As a radiologist, I am in front of a computer for 9 hours at a time on a regular basis, focused my on my computer monitors while holding a dictaphone in one hand and a mouse in the other.
After a 7 night stretch during residency it commonly took several days to fully recover from the physical and mental exhaustion of working nights. But while I would get over my sleep deprivation and the mental fog of fatigue would clear, the achy tightness in my right wrist and forearm would nag for several weeks, sometimes never really recovering before my next week of night shift.
I knew I had a problem the day I was at the community pool, playing with my kids. When my kids were younger, they loved it when I would pick them up by their feet as they stood erect, hovering over the water as if the were surfing.
But one day at the pool after an especially busy week of nights, while holding my son by his feet above the water, I felt a dull pain shoot to into my hand. I dropped my son into the water and winced in pain.
My son thought it was funny to “wipe out” and he quickly swam over to me and asked to go “surfing” again. We tried, but the pain returned. This became a problem I could no longer ignore.
Causes of wrist pain
Before I could find a solution to my chronic wrist pain, I needed to understand the cause. I would say that 95% of my interactions with my computer takes place with the dictaphone and mouse while the other 5% of my computer inputting activities take place with the computer keyboard.
As a radiologist, I understand the anatomy of the wrist and some of the reasons for chronic wrist pain such as carpal tunnel syndrome. The carpal tunnel is an anatomic structure found at the volar aspect of the wrist (the palm side) where the median nerve runs through. The median nerve innervates the first through fourth digits, controlling sensation and movement.
Carpal tunnel syndrome develops due to repetitive overuse of our wrists which causes compression of the median nerve and leads to entrapment neuropathy. Symptoms include weakness and radial pain and tingling of the first through fourth digits, especially at night.
What most people do not know is that carpal tunnel syndrome is not as common as believed by the general public. There is a 10% lifetime prevalence and it peaks in patients of 50 years old. Carpal tunnel syndrome is also seen more commonly in women (males:females = 1:6).
Just because you have wrist pain does not mean you have carpal tunnel syndrome. Most people who feel general pain and discomfort in their wrist and forearms after prolonged use of the mouse likely have more of a strain and fatigue type injury. However, if ignored, this strain can certainly develop into something more serious like carpal tunnel syndrome.
A common injury seen with radiologists is the compression of the ulnar nerve. This is caused when radiologists put pressure on the ulnar aspect of the wrist (the pinky side) using the pisiform bone of the wrist as a pivot when mousing. This causes tingling and numbness in the fourth and fifth digits.
Once you have identified the type of pain you have, the next step is to find a solution. My pain was more of a generalized achiness with some occasional tingling likely associated with compression of the ulnar nerve. By understanding this, the solutions below helped me on the road to recovery.
Wrist Pain Road to Recovery
When I was suffering from wrist pain as a radiology resident, I spoke with colleagues and attendings and found that I was not alone. In fact, many of my colleagues in radiology had suffered from some sort of pain due to chronic repetitive motion such as using a mouse. I was able to then find out what had helped with their wrist pain. I also researched the subject and tried different methods to help ease my suffering. It was during my fellowship training that I found methods that worked for me and I have been pain free ever since.
1. Relax the Grip
This tip was given to me by one of my attendings during residency. As a young resident, and especially towards the end of a shift when the work lists got long and I was most tired, I had a tendency to hold on to my mouse a little too tightly, push down on the mouse buttons a little too forcefully, and turn the scroll wheel with a little more intensity than needed. I did not know if this was done out of frustration or if this was a way to deal with my exhaustion near the end of a shift.
Regardless, as soon as I learned to relax my grip on the mouse, I noticed an immediate difference. If you have a problem with holding on to the mouse too tightly or pushing on the mouse buttons and scroll wheel with too much force, try to relax. I was surprised at how much I could ease up on the mouse and still be able to do my work. It may take a while to train your muscles to relax, but once the problem is realized, a few weeks of constant reminding will break you of this habit.
