Information about Repetitive Stress Injury

Repetitive Strain Injury
Classification & external resources

DiseasesDB	11373
eMedicine	pmr/97
MeSH	D012090

A repetitive strain injury (RSI), also called cumulative trauma disorder, occupational overuse syndrome, or work related upper limb disorder (WRULD), is any of a loose group of conditions resulting from overuse of a tool, eg. computer, guitar, knife, etc. or other activity that requires repeated movements. It is a syndrome that affects muscles, tendons and nerves in the hands, arms and upper back. The medically accepted condition in which it occurs is when muscles in these areas are kept tense for very long periods of time, due to poor posture and/or repetitive motions.

It is most common among assembly line and computer workers. Good posture, ergonomics and limiting time in stressful working conditions can help prevent or halt the progress of the disorder. Stretches, strengthening exercises, and biofeedback training to reduce neck and shoulder muscle tension can help heal existing disorders.

Specific conditions

The most well known repetitive strain injury is carpal tunnel syndrome, which is common among guitarists as well as assembly line workers but relatively rare among computer users: computer-related arm pain is generally caused by another specific condition.

Many of these disorders are interrelated, so a typical suffering person may have many of these at once. For other people, no specific diagnosis is possible. In these cases it is often best to treat RSI as a single general disorder, targeting all major areas of the arms and upper back in the course of treatment.

Some of these are:

• Carpal tunnel syndrome
• Cubital tunnel syndrome, a form of Ulnar nerve entrapment
• Intersection syndrome
• Reflex sympathetic dystrophy syndrome (RSDS)
• Stenosing tenosynovitis
• DeQuervain's syndrome
• Trigger finger/thumb
• Epicondylitis
• Golfer's elbow
• Tennis elbow
• Tendinitis
• Tenosynovitis
• Thoracic Outlet Syndrome
• Radial tunnel syndrome
• Gamekeeper's thumb
• Rubik's Wrist (tendonitis or Carpal Tunnel Syndrome caused specifically by repetitive use of a rubik's cube for speedcubing.

Warning signs

RSI conditions have many varied symptoms. The following may indicate the onset of an RSI.

• Recurring pain (myalgia) or soreness in neck, shoulders, upper back, wrists or hands.
• Tingling, numbness, coldness or loss of sensation.
• Loss of grip strength, lack of endurance, weakness.
• Muscles in the arms and shoulders feel hard and wiry when palpated.
• Pain or numbness while lying in bed. Often early stage RSI sufferers mistakenly think they are lying on their arms in an awkward position cutting off circulation.

Symptoms may be caused by apparently unrelated areas — for example hand numbness may be caused by a nerve being pinched near the shoulder. In the initial stages of RSI, an area may be in quite bad condition but not feel painful unless it is massaged, or feel weak unless a long endurance exercise is performed. Therefore all areas of the upper body are considered when evaluating an RSI condition.

Stress and RSI

Studies have related RSI and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the reported pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in pain, even after short term exposure.^[1] Some believe that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to RSI.

Treatment

If RSI symptoms have already appeared, there are various further methods of treatment that can be applied in addition to the above preventative techniques. For most of these treatments, there has not yet been enough medical research to conclusively demonstrate their long term effectiveness, but they may be helpful.

• RSI healing generally cannot be achieved solely by medical professionals and requires active participation by the patient over a period of several months or years. The more the patient understands, the more likely it is that treatment will be effective. Occupational therapists, physical therapists, physiatrists, surgeons, and alternative medicine practitioners all offer diagnosis and treatment plans.
• It is likely the partial or complete cessation of hand activity might be necessary for some period of time in order for healing to begin. Adaptive technology ranging from special keyboards and mouse replacements to speech recognition software might be necessary.
• The medical professional may prescribe orthopedic hand braces, but warn against self-prescription, or further injury might result.
• Medications: The medical professional might prescribe Non-steroidal anti-inflammatory medications such as ibuprofen to reduce swelling, or anti-convulsant medications such as gabapentin to reduce neuropathic pain.
• Cold compression therapy administered by the patient, or perhaps immediately followed by TENS therapy administered by a health professional, circumvents occupational stress and may be one of the simplest ways to reduce inflammation and relieve pain.
• Soft Tissue Therapy works by decompressing the area around the repetitive stress injury thus enhancing circulation and promoting healing.
• Biofeedback can be used to reduce stress-related muscle tension in the muscles of the neck and shoulders.
• Massage treatment (for acute pain and nerve trigger points). This is best administered by a trained therapist but self-massage is also sometimes helpful.
• Stretches (for less acute pain and general maintenance). Many doctors will prescribe occupational therapy or physical therapy to rebuild strength and flexibility. Some sufferers find great relief in specific movement therapies such as T'ai Chi Ch'üan, yoga, or the Alexander Technique.
• Strengthening exercises (to improve posture and reduce fatigue in the long term).
• Surgery. This is generally used as a last resort and is not always effective.
• Mind/Body approaches. In the mind/body approach, RSI is not seen as a structural injury, but as a psychosomatic condition. The pain is a way the subconscious diverts attention from painful emotions.
• Pause software. Such programs remind the user to pause frequently and/or perform practices while working behind a computer. One such program is Workrave, an opensource free program that assists in the recovery and prevention of Repetitive Strain Injury. The program frequently alerts user to take micro-pauses, rest breaks and restricts user to a predefined daily limit.
• Switching to a much more ergonomic keyboard layout such as Dvorak keyboard.

Footnotes

References

• Repetitive Strain Injury: A Computer User's Guide; Emil Pascarelli and Deborah Quilter (ISBN 0-471-59533-0)
• It's Not Carpal Tunnel Syndrome! RSI Theory and Therapy for Computer Professionals; Suparna Damany, Jack Bellis (ISBN 0-9655109-9-9)
• Conquering Carpal Tunnel Syndrome & Other Repetitive Strain Injuries, A Self-Care Program; Sharon J. Butler (ISBN 1-57224-039-3)
• The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition; Clair Davies, Amber Davies (ISBN 1-57224-375-9)
• Electromyographic Applications in Pain, Physical Medicine and Rehabilitation: Repetitive Strain Injury Computer User Injury With Biofeedback: Assessment and Training Protocol; Erik Peper, Vietta S Wilson et al. The Biofeedback Foundation of Europe, 1997
• van Tulder M, Malmivaara A, Koes B (2007). "Repetitive strain injury". Lancet 369 (9575): 1815-22. DOI:10.1016/S0140-6736(07)60820-4. PMID 17531890. 

External links

• Talk RSI discussions for individuals who suffer from RSI
• Repetitive Strain Injury an informational resource for sufferers of RSI
• Musculoskeletal Disorders from European Agency for Safety and Health at Work (EU-OSHA)
• Harvard RSI Action Harvard RSI Action
• RSI Action a national charity campaigning for greater prevention measures.
• RSI Cure The ongoing battle of a patient with RSI since late 1998, with a package of solutions that has significantly improved his condition.
• Human Factors and Ergonomics resources