The assessment and conservative interventions in patients with carpal tunnel syndrome (CTS) are described in this paper. Information about surgical procedures and postoperative care has also been included. It is difficult to make definitive conclusions about the literature regarding success of treatment for CTS due to variations in outcome measures, severity of CTS, and inconsistencies in duration, dosage, and follow-up time for interventions. Based on what is known to date, this author recommends that patients with mild or moderate CTS be provided with a conservative program of splinting the wrist in neutral for nocturnal wear. In addition, intermittent exercise (nerve-gliding exercises) and activity modification, including avoidance of protracted periods of sustained gripping activities and awkward wrist positions, can be useful. This conservative program may be complemented by pain-relieving modalities during times of activity and supplemental participation in other exercise such as yoga. If symptoms are not relieved to the satisfaction of the patient, or they recur, then it is incumbent upon the therapist to refer the patient to a hand surgeon for injection or possible surgical decompression.

J Orthop Sports Phys Ther. 2004;34(10):589-600.

Key Words: carpal tunnel syndrome (CTS), intervention, nerve-gliding exercises

The purpose of this commentary is to present recent epidemiological findings regarding work-related musculoskeletal disorders (WMSDs) of the hand and wrist, and to summarize experimental evidence of underlying tissue pathophysiology and sensorimotor changes in WMSDs. Sixty-five percent of the 333,800 newly reported cases of occupational illness in 2001 were attributed to repeated trauma. WMSDs of the hand and wrist are associated with the longest absences from work and are, therefore, associated with greater lost productivity and wages than those of other anatomical regions. Selected epidemiological studies of hand/wrist WMSDs published since 1998 are reviewed and summarized. Results from selected animal studies concerning underlying tissue pathophysiology in response to repetitive movement or tissue loading are reviewed and summarized. To the extent possible, corroborating evidence in human studies for various tissue pathomechanisms suggested in animal models is presented. Repetitive, hand-intensive movements, alone or in combination with other physical, nonphysical, and nonoccupational risk factors, contribute to the development of hand/wrist WMSDs. Possible pathophysiological mechanisms of tissue injury include inflammation followed by repair and/or fibrotic scarring, peripheral nerve injury, and central nervous system reorganization. Clinicians should consider all of these pathomechanisms when examining and treating patients with hand/wrist WMSDs.

J Orthop Sports Phys Ther. 2004;34(10):610-627.

Key Words: carpal tunnel syndrome, hand/wrist tendinitis, inflammation, neuroplasticity, repetitive-motion injury

Design of computer keyboards no longer is limited to the flat keyboards that are typically shipped with personal computers. Keyboards now exist that are split into halves and these halves can be slanted away from each other (creating a triangle between the halves), sloped downward toward the visual display terminal, tilted upward like a tent, or simply separated. These design features are intended to alleviate discomfort and possible musculoskeletal disorders that have been suggested to be associated with the extensive use of conventional computer keyboards. The geometry of conventional keyboards requires the wrists to be in 10° to 15° of ulnar deviation and 20° of extension and the forearms to be nearly fully pronated while typing. A review of the available experimental data collected on 10-digit touch typists indicates that (1) keyboards with a slant angle (half of the opening angle) of 10° to 12.5° or keyboards with halves separated to approximately shoulder width are both effective in placing the wrist in near neutral (0°) ulnar/radial deviation when typing, (2) wrist extension can be reduced to near neutral (0°) when a keyboard with a negative slope of 7.5° is used, contingent on the wrist rest also sloping with the keyboard, and (3) tilting the keyboard halves 20° to 30° is effective in reducing forearm pronation to approximately 45°. These studies also indicate that experienced 10-digit touch typists readily adapt (within 10 minutes) to these individual alternative keyboard features, and can type with approximately the same speed and accuracy as with the conventional keyboard. While placing the wrist and forearm in a more neutral position could, in theory, reduce the incidence of musculoskeletal disorders, randomized controlled trials are necessary before strong recommendations can be made on the effectiveness of alternative keyboards for the prevention and/or treatment of musculoskeletal disorders. In the absence of these randomized controlled trials, the information in this article provides preliminary guidance to clinicians in their evaluation of computer keyboards and workstations and their recommendations to patients.

J Orthop Sports Phys Ther. 2004;34(10):638-649.

Key Words: alternative computer keyboard, office ergonomics, slant angle, slope angle, tilt angle