Writers' Health
Protect Thy Hands
by Martin Zucker

We all tend to take our hands for granted. Yet imagine being without their multiple services: holding, gripping, pinching, twisting, caressing, pulling, pushing, pointing, beckoning, lifting, cutting, eating, wiping, dialing, drawing, sculpting, cooking, cleaning, brushing, making music, playing video games, and, of course, writing.

I had such things in mind when I first interviewed San Francisco hand specialist Robert E. Markison, M.D., for a book I was writing several years ago on preventing arthritis and again for a second interview last year about aging hands. His insights have relevance for all, and certainly for us writers.

Dr. Markison treats considerable osteoarthritis—the common wear-and-tear arthritis generally associated with aging. Osteoarthritis, in fact, affects the hand joints more than any other part of the body. The first joint to give in to arthritis is often the carpometacarpal joint—also known as the basal joint, located at the base of the thumb, just above the wrist. This pivotal joint facilitates countless positions for the thumb and great freedom of motion for the hand.

Osteoarthritis in this joint preferentially affects women—10 to 20 times more than men. Arthritis in the small joints of the fingers tends to be less gender-related.

"The basal joint is a major trouble spot because it is not particularly stable," says Dr. Markison, an associate clinical professor of surgery at the University of California/ San Francisco. "The joint receives a tenfold increase of any force transmitted from the thumb tip, because of the pulling influences of thumb muscles and tendons. The effect is something like holding up the center pole of a circus tent."

The joint comes relentlessly under siege during typical activity—pinching and holding actions and everything from lifting a single piece of paper to tapping your thumb against the computer space bar, clutching the mouse, opening a door or a jar, or turning the key in a door. Daily living becomes difficult or impossible without a healthy basal joint.

"We develop osteoarthritis of the hands from a combination of heredity and a lifetime of use with longer lifespans," says Dr. Markison. "In our contemporary high-speed lifestyle with a broadened scope of the use of the hand in and out of work we accelerate the aging of the parts, including joints.

"No question that someone with the natural progression of basal arthritis who works all day on the keyboard or who is a musician and practices for many hours is likely accelerating the disease. The work activity adds more wear and tear than ordinary. But does that same person surf the net and clutch a mouse at home? Does that same person ride a mountain bike or play racket sports? The variables make it hard to say that the thumb on the space bar or the cello bow was the primary cause.

"We use our hands repetitively and forcefully in and out of work in innumerable ways that create microtraumas to the joints and all this can contribute to the development of osteoarthritis."

Dr. Markison shared many hand-saving tips with me. Here are some to keep in mind:

• How you work at the computer can play a role in avoiding or developing repetitive motion injuries such as carpal tunnel syndrome and muscular strain. Avoid fixed, odd, twisted postures. Strain develops with the head and limbs forward, and the forearms, wrists, and hands twisted into a palm down position. This limb-forward position tightens up the chest wall (pectoral) muscles that overlie a cable of nervous tissue feeding the arms called the brachial plexus. Tightness can affect those nerves and result in tingling in the hands.

• An adjustable chair is essential. Maintain a relaxed, upright position. The backrest should support the inward curve of your lower back. Armrests should support the forearms comfortably while typing and at a height that enables shoulders to be relaxed. Let the shoulder girdle hang loose. Don't work in a shrugged position.

• Adjustable keyboards with split and tilt features help you avoid strained, unnatural positions. Your keyboard should be at the height of your elbow, so that your forearm is generally parallel to the floor and at about a 90 degree angle to your upper arm. The hands should be in line with the forearm, a "neutral" position. Adjust the slope of the keyboard so that your wrists are straight and not bent back. Type with your hands and wrists "floating" above the keyboard. Use a wrist pad only to rest your wrists between typing. Don't rest your wrist on sharp edges. Press keys gently—don't bang on them.

• Keep your hands warm. Cool hands mean less blood flow—with less oxygen and nutrients—to sustain repetitive or forceful use, and can contribute to repetitive strain problems and make arthritic pain worse. Healing and maintenance depend a great deal on blood flow. Put your hands up to your cheeks. If they feel warm, it's a good sign. If not, try these remedies:

• Avoid undue cold exposure.

• Make yourself a pair of fingerless gloves. Cut the tips off a pair of gloves that will still allow you freedom of movement on the keyboard.

• Help your hands eliminate waste products through the lymphatic system by massaging the tips of the fingers up to the elbow with a gentle squeezing action. Do this massage several times a day.

• Stay hydrated. Adequate water intake is important for both joint and overall health, and promotes blood flow to the fingertips.

• Take short breaks. Get your blood pumping. Stretch and move around.

• Change your posture frequently. Shift your load over different muscles. Even slight changes can make a difference.

• Improve your physical fitness. Do yoga or exercise regularly. Many computer users are out of condition. When you take out-of-shape muscles and use them thousands of times a day, doing the same minute hand movements over and over, you set yourself up for injury and extra wear and tear. Fit muscles help prevent problems.
  

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Martin Zucker writes about health. Move Yourself, his latest book, was published by Wiley in 2008.