An injury with a lifelong impact
Two days after getting the idea for my dissertation, I wiped out on the first base line of a wet softball field at UCLA, sustaining a complex comminuted Colles fracture with displacement of my dominant arm. What this means is that you’ve broken off the top of your arm and your arm has “left the building.” Meanwhile, the top of your arm is also broken into little pieces, a phenomenon not so endearingly described in the emergency room as “rice crispies.” Prior to modern medical interventions, this injury created considerable disability because the thumb can no longer provide purchase to permit grasping of objects, leaving the person able unable to work.
Fortunately, the good folks at the UCLA emergency room put my radius back into place, but that was not the end of the story. I completed several weeks of physical therapy at the VA, and the hand therapist there warned me that as I aged, I might hear from this injury again.
Developing Complex Regional Pain Syndrome
Unfortunately, she was right. It turns out that a considerable proportion of people who sustain this kind of injury end up with Complex Regional Pain Syndrome (CRPS), a condition in which the nerves behave as though one is acutely injured. Basically, what can happen is that the nerves that regulate the blood flow to your wrist are injured, resulting in constant ischemic pain and heightened sensitivity to vibration and even airflow (dynamic allodynia). This syndrome used to be known as causalgia (World War I era) and later Reflex Sympathetic Dystrophy. There is no cure, although interventional nerve blocks and medications that increase blood flow to the wrist have worked well for me (these are services available at pain clinics). Even amputating the limb doesn’t work – people still experience phantom limb pain.
Meanwhile as a busy Ph.D. student and then Assistant to Associate Professor, I continued to do many, many hours per day of computer work and handwriting. This – and especially the keyboard and mouse use – created repetitive-motion tendon injuries on top of my fracture history, which by that point included a fracture to my other arm sustained in a freak accident in a volleyball match.
Believing that one could work through pain and focused on my next deadline, I reached a point where my hands would no longer open and close, so that I could not hold a pen, and if I rotated or flexed my wrist, it sounded like a car accident. This sound is called crepitus. It is created when tendons are so inflamed that they can no longer mechanically pass through their sheathes (like oversized pieces of spaghetti going through a straw they no longer fit). In my case, the tendons I injured in both wrists were my extensor tendons – the ones used for reaching, pointing, and grasping. After physical therapy, rest, ice, anti-inflammatories, and cortisone shots didn’t work, it was time for surgery to open up and enlarge the tendon sheathes. The surgery was successful in terms of the mechanics of my hands and wrists, but had no effect on nerve damage and chronic nerve pain. Further, once you’ve had a repetitive-motion injury, it doesn’t take much to make it flare up again, making it essential to find ways to reduce the need to type or take notes by hand.
Learning to live with CRPS
I wish I could say that I learned about all of the equipment and strategies to be described in future posts right after my surgeries, but this was not the case – it took another 3 to 4 years of physical and occupational therapy, efforts to figure out ways to work without typing or handwriting, pain clinic visits to be evaluated and receive a diagnosis for CRPS, and finally, evaluation for a formal workplace disability accommodation and a visit to a state-run assistive technology center to get the tools I needed to continue to work full time.
In the next posts, I will share my tips for using voice recognition and other input technologies for computer work, and then describe some of the social challenges of living and working with an invisible disability.