How to host Thanksgiving Dinner with a Hand Injury

How to host Thanksgiving Dinner with a Hand Injury

The American Society for Surgery of the Hand has published some good tips on avoiding a hand injury while preparing your Thanksgiving meal (ASSH.org; Turkey Carving Safety). But…. what if you already have hand pain from a tendinitis, or arthritis, or carpal tunnel syndrome, or a recent hand or wrist sprain/fracture/injury?  Anticipating a full day of hand intensive activity when you are already in pain can be intimidating and anxiety-producing. Here are some survival tips to help those with hand injuries host the big event  without increasing pain. 

  1. Ask for help. Although this seems like common sense, it is often hard for a host to request help from his or her guests.  However, most family and friends would be more than happy to lend (a literal) hand. And don’t some of the best holiday moments actually take place in the steamy, fragrant kitchen?  Generate a party atmosphere -sipping something bubbly while chatting and sneaking food tastes- all while sharing the tasks of chopping, stirring and dish washing. Enlist someone who is strong and injury-free to lift the turkey out of the oven or perform the turkey carving. When someone offers to help with the dishes, accept gracefully. 
  2. Cut corners.  Less work=less hand stress=less pain. Thanksgiving should be about enjoying time with family and friends.  However, often Thanksgiving becomes all about the food. Large quantities of food. So much food, that we are obligated to overeat.  Be creative in finding ways to minimize the amount of work you actually need to do. Would anyone really be heart-broken if there were  fewer dishes on the table (as long as Mom’s famous stuffing is front and center)? Would anyone know if you used onions that were purchased already chopped?   Or if that apple pie was made from pre-sliced apples and prepared pie dough? Or, better yet, bought at a local bakery?  How about throwing tradition out for one year and planning a potluck?  Or purchasing a packaged dinner from the grocery store?  Could you use bottled gravy?   Can the butcher pre-cut the turkey so that smaller and lighter pans can be used for cooking?  Or, if it’s a small gathering, how about purchasing a turkey breast rather than the whole beast?
  3. Preparation is key. Plan ahead so hand intensive and possibly pain producing activities can be spaced out.  Design a menu that allows you to perform some early meal preparation over the 2-3 days preceding the holiday. Include house cleaning tasks and preparation into your Thanksgiving plan as well.  Perform heavier activities early in the week and complete only 1-2 a day.  The more you can pace your activities, the less physical and emotional stress on Thanksgiving day. 
  4. Gadgetize.  Dust off those kitchen tools. Use food processors, electric can and bottle openers, even an electric knife to reduce physical stress on the hands. 
  5. Minimize.  Ease stress on the body by following some general principles of joint protection and energy conservation: use leverage rather than grip (such as those “Y” shaped bottle openers); push rather than pull; slide rather than lift (use a dish towel on the counter to slide heavier pots and pans closer to the stove so you don’t have as far to carry them); use comfortably bigger and cushioned handles (the Oxo kitchen tool line is a good example). 
  6. Be practically festive.  Bring in some holiday cheer with a themed paper tablecloth and napkins (less laundry) and sturdy, decorative paper plates and paper or plastic glasses and stemware (fewer dishes). 
  7. Take time to care for yourself.  If, in spite of all your preparation and planning, your hands are more painful or swollen by the end of the day, sit for a few minutes, put your feet up and apply a cold pack.   Perform only the most necessary clean up. And aim to have a relaxing day the following day. Intending on carrying a bunch of shopping bags on Black Friday?….although fun, perhaps not the best timing for the hands.  

Wishing you and yours a healthy and happy Thanksgiving. 

Best, Marji

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The Wrist & Repetitive Strain Injuries

The wrist joins the hand to the forearm. It is able to move forward and back, side-to-side, and in circular movements. This variety of motion allows the hand to reach objects and function in a wide range of motion. In addition, a strong and stable wrist is important during grip activities.The wrist is a complex joint where the two long bones of the forearm meet the eight small carpal bones of the wrist. These carpal bones are essentially arranged in two rows of 4 bones. The eight small wrist bones then meet the five long finger bones in the palm of the hand. Most of the muscles that move the wrist, fingers and thumb are located in the forearm. The tendons (the cords that connect muscle to bone) that bend and straighten the wrist and the fingers must cross through the wrist joint on their way from the elbow towards the hand.Many of the repetitive strain injuries associated with computer work occur at the wrist. In fact, according to the National Occupation Research Agenda for Musculoskeletal Disorders, the most frequently reported upper-extremity musculoskeletal disorders affect the hand and wrist region.

