Hello, I have had chronic and mysterious repetitive stress injuries for more than four years from computer usage and similar fine motor activity. The primary injury is in my hands. I have seen many doctors for the problem, and they have ruled out a large range of physical disorders, but they don’t know what is wrong with me. I recently heard about TMS, and have been reading various TMS resources for the past couple of days. It seems like I have some of the warning signs, but not others, so I am uncertain whether or not I have this condition. I am fair-skinned, 6’2”, 165 pounds, 23 years old, and in otherwise good health. The onset of my pain was gradual, and largely began at my first internship, during which I was using the computer in a poor ergonomic setup for about 25 hours a week (in addition to moderate amounts of texting, piano, video games, etc.) I began to experience quickly worsening pain in the backs of both hands. I attempted to continue work for a month or two with ergonomic improvements, which helped some, but it was too little too late. I quit the internship early, and rested my hands for six weeks before resuming school. Since then, I have been unable to use the computer with my hands for any significant amount of time without exponentially increasing pain. I managed to get through college by using speech recognition software and a variety of hands-free computer mice, such as a foot mouse, head mouse, chest mouse, eye mouse, etc. I have incurred a series of cascading (and notably similar) repetitive stress injuries in other parts of my body from these adaptations—knee pain from the foot mouse, neck pain from the head mouse, and even throat pain from talking too much. Symptom summary: My hand pain is generally delayed from the activity that causes the irritation. Pain/irritation seems to cumulatively build up from repetitive, fine-motor hand usage, and then takes long periods of rest to dissipate. Stages of pain: 1. When my hands first get irritated, the veins in the back of my hand pop out and my hands feel like they are swollen with blood. This is uncomfortable, but I wouldn’t call it painful. 2. If I continue using them beyond this point, soon they begin to throb painfully. The precise location of this throbbing pain moves around from day to day, sometimes faster than that, but generally remains in the area in the backs of my hands, between the wrists and knuckles. Usually, it is concentrated in lines that are about an inch long. These lines are often, but not always on top of sections of veins that are popping out especially. Additionally, I sometimes get a burning pain across specific tendons (the particular one(s) depending on the specific aggravating motion). 3. If I continue the activity further, eventually my hands become sore to the touch, sometimes even bruising. Sometimes the bruises/sore spots occur in the backs of my hands, where the initial pain is. Other times, these spots occur in different locations—for example, recently, I have been getting sore spots in my forearms from hand overuse. If I continue use at this point, the same spot(s) become more intensely sore. If instead I rest my hands for long enough, the spot(s) dissipate. When they come back from future overuse, they are usually in different locations within the same general area. Aggravating activities: -worst: using a touchpad or a touchscreen device -next worst: other computer activities like using a mouse and keyboard -next worst: other fine motor activities, like writing with a pencil I injured my knee is in a similar manner from overusing a foot mouse about a year after my initial hand injury. My knee pain is similar, but not exactly the same. I have not noticed stage 1 pain with my knees, but stages 2 and 3 are pretty much exactly the same. At first I get throbbing pain in shifting locations, then I get sore spots in shifting locations. Aggravating activities (decreasing magnitude): foot mouseing, biking, driving. Next worse is my throat. I initially injured it talking to someone all day so that they could use the computer for me. Just like my knees, I have not noticed stage 1 increased blood flow, but I get stage 2 throbbing pain, and stage 3 sore spots. These spots, when present, hurt when I swallow, as well as when I touch them. It’s pretty much just talking that bothers my throat, depending heavily on the volume and duration. Finally, I have had more minor repetitive stress pain in my shoulders, neck, and back. Fortunately, I never let any of these get as bad as the previous three. With all of these injuries, there is an unmistakable pattern: as the injury gets worse, different activities begin to bother the affected body part, and old activities that already bother it do so at an increased rate. To make matters worse, once beyond a certain level of irritation, the underlying problem never seems to go away. For example, since initially injuring my hands, I have rested them almost completely from aggravating activities for months at a time. One summer I lifeguarded rather than doing an engineering internship. My hands didn’t hurt by the end of the summer. But I re-irritated them the very first day of school just unpacking my stuff. The pattern is consistent: the pain subsides after adequate rest but comes right back as soon as I return to aggravating activity. Notably, if I respond with adequate rest early enough in the course of a particular injury, then rest does seem to improve the underlying problem (as was the case with my shoulders and neck). Unfortunately, the point beyond which healing does not seem to occur is very low, and I am way past it with my hands, knees, and throat. Experience with doctors: I have seen four physical therapists, many primary care doctors, two rheumatologists, two sports medicine doctors, one hand surgeon, two hand specialists, two neurologists, one geneticist, and one psychiatrist. No diagnosis has been made. According to various