1. Stop. Don't type/mouse through pain, or you could be causing permanent damage. Figure out what the problem is, maybe with the help or a doctor and/or workstation ergonomics expert.
2. If TrackPoint is involved, that's possible, but I find it's mostly a win, but the win might depend on how one uses it. I use little force, and have done it all day for 20 years, without problem. The sensitivity is adjustable. Which cap you put on it makes a big difference. There are 5+ different caps. I like the soft concave top one best. With some of the other styles of cap, especially early on (like the hard sandpaper one, and the slick Toshiba(?) one), I found I was pressing much harder, just to get a grip on it.
To point #1: it’s been my experience that ergonomics and orthopedics are incredibly misunderstood by the tech industry at large, and in my personal experience, orthopedic doctors are often wrong in their diagnoses.
One of many examples is the prevalence of Carpal Tunnel Syndrome in the world. It’s the most-common orthopedic surgery in the US, yet its success rate is thought to be around 90%. What would cause the surgery to fail? Technically it could be a botched surgery (eg scalpel cuts the median nerve), but that’s always known at the time of surgery because duh. Rather, the ~10% failure rate is mostly made of cases where the surgery went as expected, yet the nerve impingement symptoms persisted. There’s very little out there on the notion that these patients could simply have been misdiagnosed. If you feel tingling or numbness or burning in your fingers/hand, it could be caused really at any point between the spine and the hand. Typically nerve impingement of the hand occurs in the spine, thoracic outlet, cubital tunnel, forearm, or the carpal tunnel. The symptoms are more or less the same regardless, yet Docs seem to always implicate the carpal tunnel, even though there does not exist a reliable study that shows keyboard/mouse use is a risk factor for developing CTS.
An EMG/NCS isn't necessarily going to bear fruit. Studies and anecdotal evidence both support the idea that nerve conduction tests do not rule out nerve impingement in a particular area. TOS in particular can be tricky to "truly" diagnose through diagnostic imaging.
Cannot second this enough. I typed through the pain and couldn't use a computer for 10 months. That was very stupid of me; please be smarter.
It's worth investing time & money in a good, ergonomic typing setup. If you don't do it up front, you'll be investing a lot more time in money - in physical therapy, and buying top-of-the-line stuff because the mid tier equipment isn't good enough for you to avoid reinjury anymore.
Some things that work for me:
- Vertical mouse (Logitech MX Vertical - there are knockoffs, I haven't tried them)
- Mechanical keyboard with a good amount of travel (laptop keyboards with hardly any travel are no good for me anymore)
- Gaming mouse pad (it's like a mousepad that covers a large area)
- Pads that go over the armrests of my chair (if my arms are resting on hard plastic, it limits my circulation, which exacerbates my tendonitis)
I strongly encourage you to learn proper typing habits. I don't want to speak too authoritatively (if I'm saying anything incorrect, please correct me, and please do research this yourself - it's really important for your health & career), I'm not an expert I just know what works for me, but you shouldn't rotate your wrists, and you shouldn't have them at any sort of angle relative to your firearms; it should be straight and they should just glide over the keyboard. It's a good idea to learn how to stretch your wrists as well.
This is funny and why Thinkpad people are so … religious.
- Vertical mouse (Logitech MX Vertical - there are knockoffs, I haven't tried them)
Or a trackpoint.
- Mechanical keyboard with a good amount of travel (laptop keyboards with hardly any travel are no good for me anymore)
Or a Thinkpad keyboard (though they have been getting shallower).
I've been addicted to Trackpoints since forever. Trackpads seem so backward to me. A trackpoint is like mind control in comparison. I'm lucky Thinkpads are generally good and I don't care for MacOS, because otherwise I'd be really stuck.
Thinkpad keyboards are way better than other laptop keyboards, but it's just not in the same league as a decent mechanical one.
Which then requires a mouse (especially annoying when you're left-handed), but I only need that to click things on websites. There's nothing else I can't easily reach from the comfort of my (mechanical) keyboard. I just plug in a hub filled with HDMI/USB devices and close the lid.
I loved the Trackpoint. Personally I can't use the Thinkpad keyboard anymore (that being the keyboard I was using when I injured myself). Once you commit to an external keyboard, you can't really use the Trackpoint anymore.