2. Use a Good Mouse that Fits You
When designing a radiologist’s workstation, there is so much time and money that goes into researching and setting up the system. From the medical grade monitors and powerful processors to the workstation desk– just about every component is scrutinized.
The most overlooked aspect of the radiologist’s workstation is the way the radiologist interacts with the computer. Chances are, you are using the $3 stock mouse and keyboard that were shipped with the computer from the vendor as an afterthought.
It amazes that while so much money is spent on setting up a high end workstation, so little money and thought is put into the actual devices the radiologist physically use every day to interact with our computers, namely the mouse and keyboard. It should be no surprise that radiologists who work at a computer for a living that using cheap computer peripherals often leads to chronic wrist pain.
A good mouse is like a good pair of shoes. Find one that fits you well and feel comfortable in your hand. Since radiologists often work at multiple locations, get a mouse that you can take with you wherever you work so you can just plug and play. A new mouse will also act as a reminder to loosen your grip and improve your posture.
A wireless mouse allows you to switch mouse hands more easily, another very helpful strategy to reduce fatigue (see below).
The advantages of a wired mouse include not needing batteries or recharging, it is harder to lose, and you doesn’t run the risk of forgetting the USB receiver if you rotate between multiple locations.
The gaming community has developed some pretty fancy mouses and some of those mouses transition very well to radiology. There is no need for all the extra flashy lights that some gaming mouses have which can be distracting. But if you are willing to learn, many gaming mouses come with internal memory to store macros so that you can program specific functions for each battery.
My favorite wireless mouse for most people is the Logitech G703 LIGHTSPEED Gaming Mouse
3. Good Keyboard
Since radiology reports are dictated, there is very little typing compared to mousing. Therefore a keyboard is less vital when trying to alleviate wrist pain for the radiologist. The feature I find most helpful in a keyboard is having an illuminated keyboard. This is very helpful when you are looking for those hot keys/ keyboard shortcuts in those dimly lit reading rooms. Oh, and using those keyboard short cuts can really help to reduce wrist fatigue.
I have had my backlit keyboard by Logitech for my home workstation for 5 years now and love it. While the model that I own is still available, it seems that this Logitech Backlit Keyboard
4. Take Breaks
Taking a break is important. But taking frequent breaks can be impractical as there are pressures to be productive and to keep the queues from getting out of control. There are things that radiologists can do is give their right hand a break from its mousing duties, keep reading below.
5. Switch Hands and Become Ambidextrous
This was probably the most helpful tip when I was suffering from wrist pain. During undergrad and medical school, I challenged myself to take notes with my left hand during class, especially when things got boring. This did two things, it helped me to focus and it kept me awake.
During residency, I realized that my left handed colleagues used a mouse with their right hand (non dominant hand) just as adroitly as those using the mouse with their dominant hand. Therefore, I decided to try using the mouse with my left hand (non dominant hand) just like I had taken notes in college and medical school with my left hand.
It will feel awkward and uncomfortable at first. Try brushing your teeth with your non dominant hand tonight for a similar feeling– very frustrating. But I started easy with plain films and Ultrasound exams where the mouse movements are fairly simple. Once I started to get the hang of it, I moved on to reading cross sectional imaging with the mouse in my left hand.
Eventually my non dominant hand became as good at mousing as my dominant hand. Now I routinely switch off between the two hands during the work day. The only awkwardness is when other radiologists come to use my workstation and find that the mouse is to the left of the keyboard. I am often asked if I am left handed.
There is no rule that says you have to mouse with your right hand. Train your left hand when you get the chance. Eventually, the left hand will improve and whatever time you use your left hand to mouse is time that your right hand can take a break and work on the dictaphone.
If you are splitting the time 50/50 mousing between your right and left hands, that is 50% less wear and tear on your right hand which can lead to twice the longevity of your right hand’s mousing career.