Carpal Tunnel Syndrome is the most commonly diagnosed nerve injury in the arm. The nerves are the power cords for the arms, providing strength to the muscles and sensation to areas of skin. Carpal tunnel syndrome is the compression of the median nerve as the wrist as it passes from the neck to the fingers. Carpal Tunnel Syndrome can cause pain at the base of the hand and in the bulky muscles in the palm right below where the thumb meets the palm. Also, people often say they feel as if they have a tight band around their wrists. Numbness in the thumb, index and middle fingers is common. The pain may feel as if it is traveling up the arm and into the shoulder and neck

Pain where the thumb meets the wrist may be caused by a tendinitis of the muscles that pull the thumb back (as if you were hitchhiking). People who type tensely are prone to developing this tendinitis as they hold their thumbs over the keyboard with tension. Pain at the base of the thumb can also be caused by arthritis in the joint where the long palm bone meets one of the tiny wrist bones of the thumb.

Tendinitis of the wrist and finger flexors (the bending/closing muscles) and extensors (the straightning muscles) and benign ganglion cysts also occur fairly frequently at the wrist.

RSI Prevention

  • Maintain a neutral wrist position.
    • The wrist should be flat in relationship to the forearm; it should not be bent forward or back.
    • For each 15 degrees that the wrist is out of alignment, the pressure on the median nerve increases.
    • The middle finger should be in alignment with the forearm, not angled toward the thumb or the small finger.
    • Wrist supports can provide proper positioning during the night.
    • Do not fight against a wrist support. It is better to remove the brace and perform activities carefully than to wear a brace that prevents necessary movement.
    • Softer, neoprene braces without the rigidity provide support but also allow for some movement and may be a better choice is the task requires wrist movement.
    • Using a wrist brace can cause the body to compensate for loss of motion by moving the elbows differently. Monitor for a shift in pain symptoms in other body areas.
  • Ergonomics
    • Using a split keyboard can align the wrists into a more neutral position.
    • Try a negative tilt of the keyboard where the row of keys closest to you is slightly higher than the row farthest away.
    • The keyboard height should allow the wrists to be neutral while the shoulders are relaxed and the elbows are open slightly greater than 90 degrees.
    • Use the upper arm to manipulate the mouse. Do not activate the mouse by using side-to-side movements of the wrist.
    • The mouse should be located by the keyboard. Do not reach forward to activate the mouse positioned on a different level than the keyboard or positioned out of easy reach.
    • Keep the fingers and thumb relaxed on the keyboard. Use only the minimum necessary force to activate the keys. Do not float the fingers stiffly over the keyboard.

And It Hurts…Here…Because? Ergonomic Recommendations

The location of where you are experiencing pain while working at a desk or on a computer can often give clues as to what needs to be adjusted during an ergonomic intervention.  Here is a quick guide of worksite and work-method recommendations that may help when you are feeling pain in a specific area.

Finger Pain – May indicate arthritic joints, a trigger finger, or strain from overuse.  Avoid squeezing the mouse too hard or pounding the keyboard.  Keep a light touch when typing.  Hold your pen lightly when writing.

Thumb Pain– May indicate a trigger thumb or DeQuervain’s Tenosynovitis.  Often occurs from either squeezing the mouse too hard or from tensing the thumb (as if hitch-hiking) over the keyboard keys.  Keep the thumbs relaxed using only the minimal amount of force needed to control the mouse.  When typing, keep the thumbs relaxed and just hovering over the keyboard.  Don’t pound the space bar.  Also, when writing, use a larger-barreled pen and don’t squeeze the pen too tightly.  Keep the thumb tip relaxed and only slightly bent – it is common for people write with their thumb tips bent at an extreme angle.

Wrist Pain or Pain at the Base of the Hand/Thumb– May indicate a tendinitis where the wrist muscles attach (flexor or extensor tendinitis), DeQuervain’s Tenosynovitis, or Carpal Tunnel Syndrome.  These are often caused by swiveling the mouse in or by poor wrist positioning.  Keep the wrist neutral (flat – not bent forward or back or angled side-to-side; the middle finger should be in a parallel line with the forearm).  Initiate small movements to control the mouse from the elbow and shoulder.   Don’t squeeze the mouse too tightly – use only the minimal amount of force necessary to control it.  Check your keyboard size and fit.  Pain over the small finger side of the wrist is often caused by the outward angulation of the wrist required to rest your hand on the home keys.  Using an ergonomic split keyboard is a quick-and-easy way to provide neutral wrist positioning.

Elbow Pain – May indicate an inflammation where the forearm muscles attach into the upper arm bone at the elbow – Medial or Lateral Epicondylitis.  Can also be caused by several nerve compression syndromes that occur near the elbow – Cubital Tunnel Syndrome, Radial Tunnel Syndrome.  Check out the positioning of the keyboard height and mouse location.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may need to change positioning by lowering the keyboard surface or getting in closer to your desk.  The elbow should not be bent at more than a 90 degree angle while using the computer.  A mouse that positions the arm in a more neutral “hand-shake” position may also be helpful.  Don’t swivel the mouse from the wrist.  Also, keep the hand relaxed on the mouse and use only the smallest amount of force necessary to activate the mouse click.  Don’t hold the index finger stiffly over the mouse (as if pointing) and don’t pound the mouse buttons, especially with a straight finger.  Rather, keep the index finger slightly bent and lightly touching the mouse.