One hundred and eighty five dollars for the Tex one, ugh. I love the trackpoint to almost death but I go through thinkpad keyboards faster than average (I guess) and couldn't afford such a luxury, sadly.
I have the ThinkPad TrackPoint Keyboard II. It's pretty good, feels … plasticky but good travel and has a Trackpoint.
However, for me I use the Thinkpad as a "controller" for a desktop, so I get two (well, three, the desktop has two) independant screens and kvm functionality via Barrier (derived from Synergy).
Maybe I'd never want to go back if I tried a mechanical (I got my partner one, but haven't touched it), but I could not go back (way back) to a mouse.
There are a litany of reasons why one’s hand may hurt. As far as non-traumatic injuries go (meaning pain that develops over a period of time as opposed to, say, a skateboarding accident), it’s usually going to be caused by inflammation of tendons (tendonitis), wearing away of bone cartilage (arthritis), or nerve impingement. Diagnosis of the first two is typically straightforward, while diagnosis and treatment of nerve impingement is more complex, reason being the nerve or nerves could be impinged in one (or more!) of several locations between the spine and hand.
I have seen many armchair orthopedic experts on Reddit, Quora and elsewhere talk about “RSI” like it’s a single disorder with a single treatment. In reality, RSI is an umbrella term for many conditions, and not just of the arms and hands. Googling “RSI” is useless. You MUST determine which RSI (if any) you have. The treatment for tendinitis is very different from the treatment for cubital or carpal tunnel syndromes. This is probably why so many people who identify as having “RSI” have been unsuccessful in finding an effective treatment. Heck, if you truly have Carpal Tunnel Syndrome, surgery is THE treatment. Anything else is a band-aid. Fortunately, the surgery is quick, the recovery is quick (typically within a week for light activity), and it is usually permanent.
To be sure, if you're experiencing pain you need to see a doctor, and explicitly this is stuff that worked for me that people might try but is not a prescription. I guess what I'm trying to do is encourage people to research ergonomics and experiment with their setup before they experience pain. If you type with bad habits & bad ergonomics for 40 hours a week, it's likely that you will end up in trouble eventually, no?
I just feel like this is a huge missing stair, not only in our industry but in life in general (I've met people who've had similar issues playing piano, using a cash register, and playing guitar), and I try not to overstate how much I know about it, but I also want to let people know it is something they should pay attention to. When the opportunity presents itself I try to give people the warning I wish I'd had.
I saw a physical therapist, an orthopedic surgeon, etc. The surgeon didn't really examine me at all, and no one per say looked too close. I guess I've just never questioned their diagnosis of tendonitis. They were surprised it took me so long to recover, but I chalked it up to being the second time I got an RSI from typing (go figure) and that I probably kept reinjuring myself despite my best efforts (there certainly was some of that).
I don't want to give specifics of my age publicly (if you'd like them please shoot me an email & I'll share then privately) but I'm on the younger side. I don't remember every symptom, but it hurt to type, my hands would fall asleep in the night if I wasn't very careful, I couldn't rotate my wrist comfortably, et cetera. My forearms were covered in adhesions.
That was a few years ago. I don't do as much as I should to take care of my hands but things are a lot better. My hands tire easier than they ought to, they're very sensitive to being impinged upon (eg I can't use the hard plastic armrests of my chair without additional cushioning), and I can't type or especially use the mouse if it's cold without pain (so I don't, I turn the heat up and wait).
I do have this memory of when I was a child, I regularly refused to hold anything when I first woke up. People would try to hand me things and I'd insist my hands felt weird and that I couldn't hold anything until they "warmed up" (figuratively). From what I remember it was similar to how my hands feel when I'm not using my armrests of when I've typed too much. I did have a terrible sleeping habit where I folded my arm under my neck like a chicken wing; maybe I did impinge a nerve in my shoulder or some other weird thing that's followed me around this whole time, I can't say for certain. That sleeping habit did start fucking me up more and more in my adulthood and I had to stop it, and I do get aches in my neck on that same side of I don't use a special pillow. I think I still have a remnant of it where I turn my head at night if my special pillow doesn't discourage it, and then I wake up with a sore neck. I got that special pillow after an incident where I somehow fucked up my back and my whole back was stiff and it was a struggle to move for a day or so.
I don't know if any of that means anything, but there you go.
