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Ergonomics

• There should be negative tilt of the keyboard that is rows of keys farthest away from you should be slightly lower so that while typing wrists are not bent upwards.
• Height of keyboard should be such that wrists are in neutral position while shoulders are relaxed and elbows are bent less than 90degrees.
• Use arm to navigate mouse rather than side to side movements of wrists
• Mouse should be at same height as keyboard by its side.
• Keep fingers and thumb relaxed on the keyboard and don’t use excessive force to activate keys.

Posture

·        Wrist should be horizontal in line with forearm so that wrist is not bent upwards or downwards. More that 15 degrees variation either way increases pressure on median nerve.

·        Middle finger should be in line with the forearm, neither angled towards thumb or little finger.

TIPS TO REDUCE NECK, SHOULDER AND BACK STRAIN

1. Position the monitor in centre, in front of the keyboard so that you are facing it directly.
2. Top of the screen should be at eye level. A screen that is too high or too low will cause awkward positioning of the head, neck, shoulders and back.
3. Tilt your monitor upward so that the base is slightly closer to you. This improves legibility of print and reduces eye strain.
4. Install the monitor on a swivel arm so you can easily make small adjustments in height and distance. Especially if you sharing your computer height of chair must be adjustable.

This is especially for my orthopedic colleagues. I came across this very good article “Primary arthroscopic stabilization for a first-time anterior dislocation of the shoulder. A Randomized, double-blind trial.” J Bone Joint Surg Am. 2008;90:708-721  Published July 2008.

In the recent years there has been lot of debate regarding what to do after first episode of anterior dislocation of the shoulder. Opinion ranged from closed reduction followed by 3 weeks immobilization to primary arthroscopic Bankart repair (repair of detached glenoid labrum). Though many surgeons have shown that arthroscopic lavage of the joint alone benefits patients. There are numerous studies which have shown that traumatic anterior dislocation of shoulder is associated with persistent deficit of shoulder function and a high risk of recurrent instability in young adults.

The above mentioned article was published from Edinburgh, United Kingdom. Authors assessed efficacy of primary arthroscopic Bankart repair and also compared the results with arthroscopic lavage. This study is very well designed double blind prospective trial. It included 84 patients aged between 15-35 years.

Authors concluded in this study in Bankart repair group risk of all instability reduced by 82%. The functional scores were better, treatment costs were lower and patient satisfaction was higher after arthroscopic repair. Regarding cost according to authors initial cost is high because of surgery but subsequently because of recurrent instability no. of working days lost and additional procedures are also required. There fore authors recommended early arthroscopic Bankart repair even after first time traumatic anterior dislocation of shoulder.

Further I would invite comments from my orthopedic colleagues regarding this study and its conclusions.              

there was a patient, a young lady working in BPO industry having recuurent neck pain.  she was started on treatment after which she would become better but after some time she would come back with same complaints. After investigating in detail we found that her pain would precipitate when there was bumpy ride and she would be back from night shaift and siiting in rear seat. this led to conclusion that cab driver who is trying to be on schedule on bumpy roads is sometimes driving fast along with employee who is half sleep and unable to sit erect gets a jerk resulting in tissue injury which cuases pain neck radiating to arms and muscle spasm. i think we can term this as “BPO cab symdrome“. treatment in such cases would be sitting properly in cab and avoiding driving fast and bumpy roads if possible.

Having been a Hand Surgeon for so many years, even today the most common question I come across is “What is Hand Surgery? Isn’t it the same as Orthopedics?”. And finally, I thought why not try and answer this question, and hopefully shed some much required light on why Hand Surgery is in fact a subspecialty of Orthopedics and not the same. Due to my experience with live surgeries and the passion that I possess for this particular field, I have learnt a lot about this field and I hope that this platform will help me share all my knowledge with colleagues and learn from them in the process.

Hand surgery deals with all problems related to the upper extremity and its functioning is much more complex than that of the lower limb. This has led to the need for surgeons specializing in hand surgery. Over the years I have tried to explore this field and also tried to gain expertise on the nuances that make up hand surgery. Over the years, hand surgery has seen a lot of contribution from various fields of medicine, with orthopedic surgeons developing special techniques to handle small bones, plastic surgeons finding new microsurgical techniques for repairing the small nerves and arteries in the hand. Surgeons from all three specialties have contributed to the development of techniques for repairing tendons and managing a broad range of acute and chronic hand injuries. Incorporating techniques from the fields of orthopedics, plastic surgery, general surgery, neurosurgery, vascular and micro-vascular surgery and psychiatry it is a complex and fascinating specialty.

During my career I have dealt with many problems, including a case where the patient was diagnosed with fracture dislocation proximal humerus, and was told that even after surgery he would face considerable pain and stiffness. After I took up his case, I decided to conduct surgery on his shoulder and followed it up with intensive physiotherapy for nearly 9 months and sure enough, he is now pain free and can move his shoulders almost normally. I believe that as a hand surgeon, the extra efforts I have put into learning up about the upper extremity paid off in this case. Just like it is sure to be more effective to go to ENT specialist for a ear infection, or a cardiologist for a heart problem, rather than going to a general physician, it is definitely more fruitful to go to a hand surgeon in case of upper extremity problems, than an orthopedic.

I believe that India is waking up to the importance of hand surgery, especially with the increase in jobs requiring computer usage and overuse of hands for extensive periods. The response to guest lectures I recently gave in New Delhi has been heartening, showing an increase in awareness about this field of medicine. I look forward to opinions from my medical friends and even interested guests who are looking to share some information on this subject. In case you are looking for some advice on endoscopic cubital tunnel release, a surgery conducted for the first time in India contact me. I was extremely thrilled at the success of the surgery and would love to share the experience with you. Feel free to email me and I’ll get back to you as soon as I can. Hopefully my intention of making this blog as a platform for the sharing of information will be a success.

Dr. Vikas Gupta