exoform Carpal Tunnel Wrist from an online medical supplies store in the US, and had the product couriered to me – the process from order to delivery took about three weeks. I received the wrist brace on January 6. 2022.
While waiting for the right wrist brace, I wore the left one as much as I could during the day but not while sleeping because I found it quite uncomfortable to sleep with the brace on. Wearing the wrist brace alone seemed to alleviate the symptoms in my left palm and fingers considerably. However, my right-sided symptoms worsened while I was waiting for the right brace to turn up despite all efforts to minimize repetitive movements of my right hand and wrist, and avoiding doing anything that might aggravate the condition.
When the right brace finally arrived last week, putting it on afforded almost immediate relief. In the past week, I have worn a brace on each wrist for several hours each night while sleeping (even though I find it difficult to get into a comfortable position while wearing the braces) and whenever I felt pain or significant paresthesia during waking hours.
Using a trackpad
Although I got the sense I was gaining control over my bilateral carpal tunnel syndrome, in that my symptoms were not getting any worse, they still persisted and were noticeable, particularly on the right side and when I was not wearing the wrist braces.
I considered several options to reduce the motion of reaching for the mouse but ultimately decided to place an Apple Magic Trackpad 2 between the keywells of my Kinesis Model 100 contoured keyboard, above the thumb key clusters.
Apple Magic Trackpad 2
I received my order for the Magic Trackpad 2 only a few days ago but I have already noticed the ergonomic benefits of having this mouse alternative located closer to the home row keys. Despite the short period of time using the trackpad, my carpal tunnel syndrome has improved on both sides, more noticeably on the right.
In my view, the trackpad has helped to ameliorate my symptoms in a few different ways:
- Reducing the frequency at which I reach for my right-handed mouse. I still use the mouse, e.g. out of habit, when I need more precision than what can be gained with the trackpad, while playing online chess (when I have to make rapid and sudden movements, not possible with a trackpad).
- Allowing use of the fingers of both hands to move the cursor and scroll.
- Keeping the palm, in particular the area over the pisiform bone, of both hands on the cushioned palm pads. To do this, I try to use the middle fingers to move the cursor and the middle and ring fingers to scroll (two-finger scrolling), while keeping my hands in a tented, semi-neutral position. I avoid using the index fingers because I find it unergonomic.
- Minimizing the force required to move the cursor, scroll, and to simulate mouse clicks. The glass on the Magic Trackpad 2 is smooth but not in the same way as that on an iPad – I prefer the texture of the glass panel of the Magic Trackpad 2. The smoothness of the trackpad makes cursor movements and scrolling with my fingers almost effortless. In the Windows 10 Touchpad settings, I selected “Most sensitive” on the drop-down menu for “Touchpad sensitivity”. Although I enjoy Apple’s haptic feedback technology on the Magic Trackpad 2, I try not to use it because it requires my fingers to exert additional force on the trackpad. Multi-touch gestures functionality improves user interface efficiency and reduces movement of my hands and fingers even more.
Alternatives to the Apple Magic Trackpad 2
These were some other options for a mouse alternative I deliberated over:
- Contour Design Rollermouse Red – moving my Kinesis Model 100 farther away from me to make room for a Rollermouse did not appeal to me after several mock-ups. I also considered placing the Rollermouse in front of the keyboard but this would also entail plenty of hand travel.
- Harvesting parts of a retired Logitech Trackman Marble Mouse in my storeroom to place a trackball just north of the right thumb cluster of my Kinesis Model 100 – the trackball would sit relatively high and I was concerned about the possibility of discomfort from repetitive finger movements while moving the ball with my fingers and wrist extended. Use of the trackball would be limited to the right fingers.
- A Ploopy Nano Trackball between the keywells of my Kinesis Model 100 – this configuration would be similar to the previous option plus the trackball, while affording ambidextrous use, cannot be easily reached by the fingers of either hand without lifting the palms off their respective palm pads.
- Mousetrapper Flexible – I have owned a Mousetrapper Flexible for over 9 years and I hate it. Quality issues aside, the ergonomics of this thing leaves a lot to be desired.
The following products were also considered. They all shared the common problem of being unilateral and had product-specific issues.
- Kensington SlimBlade Trackball – unergonomic buttons and its scrolling mechanism may cause excessive movement of my fingers.
- Kensington Expert Mouse – the angle of the device looked uncomfortable and I didn’t like the idea of using its scroll ring.
- Elecom HUGE Trackball – anecdotal reports of quality issues.
- 3M Ergonomic Mouse – anecdotal reports of quality issues, less-than-ideal button placement and scrolling mechanism.
A recurrence of bilateral carpal tunnel syndrome in November 2021 was probably provoked by unusually heavy use of computer mouse and keyboard. The symptoms in my right palm and fingers were significantly worse than on the left side. I refrained from performing strenuous activities with my hands and avoided cycling. In addition, wrist braces and use of a trackpad on my Kinesis contoured keyboard have probably helped.