For you I would be looking at Thoracic Outlet Syndrome being that you are I assume under 35 and male. Just from those two datapoints (age and gender) and the fact that your symptoms seem to be nerve-related rather than tendon-related... sounds like nerve impingement between the spine and arm. I would read up on the symptoms of Thoracic Outlet Syndrome (and related/sub-syndromes like Pec Minor Syndrome, which is sometimes considered an entirely separate condition and other times considered a sub-type of TOS).
There are tests you can do at home (some require another person) to test for all of these, and I suspect at least one will aggravate your symptoms:
- Carpal Tunnel Syndrome
- Cubital Tunnel Syndrome
- Pronator Teres Syndrome
- Thoracic Outlet Syndrome
- Arthritis (it's probably not this)
- Cervical Radiculopathy (it's probably not this, unless you are old or recently experienced trauma in that area, like a car accident)
All of these are TREATABLE, especially the first four. Ideally you don't have one of the last two, but both of those seem to typically be an "advanced age" thing. Statistically speaking, you probably have one of the first four. It is theoretically possible to have more than one of these things, but probably very unlikely (I don't have any stats handy, but I know it's uncommon).
It doesn't sound like tendonitis to me. I'm not a doctor, but I've spent "tens of hours" researching in this area for my own sake.
There are a lot of people out there who will tell you their "symptoms" got better when they switched to an ergonomic keyboard or a vertical mouse. My theory is that this "very gradual relief" is typically because those ergonomic peripherals subtly relieve nerve impingement going on in, say, the shoulder area. For example, a split keyboard that slopes up towards the middle achieves two things: 1) it pushes the shoulders more out of interior rotation (interior rotation causes Thoracic Outlet Syndrome) and 2) allows the forearms to not be in full pronation (though this is apparently less important as the related nerve impingement, Pronator Teres Syndrome, is linked to repeated pronation MOVEMENTS, not static pronation like you'd expect at a desk job).
I remember reading a Medium article last Summer where the author (a SWE) talked about how switching to an ergonomic keyboard helped, but it took several months to recover from "RSI". To me, it sounds like he switched to an ergonomic, split keyboard, that VERY SLOWLY (over a period of months), relieved interior rotation of the shoulders. I believe that the author would have experienced more drastic relief, sooner, if he engaged in certain stretches and exercises aimed at correcting posture/strengthening posture muscles.
I can't stress enough how important it is that you figure out WHICH RSI you are dealing with. There's A LOT of armchair/self diagnosis going on in places like /r/RSI where people A) don't know which RSI they have and just try things until something works and B) often assert they have "many" RSIs (e.g. tendonitis AND carpal tunnel syndrome AND cubital tunnel syndrome) - this is possible but unlikely. The problem with A is that the treatment for tendonitis is very different from the treatment for carpal/cubital tunnel syndromes, arthritis, radiculopathy, etc. Some on /r/RSI complain of "years of pain", were diagnosed with Carpal Tunnel Syndrome, but are refusing (or are perhaps unable) to get Carpal Tunnel Release surgery, which I compare to wisdom teeth removal in both commonality and risk-reward.
Finally, it seems to often take many months, or even years to get a proper diagnosis for "RSI". I recommend to people to do their own research, but do NOT rely on Google. OrthoBullets is a great website full of reliable information, especially in the area of diagnosis. It's meant for medical students, but still very readable by those with other backgrounds. NIH.gov has a lot of good info, like research papers/studies that shows things like:
- There lacks strong evidence to support the notion that Carpal Tunnel Syndrome and using a computer have a causal relationship (correlation does not imply causation!)
- Nerve conduction studies (often abbreviated as NCS and EMG) often return a normal/clean result, in spite of nerve impingement, and seem to be useless particularly in early cases (e.g. the nerve related symptoms started, say, a few months ago).
A few times a month my wife has what she calls a "Google patient". Her canned response is: "Your google search isn't equivalent to my medical degree." Some get it.
The part that isn't visible by reading a simple one-line comment describing the interaction is the reality of dealing with patients in almost any kind of practice. I cannot properly convey the experience here. For one, I am just an observer. Here are a few points that seem to come up with some frequency during our "How was your day?" conversations:
Patients, just like doctors and engineers, are in a range between good and horrible. Some work with the doctor, follow directions, take the medicine/treatment and make progress. Others are the opposite, they keep coming back with the same issues (and often more) and, when interrogated, doctors discover they completely ignored (or worse, modified) what they where told to do. This kind of thing is truly frustrating. To put it in CS terms, imagine telling a junior developer how to fix a problem that has been compromising a codebase, only to discover, a month later, that the developer ignored your advice and decide to change variable names instead, because an article on the web said short variable names are better. Bullshit example, yet not too far from medical reality sometimes.