specialists, I don’t have tendonitis, carpal tunnel syndrome, Marfan Syndrome or Ehlers-Danlos syndrome, rheumatoid arthritis, or psoriatic arthritis, or any kind of similar chronic chemical inflammatory condition. Oh, and physical therapy (stretches, exercises, massages, and heat application) definitely didn’t help. It may have actually made things worse. Things that do help (besides rest): I have concluded, through self-experimentation, that anti-inflammatories, such as ibuprofen, Celebrex, and methylprednisolone increase the amount of aggravating activity I can sustainably do. Unfortunately, the effect is not very pronounced, so I cannot simply load up on ibuprofen and use the computer pain free. In fact, even the steroids only allow me to sustainably use the computer for only about an hour per day. This seems to suggest that I have some kind of positive feedback loop of inflammation, although this is in turn contradicted by the fact that I have had many blood inflammation tests and they have all come back negative. I recently switched to a vegan diet, as outlined in the following book: https://nutritionfacts.org/book/ (HOW NOT TO DIE, an instant New York Times Best Seller | NutritionFacts.org) Surprisingly, this seems to help almost as much as steroids did (I can now sustainably use the computer with my hands for about an hour a day). This seems to reinforce the inflammation feedback loop theory, because supposedly the diet is highly anti-inflammatory. Ice makes my hands feel like they are completely healed (it eliminates stages 1 and 2), for like 10 seconds. Then the pain comes rushing back with the blood flow. Other medical conditions/potentially underlying physical causes: -My whole life, I have had trouble sleeping—trouble getting to sleep, although I have mostly mitigated this with good sleep hygiene in the past year, and frequent wake ups (~3-6 times/night) -Poor circulation. My extremities get cold easily, and that they take a long time to warm back up without external heating. -Scoliosis—I have had persistent upper-back pain from sitting and other types of immobility since I stopped wearing a scoliosis brace 23 hours/day at about age 16. Worst curve (and the one nearest the pain) is about 25° -Recently discovered food intolerances (through an elimination diet) to milk, onions, and a few other foods. I previously ate these foods regularly, and had correspondingly regular diarrhea. I stopped eating them a few months ago, which eliminated my diarrhea, but had no other noticeable effects Personality/psychological problems: If I was any fictional character, I would be Spock from Star Trek. I am extremely analytical, logical, and driven. However, just like Spock is half human, I am not 100% this way—I have a sense of humor, and sometimes can just let things go. I pretty much never get angry, but I am easily annoyed, and easily frustrated. I’m definitely a perfectionist, and go to great lengths to behave morally correctly. I also definitely have a tendency to repress my emotions, although ironically, I’m often trying to repress this tendency. I have some OCD/anxious tendencies, such as frequent nose blowing and urination, and the inability to turn my mind “off”. This last part is why I have so much trouble going to sleep. Other symptoms that could possibly fall under the TMS umbrella: back pain associated with scoliosis, dust allergies that randomly onset sometime during high school, and plantar fasciitis that I have gotten under control with orthotic shoe inserts So now I’m trying to figure out whether I have TMS or one of its equivalents. I have compiled a list of arguments for and against, but would be curious to hear what other people think. For: ~4/8 personality traits (http://www.tmswiki.org/ppd/TMS_Personality_Traits (TMS Personality Traits)): perfectionism, goodism, stoic, ½ legalist, ½ anxiety I have seen many doctors that said there was nothing physically wrong with me (with reference to the RSI issues), and have had many tests, 99% of which have come out totally normal (and the 1% that came out abnormal don’t seem adequate to explain my symptoms) 23 years old, and am in otherwise good health Writing with a pencil and paper is significantly less aggravating than using the computer, even though they are similarly fine motor and repetitive. They are not the exact same motion though, so it is possible that this is not an “exception”. I noticed in the mindbody prescription book, it mentioned that tinnitus is an equivalent to TMS. I definitely don’t think I have tinnitus. But very infrequently in my life, maybe once a year on average, I will hear a high-pitched ringing sound in one of my ears for a few seconds for no apparent reason. And it happened just yesterday, two days after reading the book and trying some of the techniques. Could just be a complete coincidence, but I thought I’d mention it. Scored a 5/10 on this diagnostic quiz: http://www.rsi.deas.harvard.edu/mb_diagnostic.html (Harvard RSI Action --> The Mind/Body Approach --> A Diagnostic Quiz), which is exactly in the middle. (answers: 0,2,0,1,1,1) Against: type of pain (especially the sore spots) sounds very different than the oxygen deprivation kind of pain described in the mindbody prescription, but the chronicity of pain sounds very similar to Alan Gordon’s neural pathway theory Pain doesn’t seem correlated to stress levels, although I suppose it’s possible that I’m just perpetually stressed/anxious from the pressure I put on myself Pain is thoroughly and (almost) always predictably correlated to usage PS: the book mentioned that 98% of patients have muscle tenderness in at least one of three spots on their body—top of shoulders, part of the butt, and I can’t remember the third one. This seems worthwhile to try, but I haven’t been able to figure out exactly where I should be pressing. Apologies for the long post, but I just didn’t want to miss anything. What does everyone think?