Success Stories

CRI: Is it Curable?
By V. Srinivas
E-mail: srvarada@yahoo.com

What is CRI?

CRI or Computer Related Injury is an uncommon word in our subcontinent and even in our medical fraternity. It refers to injuries caused due to repetitive stress, incorrect posture and many other factors. I too had heard about it but never really tried to understand it. Who thought that one day I would be writing my own story?

How it all Started?

After a nice weekend it was time to get back to my training. It was a warm and sunny day I had just finished my breakfast and started driving back to my final week of the training session. Hewlett Packard (HP) had just then acquired a Middleware company called Bluestone. My colleagues and I were in Philadelphia on a two-week training on Bluestone's products. One fine morning, on the 7th of May 2001, as I was on my way to the training session I felt some sort of stiffness/numbness in my left hand. As I had kept the car a/c quite cool I thought that it must be some sort of cramps and would probably go away soon.

Even after I reached the training room, the 'cramps' refused to go away. I found it a little difficult to type with my left hand. During the break I tried pouring some warm water on my left hand, but in vain. When I reached my hotel in the evening I tried massaging my left hand, applied some balm but the 'cramps' refused to go away. The problem persisted for rest of the week and I found it harder and harder to use my keyboard and mouse. As I was about to return back to Bangalore, the next week I didn't bother to consult any doctor in Phily.

In search of a suitable doctor

After I landed in Bangalore, I got busy with a marriage in our family. During the coming week I consulted one of the physicans nearby. The doctor put me on a dose of vitamin injections for about two weeks and assured that I would be okay soon. During the course of two weeks I spent quite a bit of my time searching the web and reading about CRI. My symptoms resembled a typical CRI injury like Carpal Tunnel Syndrome. During my next visit to the physician I discussed about CRI and enquired whether I was affected by CRI. The doctor was positive that I didn't have any CRI related symptoms. It was nearly after two weeks of treatment with practically no relief that I was referred to a neurologist.

On my first visit the neurologist conducted some nerve conduction tests. After the test I was told that there was a minor problem in my nerves and was referred to an ortheopaedic surgeon. The orthopedic surgeon examined me and said that there was some sort of inflammation of the muscles in my wrist and asked me to wear a wrist splint (to rest my muscles in the wrist) and put me on a course of anti-inflammatory medication for two weeks. However, even after the medication the problem refused to go away. Meanwhile, I started using more of my right hand for lifting and even typing too. Gradually I started getting pain and tingling in my right hand too. I could no longer drive my car, could hardly type or click my mouse.

My earlier doctor was not available immediately, so I decided to take the opinion of another neurologist. I was again asked to undergo a series of tests like x-ray of my neck/spine, 20-30 blood tests and yet another nerve conduction test. The nerve conduction test is quite a painful test (they use a ENMG machine), a set of electrodes/sensor are placed at various nerve paths (in my case) along the arm (from the fingers to the shoulder and neck). In this test a small current is injected (about 25 milliamps) and it was during this test I realized how painful electric shocks could be. After reviewing the test reports my neurologist asked me not to worry and said that there was a minor problem in my ulnar nerve near my elbow. I was put on a dose of steroids (cortisone) and several other medicines. I took the medicines and even after a month my problem only became worse. I repeatedly consulted my neurologist during this period and I was told that everything would be okay and was asked to continue the medication. I too was puzzled the cause of my problem still remained elusive. The nerve conduction tests were repeated several times during this period.

It was nearly two months since I consulted this neurologist. I had seen no signs of improvement and my problems still remained unexplained. Both my hands were getting worse and I found it too hard to use my keyboard and could hardly work in my office. I decided to take some time off. Another orthopaedic surgeon I consulted in the meantime advised immediate surgery for my nerves. Fortunately, I turned down his suggestion. I also consulted a Rheumatologist who prescribed a battery of blood tests again and more vitamins and painkillers. I developed infections in my nail beds due to immunosuppression caused by a prolonged course of cortisone. I had already visited most of the top Corporate Hospitals in Bangalore and was now getting desperate.

However, I would like to acknowledge the help and co-operation my colleagues during these few months that many a time they took on the burden of writing the documents, making presentation slides, etc. It's an irony that we only realize the kindness of people around us only when we are in trouble! Even my son who was about 3 years old then realized my problem and never asked me for a car ride. I had taken about 4 weeks of sick leave but occasionally used to visit my office for any urgent discussions/meetings. During one of those days TMG Enter (Technology Channel on T.V.) folks interviewed some of my colleagues and me about CRI (I was a perfect fit for their topic).