At the extreme are patients who are uninformed, rude, entitled and combative. It seems my wife comes home rattled once every couple of months after having to deal with a complete asshole who ruined her day.
With regards to information, yes, of course, she absolutely prefers informed patients. Why? Because those often turn out to be the good patients she can really help. The "Your google search..." comment isn't a universal statement delivered to anyone who says "I read on the web...". No, that isn't the case at all. She tells me patients do come-in who have done their homework and contribute valuable information to the process. These patients are actively engaged in the process.
There's a vast difference between being informed and engaged in what's going on and reading a few things in social media and actually thinking you know what you are talking about. People insisting on getting antibiotics for just-about everything is one example of this.
Those who receive and deserve the put-down are zero-effort, zero-knowledge patients who, after having read something on the web --which is often irrelevant or way out there-- come to the doctor absolutely convinced that is THE way to handle whatever it is might ail them. These patients are often in the combative, arrogant, rude category. The often require what my wife calls "The New York attitude" treatment. In other words, you have to forcefully (not physically, of course) assert yourself or you can't help them.
As an example, imagine someone coming in asking for a prescription to some ridiculous medicine to be protected from COVID and, at the same time, refuse to get vaccinated because they believe the government injects you with microscopic radio transmitters that track you. Yes, this is an extreme example, of course, however, it is hard for someone not dealing with dozens of patients a day to imagine the range of situations a doctor encounters on a daily basis.
Thank you for writing that down so nicely. I was imagining you meant something like this but I'm still grateful you made it explicit.
I guess the reason I'm touchy about the topic is that, given that I am not a doctor, I have much more experience with encountering idiot doctors than idiot patients. This makes my fear of being patronizingly shut down for "reading things on the internet" much more prominent.
Yeah, but at the same time I saw 3 orthopedic surgeons and 1 neurologist and 2 of them said "carpal tunnel syndrome", one of them said "arthritis" (after saying my X-Rays didn't show any signs of arthritis), and none of them got the diagnosis right (thoracic outlet syndrome). The kicker is the one who settled on "arthritis" is a shoulder guy, the one you'd expect to at least test for TOS.
Just like there are bad engineers, the medical community has bad doctors. Perhaps "bad" is too strong a term. It might be more accurate to refer to them as "low information" or "not up to date" or "low skill" professionals.
On the engineering front, it takes work to stay up to date on the latest technologies. I have been in the field for 40 years, I know lots of people with the same time in the domain who can barely deal with a modern computer, much less design with modern FPGA's, processors and write software in a range of modern languages. People do stagnate. That's just reality.
The same is the case with doctors, or almost any profession. One plumber might be up to date with the latest advances and have great diagnostics skills while the other hits everything with a hammer.
Which hints at the other reality. I have worked with dozens of young engineers just out of school. It is interesting to see just how wide a range of skills and capabilities you get. Those who went into engineering with passion stand out because they are engaged in the field and have a real tangible sense of how things work. For lack of a better term, they were getting their hands dirty before they started university, and it shows. Others came to my desk with such low skills it was hard to conceive how they might succeed.
Doctors have to be in the same reality. We've all heard of doctors who misdiagnose people who, months or years later, through great personal effort, finally discover what was wrong and got it handled. What I have never seen is a root-cause analysis of this (well, there was a TV show years back that did some of this). That's what matters. Medicine (or engineering) will never improve if we don't have a mechanism through which we can go back and ensure some of these things happen with less frequency.
This is where I believe AI-based diagnosis will eventually become a useful tool. Not to replace doctors, but rather to present them with a range of opinions to explore. As with anything in computing, these systems will require accurate data, both medical and from the patient. And that's how we come full circle to the problems in medicine, one of which is having to work with patients who are uninformed or ill-informed from whom it is difficult to obtain accurate data for diagnostics. Not an easy problem.
While all the docs I saw were "friendly", they were all in a hurry, which is probably imposed by the hospital they work for (where applicable), but 2 of the orthopedic surgeons I saw were father and son, with their own practice. Nevertheless, each of them were incredibly late (over 30 min) seeing me. So I would suppose that greed is a component.