Shoulder Pain – Often caused by reaching forward for long periods of time for the keyboard or mouse.  When working at a computer, your ear, shoulder and elbow should be stacked in a vertical alignment.  If your elbow is not relaxed at your side, you may be reaching forward causing strain on the arm muscles.  It takes work to hold the arm in this position for long periods of time even if the work itself is not too forceful.  To keep the upper arm muscles more relaxed, you may need to lower the keyboard surface or get in closer to your desk.  Check your chair.  Are you sitting back in the char?  Does it provide proper lumbar support and seat depth?  Look at the arm rest height.  You may need to lower the arm rests in order to keep the shoulders relaxed.

Neck Pain, Eye-Strain & Headaches – Often caused by poor positioning of the monitor.  Position the monitor directly in front of the keyboard so you are not twisting the body while using the computer.  Check out the height and distance of the monitor.  It may need to be adjusted so that you can clearly see the monitor print without tipping the head forward or back.  Avoid using bifocals while on the computer.  If you work extensively from copy, keep the copy in front of the monitor or directly to each side.  Use a tray that holds the copy close to monitor height to avoid repetitively looking up-and-down from the copy to the monitor.  Use a phone headset to avoid cradling the phone between the shoulder and the ear if you need to type and talk at the same time.

A Quick Comparison of Carpal, Cubital and Radial Tunnel Nerve Compressions

Three peripheral nerves provide power and sensation to the hand and arm.  The following is a quick comparison of the most common sources of pain caused by compression syndromes of these nerves.

nerve paths

Carpal Tunnel Syndrome

  • Nerve Affected:  Median
  • Location of Compression:   Wrist
  • Numbness and/or Tingling:  Usually in the Thumb, Index, Middle & Half of Ring Fingers
  • Pain:
    • Usually in the Thumb, Index & Middle Fingers
    • A band of pain around the wrist
    • Pain in the muscles at the base of the thumb
    • Pain radiates up the forearm
  • Likely Cause (activity related):
    • Frequent gripping/squeezing/holding of tools
    • Gripping or pinching tools or objects for a period of time
    • Finger movement with the wrist held at an awkward angle
  • Prevention:
    • Avoid sustained or repetitive grip and pinch
    • Maintain the wrist in a neutral (straight) position with activity
    • Avoid leaning on or putting pressure against the front of the wrist of the base of the hand
  • Splinting:   A wrist brace that  holds the wrist in the neutral (straight) position at night

Cubital Tunnel Syndrome

  • Nerve Affected:  Ulnar
  • Location of Compression:   Elbow
  • Numbness and/or Tingling:  Usually in the Ring & Small Fingers
  • Pain:
    • Usually in the Ring & Small Fingers
    • Pain in the hand muscles on the small finger side of the hand
    • Pain radiates up the forearm and into the elbow along the small finger side
  • Likely Cause:
    • Leaning on the elbow or pressure against the forearm along the small finger border
    • Frequently bending and straightening the elbow, such as when pulling a lever
    • Holding the elbow bent for long periods of time, such as when sleeping or holding a phone to the ear
    • Forceful elbow extension (straightening) activities, such as rowing, gym activity, push-ups
  • Prevention:
    • Avoid leaning on the elbow or putting pressure on the forearm muscles
    • Avoid holding the elbow bent more than 90 degrees for any length of time
    • Avoid repetitively bending and straightening the elbow
    • Avoid repetitive or forceful elbow extension activities
  • Splinting:   A soft pad or elbow support that holds the elbow in a mostly straight position at night

Radial Tunnel Syndrome

  • Nerve Affected:  Radial
  • Location of Compression:   Muscles on the back of the forearm near the elbow
  • Numbness and/or Tingling:  Uncommon
  • Pain:
    • Usually in the elbow and forearm muscles
    • Pain may radiate down the arm into the wrist and the back of the hand
    • Pain may radiate up the arm towards the shoulder
  • Likely Cause:
    • Computer mouse activity, swiveling the wrist and forceful mouse “clicking”
    • Holding the fingers tensely extended over the computer keyboard
    • Forcefully bending the wrist forward and back
    • Repetitive twisting movements, such as when using a screwdriver
    • Carrying or lifting heavy objects, particularly with the forearm pronated (palm rotated down)
  • Prevention:
    • Maintain the wrist in a neutral position while using the computer mouse
    • Don’t hit the keys or click the mouse forcefully and keep the fingers relaxed over the keys and mouse
    • Avoid repetitive and forceful wrist movements or twisting movements
    • Avoid heavy lifting, especially with the palm facing down, such as carrying a suitcase or heavy briefcase
  • Splinting:   A wrist splint that holds the wrist neutral may be helpful when performing stressful activities