The Rise and Mysterious Fall of Carpal Tunnel Syndrome

Working with a computer sometimes means getting hurt. Or at least it used to.

For thousands of office workers in the 1980s and 1990s, typing on a keyboard and working with computer mice and other peripherals (like screens) brought on a little-understood condition called RSI, or repetitive strain injury.

In the United States, 61 percent of all workplace-injury claims were related to RSI in 1990. Congress called for hearings in the late 1980s, and the issue became such a major concern to the Occupational Safety and Health Administration that RSI was predicted to become the “the No. I occupational hazard of the 1990’s.”

According to Ellen MacEachen, a professor in the School of Public Health Sciences at the University of Waterloo in Canada, many bosses had to learn to accommodate their employees, and many did. Extra breaks, the use of customized keyboards, even the development of early voice-to-text software helped. Others thought the problem wasn’t nearly as bad as it was perceived, or that RSI was all in workers’ heads. According to one expert on the phenomenon, “a lot of scoffing” was what some bosses did, in response.

But white-collar workers disagreed. As The Los Angeles Times reported in the summer of 1989, “It has struck thousands of office workers who use computers for a living, from telephone operators and data-entry clerks to newsroom reporters and editors. About half of the nation’s 40 million office workers use a computer terminal daily.” What afflicted them was real, and it really hurt.

“Ergonomics” became a byword, and experts in it became popular as companies sought ways to combat this expensive and controversial phenomenon. In the United States, the Occupational Safety and Health Administration (OSHA) also pushed new standards for office workers that focused on proactive, preemptive interventions across a number of industries (not just office work), before RSI injuries became especially damaging. Workers also educated themselves, requesting more ergonomic keyboards, wrist braces and rests, and even funny-looking mice manufactured by companies such as Logitech (though some got pretty weird-looking indeed).

Despite these improvements and accommodations, RSI continued to plague workers. By the mid-1990s, according to one report, “approximately 60% of all occupational injuries were caused by repetitive strain,” with a further 22 percent of those diagnosed with RSI and related conditions experiencing eight or more years of symptoms. In some extreme cases, steroid injections or even surgery were necessary to restore even partial function, and in other cases, workers had to stop using mice and keyboards altogether.

But for mysterious reasons, RSI’s ubiquity seemed to dissipate by the late 2000s, and by the 2010s, it was comparatively less common, at least compared to 30 years before. Today, the CDC reports that about nine percent of adults experience some form of RSI, with just under half having to restrict their movements as a result. While that’s still a serious number and it does matter to those afflicted, it’s not the same as the workplace epidemic once predicted.

So, what happened?

As a media historian, I’m interested in how regular people respond to the introduction of new technologies. Because it’s an example of how tech can actually hurt people physically, I’ve been intrigued about the “origin story” of RSI.

The Osler Library of the History of Medicine at McGill University in Montreal, Canada is one of the best places on our planet to find the answers to weird medical mysteries, since it contains some of the most esoteric and interesting medical records imaginable. Perhaps their archives would reveal where RSI had come from — and if it predated the use of desktops, laptops, and computers themselves.

Two medical guides from the late 19th and early 20th century highlighted a new medical issue: clerical workers’ wrists getting strained from what was called “writer’s cramp,” which can still happen to someone today if they write in longhand for hours on end. Doctors responded by recommending that their patients use typewriters, since these fairly new machines were thought to ease the symptoms.

But then they found — perhaps not shockingly — that the use of the keyboards on typewriters could also cause injuries, or, as one guide from 1916 put it: “a new form of occupation[al] neurosis.”

Typewriters, computers, and their keyboards went on to cause injuries to office workers in the mid-to-late-20^th-century, as technology historian Laine Nooney has found, with some of this blamed on what doctors at the Cleveland Clinic dubbed “carpal tunnel syndrome” (CTS). Perhaps the most prominent proponent of this “new” injury was Dr. George S. Phalen, who studied it extensively in the mid- to late-1900s. According to medical historian Allard Dembe, Phalen thought that carpal tunnel was a condition that was mostly related to the supposedly delicate wrists of housewives. As a prominent expert on hand injuries — he served in the U.S. Army’s medical service during the Second World War — his influence on the medical field was immense in the early Cold War. He helped to define CTS for several generations, especially after he became the chair of the orthopedic section of the American Medical Association; his diagnostic technique became known as the “Phalen Sign.”

Of course, carpal tunnel was neither new nor something that plagued only women. The connection between it and RSI remains somewhat mysterious, both in the 1980s and today. RSI and carpal tunnel have become synonymous for the lay person, even if medical experts can still tease out differences that arise when tracing the actual point of injury, the role of the workplace environment, and each person’s individual susceptibility to occupational injuries.

Regardless of whether we call it RSI or carpal tunnel syndrome, these maladies faded from the forefront of the public’s consciousness as more ergonomic equipment, the larger role of mobile devices, and an emphasis on posture and taking breaks became commonplace earlier in this century. But they’re still around and will likely linger as long as keyboards and mice are used. It didn’t so much vanish, as it became less critical. As media historian Meryl Alper has explained, our devices have become more diverse in terms of how our bodies interact with them — including our voices and even eyes. What was once a strictly keyboard and mouse interaction is now spread out more. And keyboards themselves have become far more gentle on wrists and fingers, due to “membrane” technology (vs. more mechanical action, which manufacturers rightfully tout as being better for your hands). Anecdotally, as someone who types everyday for their job, I find these kinds of keyboards much, much better for my wrists.

What will be the next kind of RSI be? Perhaps something associated with vision, as virtual and augmented reality tools appear. While we’ve moved past the ill-fated Google Glass of the 2010s, today Apple’s Vision Pro — despite its $3,500 price tag — may be (part of) the future of work.

Eye-based RSI sounds far-fetched. But so did the wrist kind, at least to doctors a century ago.

 

Will Mari is an assistant professor of media law and media history at the Manship School of Mass Communication at Louisiana State University, where he teaches classes on both subjects. His research focuses on how changing communication technology impacts news workers, and on analog to digital transitions more generally. He spent eight years in the U.S. Navy Reserve as a public affairs officer. When he’s not digging around in archives, he enjoys spending time with his family, his dog, Roux, and hiking and dancing.