The son literally came into the exam room with a laptop showing my X-Rays, said I don't have arthritis, went to leave, I had to stop him and kind of press him because he didn't diagnose me with anything, then he did some test where he pressed my thumbs into their joints and asked if that hurt. It did. Then he said that I have arthritis in my thumb joints. This is the kind of sloppiness I would expect from the juniorist of junior developers, not a medical doctor who spent over a decade in school and specializes in orthopedics. Needless to say, that same maneuver does not hurt my thumbs anymore, and I brought this up when I saw his dad a couple of weeks later. He said something to the effect of "well sometimes arthritis comes and goes" and then changed the subject. The sheer arrogance (I don't think it's incompetence) in that building was astounding. So I, a 27 year old with no signs of arthritis on X-Rays, have arthritis that "comes and goes", even though I continue to work a desk job for 8 hours a day. Makes sense.
I saw a hand surgeon who said the arthritis diagnosis was wrong and couldn't explain why he made that diagnosis.
When the nerve conduction study came back normal, it was subtly suggested that the pain might be psychosomatic since I mentioned the pain went down when I started taking an SSRI.
So after being told by 3 docs it was carpal tunnel syndrome, and then the neurologist saying it wasn't, I went back to the Internet, and stumbled upon Thoracic Outlet Syndrome. It fit so perfectly, and the provocative tests for it immediately made my symptoms worse. At the follow-up with the hand surgeon, I brought this up after she said something to the effect of "well, it's not CTS so I can't help you, here's a prescription for physical therapy, good luck", she immediately said that "TOS is very rare, and it would have shown on the nerve conduction study". This is obviously false (even without the research papers I found) because performing stretches and exercises meant to treat TOS have been incredibly effective for me.
Complete shitshow. And of course I had to pay ~$1000 for all that. It's funny how we can see doctors who are either wrong or unable to come to a diagnosis, and we have to pay them anyway, but if a plumber comes to my house, says I have a bad septic tank, then proceeds to replace my kitchen faucet, obviously I am not going to pay him.
I think my issue was that I was not assertive ENOUGH with these docs, but of course I don't want to be "that guy". Kind of a lose-lose situation.
Sadly, that does happen. I know a couple of people who went through experiences similar to yours. Different ailments, same issue with incompetent/uninformed/lazy/whatever doctors.
In one case the patient had been gaining weight for a couple of years and had other issues despite eating a very restricted diet, exercising, etc. Long story short, it turned out to be a pituitary gland tumor (Cushing's syndrome). This was diagnosed at UCLA by an expert in the field. One surgery later and she was back to normal weight (half the prior weight almost) within a year and feeling healthy. The other doctors had her on a path to nothing good and potentially a short life.
Thankfully bad doctors like these aren't the norm. Yes, of course, as a patient, being informed is super important. Nobody is going to care more about you, your kids, your family than you.
The problem with google searches happens with scenarios like a patient insisting on getting Hydroxychloroquine because they found it online or heard someone recommend it.
With a strong emphasis on "occasionally". The vast majority of doctors and hospitals (the overwhelming majority) are good and medicine is too complex for most people to understand. I see how hard my wife works to keep up with the latest medicines, research, treatments and developments in her field. It's on part with what any top-level hardware or software engineer has to do on a daily basis to be informed and remain relevant. The exception is: We don't generally kill people if we make a mistake.
In other words, yes, being informed is good. Everyone should dig as deep as their education allows them to when it comes to their own medical needs. However, at the end of the day, it is impossible (and unwise) to pretend that this can substitute for a real doctor. We are talking about good doctors here, not the few at the bottom of the barrel who would have better-served society by choosing a different career.
I don't think "good doctors" and "bad doctors" is really a good framing. I think the medical system sabotages the relationship between doctor and patient and creates incentives to spend the least amount of effort on any given patient. That isn't anyone's fault but if your diagnosis is off the beaten path, and especially if it looks like a common diagnosis but isn't that one, it can be incredibly difficult to get a doctor to take you seriously. I think people reacted strongly to your comment because they felt it was emblematic of a dismissive attitude they receive from doctors - regardless of how good a doctor may be.
