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 order to generate movement 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.
Marji Hajic is an Occupational Therapist and a Certified Hand Therapist practicing at the Hand Therapy & Occupational Fitness Center in Santa Barbara, California. For more information on hand and upper extremity injuries, prevention and recovery, visit Hand Health Resources.