Subsequently the program was aired and during the program my wife heard about Dr. Deepak Sharan, an ortho surgeon, who spoke about CRI.

Finally it's CRI

I managed to get the 'doctors' phone number and finally met him at his clinic. Dr. Deepak Sharan examined me and concluded that I was suffering from a form of CRI called cubital tunnel syndrome. There was compression of the ulnar nerve near my left elbow. Finally I had found a doctor whose words and suggestions offered me a great deal of comfort. I was told to discontinue all my earlier medications (I had to discontinue the usage of steroids gradually) and do several stretches and exercises, including nerve glides. Dr. Deepak also advised me to get a massaging device (http://www.armaid.com), which is specially designed for CRI patients. I was lucky to get one such device from one my friends in the US.

Dr. Deepak had lent me many CRI related books, which I found very valuable and self-assuring. After reading these books I was more confident than ever that I would be okay soon. Sharon J. Butler's "Conquering Carpal Tunnel Syndrome" and "It's Not Carpal Tunnel Syndrome: RSI Theory and Therapy for Computer Professionals " by Suparna Damany and Jack Bellis were very useful. In addition I found a lot of useful information on RSI from and http://www.ucsf.edu/sorehand/ and http://www.rsiprogram.com.

While Sharon Butler's book describes various exercises for different CRI injuries, Suparna's book provides lots of testimonials and also tries to analyze the causes of CRI. I immediately purchased copies of these books and I continue to refer to them even now.

Dealing with social pressure

It was nearly two months since I had started doing the new exercises and also started using the massager and things weren't getting better. I continued to consult Dr. Deepak every two weeks, he repeatedly re-assured me that it was a matter of time that things would get better. However, it's very often the case that many close friends and well wishers get concerned about you and offer many alternative suggestions like trying other forms of medical treatment. I was very confident that I was getting the right treatment and I would be okay soon, this helped me to ward off pressures from various quarters to try other forms of treatment.

Getting back to work

My sick leave was over and I had to get back to work. I was used to working on the laptop and I realized that the uncomfortable posture while using the laptop was one of the causes of my problem. I immediately switched over to a docking station, got an adjustable keyboard tray, adjusted the height of the monitor so that it no longer strained my neck. I was still not comfortable with the keyboard and the mouse. Even clicking the mouse button was quite painful. I experimented with many tools like an ergonomic keyboard, voice recognition software, a touch pad (instead of a mouse). However, none of them did help. Finally I got hold of some freeware software that mapped the mouse buttons to the keyboard keys and another freeware, which enforced micro-breaks during typing. It's often the case that we stay on the keyboard for long duration's without taking breaks that aggravate CRI and other symptoms. Another important factor that contributes to CRI is that during long working we seldom breath properly, this starvation of oxygen can cause considerable damage to the various muscles.

It was nearly four months since I was doing the exercises and things had shown signs of improvement. My right hand was much better; however whenever I was exposed to cold my pain would increase and things would get worse. The numbness in my left hand still persisted, the pain in my right hand used to go away temporarily and often used to reappear all of a sudden.

The big breakthrough

It was towards the end of December that a couple of friends along with their families and I took a week-long vacation. During the vacation in the valleys of Kuderemukh, we spent most of our time trekking amidst the forests and the lust green valleys. It was an exhilarating experience: the long and often quite hair-rising treks on the steep valleys of Kalasa made me forget everything else in the world.

It was when we reached back home in Bangalore that I realized my right hand was perfectly ok, the pain had disappeared, and the numbness in the left had reduced considerably.

Getting back to normal

It was sometime in January 2002 that the compression in my left ulnar nerve had reduced and I could drive my car. However, I could not lift heavy weight, the muscles in my hand had become quite weak. Dr. Deepak prescribed a few muscle strengthening exercises. I religiously did these exercises for a couple of months and was much better. Subsequently, I was asked to do some exercises with weights. I have been doing exercises with weights since then and a recent nerve conduction test results revealed that most of my ulnar nerve problems were gone.

Looking back

It's now more than 3 1/2 years since I have had the CRI problem; currently I still do many of the nerve glides and other stretching exercises but I am almost back to normal. I write this article so that other computer professions are aware of the severity of CRI and they can take utmost care lest they be victim of it. I also write this article to give hopes to those afflicted by CRI, have patience, believe in yourself, consult an expert when your symptoms first start and you will be back to normal soon.

Very often during their 30's and 40's people do talk about long term investments, savings for their retired life etc. CRI has made me realize that "health is wealth". Invest in your health more than anything else.