Same. One doctor didn't understand the previuos one prescription - that it's a combo for self-amplifying symptoms and makes no sense incomplete - I'm lucky that the other worked there for a while. No doctor found out that as a vegetarian I may be missing an enzyme (bromelain, which dissolve mucus).
> 1. Stop. Don't type/mouse through pain, or you could be causing permanent damage. Figure out what the problem is, maybe with the help or a doctor and/or workstation ergonomics expert.
Back twenty years ago I did just this. I was working 18 hour days. Sadly, pain was normal. The thing is, when it is your own company you can't take a couple of weeks off to sort it out.
Ultimately, I designed and fabricated my own ergonomic desks. My preference has been to use a thumb-actuated trackball. Soon after making these desks I was back to my 16 to 18 hour a day schedule and had no pain at all. Yes, it took a while for the soreness and inflammation to disappear. The point is, my wrists got better, even while working long hours.
It is crucially important to pay attention to ergonomics and learn to be relaxed. Mice, in my opinion, are terrible. It depends on the task, of course. In my case, my time is split between EDA CAD (electronics design), software development and mechanical 3D CAD. In other words, reaching for the mouse is unavoidable. In this context, the trackball has proven to be the right tool for the job. I have tried some of the fancy 3D knob technology and more. None of it really worked for me.
Here are a couple of old pictures showing the key element in the design; a dropped-down surface for the keyboard and trackball and a nice forearm support bar.
I have also used for some years a thumb-actuated trackball, which was a great improvement in comfort over a mouse.
However, more recently I have replaced it with a Wacom graphic tablet configured in mouse mode, which, at least for me, has been a huge improvement in precision, speed and comfort over any mouse, trackball, trackpoint or touchpad.
In my case it spans a range from typical office/email applications to mechanical 3D CAD, software engineering, electronics CAD, various specialized manufacturing tools/applications and graphic design software. It's varied enough that there's no way I could use a Wacom tablet (I have a few). The trackball seems to be the best common denominator for everything but running tools like Photoshop/GIMP/Corel. In that case the preference these days for us has shifted to drawing tablets with built-in displays (https://www.xp-pen.com/).
I don’t understand why it is adjustable in the first place[1]. Personally I bring it all the way to the right, or one notch below, and never touch it again. To me it is less adjustable, and more that the default value is wrong and have to be mitigated.
1: On TrackPoint tab in classic Control Panel screen, separate to mouse cursor sensitivity on the other tab. Both has different effects.
I was dealing with soreness for a while, and of course it's different for everybody, but two things helped me: 1) Learning more keyboard shortcuts and terminal commands, to cut down on mouse use for a while. 2) Touch screen. Those things also helped with eyestrain headaches.
I think in the case of keyboard shortcuts, I was able to look away from the screen while typing, or at least, not focus so intently. The touch screen might be a bit more hypothetical, but I think it doesn't require as much visual acuity, so can relax my eyes a bit more.
I've read that frequently looking away from the screen, so your focus doesn't remain fixed to one position, is helpful for eyestrain. Thanks to touch typing, I can write text and even code with my eyes closed.
Of course you know how it goes... other things may have changed at the same time.
> I've read that frequently looking away from the screen, so your focus doesn't remain fixed to one position, is helpful for eyestrain. Thanks to touch typing, I can write text and even code with my eyes closed.
Interestingly, not knowing how to touch type would also mean that you frequently switch your eyes from the screen (to look at the keyboard). In fact, as someone who has learned to touch type but is still making a lot of mistakes, my eyes are much more glued to the screen than when I used to have to look at the keyboard to find my place again.
Upping the sensitivity and switching to the soft rim cap makes a huge difference. We have ThinkPads at work and I'm not surprised most of my colleagues don't like the Trackpoint with its default cap and settings; Lenovo aren't doing it and favours.
1. Stop. Don't type/mouse through pain, or you could be causing permanent damage. Figure out what the problem is, maybe with the help or a doctor and/or workstation ergonomics expert.
2. If TrackPoint is involved, that's possible, but I find it's mostly a win, but the win might depend on how one uses it. I use little force, and have done it all day for 20 years, without problem. The sensitivity is adjustable. Which cap you put on it makes a big difference. There are 5+ different caps. I like the soft concave top one best. With some of the other styles of cap, especially early on (like the hard sandpaper one, and the slick Toshiba(?) one), I found I was pressing much harder, just to get a grip on it.