6. Exercises
There are various stretching exercises that you can find on the internet and on YouTube. I’ve tried many of them in the past and I still stretch my forearms during long stretches of work.
Rock Climbing is fun with the kids and good for your forearms.
Surprisingly, what helped a ton with my wrist pain during my training was when I got involved at a rock climbing gym during fellowship with some of my wife’s cousins. I thought rock climbing would wreak havoc on my sensitive right wrist, but I found the opposite to be true. After the initial soreness that I felt after the first few times I went climbing, to my amazement, I noticed that the fatigue and ache I felt in my wrist and hand when at work subsequently went away.
While I have no peer reviewed literature to support my work, I firmly believe that indoor rock climbing on a weekly basis for a year stretched and strengthened key muscles in my forearms, wrist and hands. In addition, the kids loved to go with me and climb on the weekends.
Since finishing my fellowship training and moving away from my climbing crew, I rarely climb, but that year of strengthening and stretching my upper extremities, especially my forearms, wrists, and hands was like a year of physical therapy which really helped me to overcome my wrist pain issues.
7. Positioning
It is important to adjust your table and armrest to the correct position to decrease fatigue. The mousing hand should remain just below the level of the elbow and no pressure should be placed on the wrist. Radiology workstations are highly adjustable. Adjust your table and chair so that your wrist is below the level of your elbow.
When using a mouse, it is common to rest the wrist on the desk and extend the wrist. The wrist is then used as a pivot point. Unfortunately, over time this puts strain on the carpal tunnel or ulnar nerve. Be aware of this and try to mildly flex your wrist putting gentle pressure on the palm of your hand. Instead of using the wrist as a pivot point, use more of the whole upper extremity to navigate those CT scans.
I will often see radiologists using a gel pad affixed to their mouse pad. I am not a fan of gel pads fixed to the mouse pad. While it helps to decrease inappropriate extension of the wrist, it encourages using the wrist as a pivot point, putting unnecessary stress on the wrist.
8. Use Computer Hot Keys
If you suffer from wrist pain, any time you can give you hand a break from the mouse you are prolonging your radiology career. Instead of using the mouse to interact with the computer as you read studies, learn the hotkeys and shortcuts to change window levels and to toggle between different series or sequences.
Even something as simple as knowing how to copy and paste using the keyboard shortcuts will give your wrist a small respite. Also, having good hanging protocols so that you don’t have to rearrange every CT and MRI each time you open a study is also a big help.
9. Decrease Computer Time
If you are like me, you probably are in front of the computer for extended periods of time outside of work as well as at work. While quitting your job is not an option to decrease your computer time, finding ways to limit the repetitive mouse motion when not at work may be a possibility.
Wrist pain was one of the reasons I retired from making my medical cartoons. If I was spending 9 hours a day working in front of a computer. Then, as a hobby and means of extra income, I would be at home in front of my computer making medical comics (see my medical cartoons here). I needed a hobby that gave me a break from the computer so that meant no more cartoon making as well as no more PC gaming.
Luckily, a hobby I stumbled upon not only took me away from the computer it was therapeutic for my wrists and forearms. See wrist exercises section above. I also found ways to express the artist in me by getting into woodworking. If your extracurricular activities involve a lot of computer time, see if you can find alternatives or ways to decrease that computer time.
10. Don’t Ignore the Problem
Ignoring the problem is the worst thing you can do. If you find your hands and wrists are giving you problems, take action now, before things get serious. Most of these recommendations that worked for me are simple fixes so long as you remember to employ them.
Improving your positioning, easing up on the mouse grip, and using keyboard shortcuts just takes reminding to break yourself of old habits. Practice using your left hand to control your mouse will be a struggle at first. It will take effort but I am an example that it can be done. Finding a more comfortable mouse that fits you better may also provide a good reminder of your new goals to help save your wrists.
Your career depends on your ability to interpret medical images and your hands and wrists are vital to your success. If you have other successful strategies that have worked for you, I would love to hear them in the comments.