Wrist Update

by jefftkjefftk1 min read29th May 202111 comments

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It's been about a year now since my wrists got really bad. Unfortunately, it's no longer limited to just my wrists: I'm having similar issues with my hands. Last time I wrote about how my doctor thought that this was likely due to ganglion cysts, but since then we've done more imaging and that looks like it probably isn't the problem. After talking to a rheumatologist, it looks like [1] it's probably a kind of inflammatory arthritis, which is a chronic autoimmune disease.

So far, the only things that have helped have been minimizing use and icing (flexible wrist packs are nice!). I've tried two nonsteroidal anti-inflammatory drugs (NSAIDs), Ibuprofen and Naproxen Sodium, without effect. I'm about to start on the immunosuppressant methotrexate, which I have mixed feelings about, but positive on balance.

I'm still doing lots of dictation, but I haven't needed to continue with voice control. When using the computer/phone, as long as I dictate words, I've been able to still use my hands for navigation. The biggest problem is when I have substantial tasks that aren't just reading and writing, such as spreadsheet work or green-field coding. Luckily this is only a very small portion of my regular work, and I've been doing fine there, though I'm not sure what dictation will look like once I'm back in the office. I'm back to playing music, which I'm really happy about, but no jammer or fast melody.


[1] My understanding is that the diagnosis is primarily based on the appearance of my hand and wrist bones under x-ray. My joint spacing is narrow and my bone density has decreased, especially in my wrist. Comparing x-rays from 2020 and 2018, it is most apparent in 2020 but 2018 also showed the issues. They ran a lot of blood tests, which were all normal, including testing negative for rheumatoid factor, cyclic citrullinated peptide antibodies, sedimentation rate, and c-reactive protein. No visible swelling, but substantial stiffness in the morning—I initially didn't report this is a symptom, because I'd assumed this is just the way hands are in the morning. Since I also have some persistent dry scaly patches of skin, they thought most likely psoriatic arthritis. Possibly something I've had since a kid, since some kinds of juvenile arthritis can cause tendonitis-like symptoms.

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It seems like you went to a bunch of doctors and they couldn't help you but didn't go to other professionals that might help. Osteopaths and Alexander Technique teachers would be two classes of experts that are widely available and might help. 

I would highly recommend seeing David Bacome (based in SF). I had really bad wrist problems which he was able to fix (and teach me how to keep them from getting bad again) after doctors had me do useless exercises that didn't help at all.

Hey Adele, could you please summarize (or link to) the exercises that helped you? I'm having wrist problems as well and I've found that cycling through a wide range of exercises helps

Sure! There's not really a specific exercise as much as a method for dealing with issues. The following is just my interpretation of what he taught me in person, so YMMV.

If you move your hand/wrist/arm around, you can usually identify a configuration where there's a threshold at which it "catches" and starts hurting noticeably more. Then you keep your arm fixed at that position, and make small motions along each of your wrist/elbow/shoulder joints one at a time, to identify where the issue is:

  • wrist movement crosses threshold --> issue is in your forearm
  • elbow movement crosses threshold --> issue is in your upper arm
  • shoulder movement crosses threshold --> issue is in your back or neck (typically near the shoulder blades or up your armpits)

You should also be able to feel what side the pain is on, and so (still keeping it at the threshold configuration) you gently press in that area with your other hand until you identify an especially tender or "knotted" spot (it doesn't always hurt, I often have to go by feel). Then you try to put a shear force on this area, as if you're trying to move the overlying muscle or tendon out of the way for whatever is below. While holding it out of the way, you try slowly moving your arm past the threshold again. If successful, it will be further out than before (and if not, you probably have the spot a little off, or aren't putting the right kind of force on the area, so experiment a bit to find what works). You'll want to keep moving your arm back and forth across the former threshold, making sure to move all three joints in the process. Then you can release the force and ensure that the threshold remains at the new location (and if not, reapply the force and move through it more).

It can help to have a partner to apply the force, since it is sometimes is required in really hard to reach locations.

By the time you're having serious wrist issues, you likely have issues in several locations all along your arm, back and neck. It seems to be easier to start with the issue nearest to your hand first, and work your way up (sometimes requiring you to go back down as a new issue surfaces). It's common for fixing one issue to make new issues apparent. With David, I've also experienced sudden numbness/pricklyness, or sudden hot or cold in a strangely specific part of my arm, but I don't experience these when doing it myself.

I don't have a great model for what these issues actually are or why this technique helps, but I do appreciate the kinematic approach to the problem. David says it may have to do with the overlying muscle putting excessive pressure on the tissue below, causing the tissue to get inflamed, which then causes a high-friction point when moving in certain ways. I think there is likely more to the story than that, but I don't know enough about the anatomy to say what.

Hope this is able to help you.

Thanks for describing this in so much detail!

(Unfortunately, it's also enough detail for me to tell that this is pretty different from what's going on for me.)

FWIW I find Dragon Professional (from Nuance) excellent at dictation (even in noisy environments), and last time I checked a couple of years ago it seemed to be rated rather better than anything else.

You previously wrote that you were looking for a better solution to dictation than Google Keep - have you found anything else that works well?

Hi Jeff, I highly recommend checking out "trigger point therapy", specifically the "Trigger Point Therapy Workbook" by Clair Davies (~$20 online, third edition is best). The thesis of the method, based on research by Janet Travell (known in part for having been JFK's personal physician) is that much joint/soft-tissue pain is referred from small muscular contraction knots in other parts of the body, and that the pain can be fixed by finding those knots and massaging them. I used to suffer from a wide range of chronic pain (elbow, knee, ankle, wrist - you name it), and I would say that self-applied trigger point massage as described in the book I mentioned has reduced the severity of my problems by ~80-90%. I understand that you might be skeptical, and of course there's no guarantee that it will help you the same way it helped me, but from what you've described it seems like the bet of a few dollars for the book and a few hours of your time to read it might be one worth making.

It sounds like there is a common thread of inflammation / autoimmune aspects over the couple of posts I have read through regarding your wrist issues.

Out of curiosity, have you experimented with your diet? I only ask because I haven't seen you mention this.

There is a huge area of nutrition dealing with how modern processed foods causes inflammation, doesn't have certain needed stuff, etc. A few books that have been helpful to me: AntiCancer by Dr. Servan-Schreiber and Nourishing Traditions by Sally Fallon Morell.

Potentially there is some exacerbating inflammatory factor at play here?

 

P.S. - I also wound up with a non-standard mouse configuration over the years for similar wrist pain issues.

I currently use a Kensington Orbit trackball (I like the scroll ring) with my left hand, and an AutoHotkey script which remaps Print Screen [left], Scroll Lock [middle], and Pause [right] clicks. Bonus: it handles button holds also, so dragging is no problem. I also added CapsLock + J,K,L,; as my own version of the Vim cursor movements, plus a couple others for Home/End [U, I], Windows desktop switching [O, P], etc.

For Mac there is a program called Karabiner-Elements which can do the same things.

I know it’s a complete meme but have you given CBD a try? Also, I imagine the swipe feature on keyboards on phones/tablets would be a fair bit less irritating

Oof. As a fellow chronic arthritis haver, I'm sorry that you're dealing with this. I also get relief from compression gloves and mild movement in the morning.

I hope your new treatment is useful.