Repetitive Strain Injury (RSI)

What Is Repetitive Strain Injury (RSI)? What Causes Repetitive Strain Injury?

Repetitive strain injury or RSI, also known as repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CTD), occupational overuse syndrome, overuse syndrome, and regional musculoskeletal disorder is a range of painful or uncomfortable conditions of the muscles, tendons, nerves and other soft tissues. RSI is usually caused by repetitive use of a certain part of the body, often somewhere in the upper limbs (arms).

Repetitive strain injury is typically related to an occupation (job), but may also be linked to some kinds of leisure activity. As opposed to a sudden or 'normal' injury, RSI signs and symptoms may continue for much longer.

Experts say that repetitive strain injury is an injury of the musculoskeletal and nervous systems that may be the result of repetitive tasks, forceful exertions, vibrations, pressing against hard surfaces (mechanical compression), or sustained or awkward positions. Conditions such as RSI tend to be linked to both physical and psychosocial stressors (mental stress).

A US study found that acute and sudden computer-related injuries, a separate category to injuries that take a while to emerge like repetitive strain injury, are rising rapidly in the US, and that young children are most affected.

Many health care professionals refer to RSI as ULD (upper limb disorder) because it frequently involves the forearm, elbow, wrist or hands. RSI often affects the neck as well.

The following are examples of repetitive strain injuries:

• Bursitis - happens when the bursa is inflamed. The bursa acts as a cushion between bones, tendons, joints and muscles - bursae are fluid-filled sacs (the plural of bursa is bursae). People with bursitis will feel pain at the site of inflammation.
  
• Carpal tunnel syndrome (CTS) - caused by the compression of the median nerve through the carpal tunnel in the wrist area. When constricted, blood cannot flow freely through the hand to the fingers causing individuals with CTS to experience numbness and pain in the hand.
  
• Diffuse RSI - conditions are where the patient complains of pain and yet, on examination by a health care professional, nothing physical can be found to be wrong.
  
• Dupuytren's contracture - a condition that affects the hands and fingers. It is an uncommon hand deformity in which the connective tissue under the skin of the palm contract and toughen over time. It causes one or more of the fingers on one or both hands to bend into the palm of the hand.
  
• Epicondylitis - often occurs as a result of strenuous overuse of the muscles and tendons where the bone and tendon join. Tennis elbow and golfer's elbow are examples.
• Ganglion - fluid-filled swellings that tend to form on top of joints or tendons in the wrists, hands, and feet. They have the appearance of firm or spongy sacs of liquid and their insides consist of a sticky, clear, thick, jelly-like fluid.
  
• Rotator cuff syndrome - inflammation of tendons and muscles in the shoulder.
  
• Tendinitis - also known as tendonitis, is the inflammation of a tendon.
  
• Tenosynovitis - the sheath around the tendon becomes inflamed, specifically the inner lining of the tendon sheath.
  
• Trigger finger - a condition in which one of your fingers or your thumb catches in a bent position. The tendon sheaths of the fingers or thumb become inflamed - the tendon is also inflamed.

RSI is frequently caused by such activities as golf or tennis - activities which require repetitive movements. Signs and symptoms generally persist if left untreated. Experts say that the number of people experiencing RSI as a result of computer use has been increasing for many years. RSI that is caused by typing on a computer keyboard is often referred to as writer's cramp.

Experts often refer to two main types of RSI:

• Type 1 RSI - usually caused by repetitive tasks, but not always; some people who do not perform repetitive tasks may have Type 1 RSI. The muscles and tendons swell. Examples of Type 1 RSI include:
  
  
  • Carpal tunnel syndrome
  • Tendinitis (tendonitis)
  • Tenosynovitis
• Type 2 RSI - there is a feeling of pain but no obvious inflammation or swelling in the area where symptoms are felt. The National Health Service (NHS), UK, refers to Type 2 RSI "when a person's symptoms do not fit into one of the (above listed) conditions". Also called non-specific pain syndrome.

What are the signs and symptoms of repetitive strain injury (RSI)?

A symptom is something the patient feels and reports, while a sign is something other people, such as the doctor detect. For example, pain may be a symptom while a rash may be a sign.

Signs and symptoms vary, depending on which part of the body is affected, and what caused the problem in the first place. Initially, symptoms may only occur when the individual is doing the repetitive task - they will slowly go away when the person rests. Eventually, though, symptoms may be present all the time (and worsen during the repetitive task) if left untreated.

The most common RSI signs and symptoms include:

• Tenderness in the affected muscle or joint
• Pain in the affected muscle or joint
• A throbbing (pulsating) sensation in the affected area
• Pins and needles (tingling) in the affected area, especially the hand or arm
• Loss of sensation in the hand
• Loss of strength in the hand

Some patients with persistent symptoms may have sleeping problems - the condition is often irreversible at this stage. Early treatment is much more likely to prevent any irreversible damage.

What are the causes of repetitive strain injury (RSI)?

Experts say the causes of RSI are a bit of a mystery. Sometimes there is no swelling in the muscles or tendons, but the patient feels pain and discomfort. We know that often repetitive movements of a part of the body are linked to symptoms - movements, such as typing, using a computer mouse, poor posture while doing a movement, using excessive force, doing the repetitive movements without sufficient breaks, etc. But the precise reason for RSI is not clear. Neither do we know why some people develop RSI and others don't, when doing the same tasks for similar periods.

Some studies indicate that some psycho-social workplace factors, such as stress may be significant contributory factors to RSI. Perhaps stress affects our muscles (makes them tense), which in turn makes us more sensitive to pain.

The following are seen as causes of RSI:

• The overuse of muscles in our hands, wrists, arms, shoulders, neck and back are linked to RSI symptoms.
• The area is affected by repeated actions, which are usually performed on a daily basis over a long period.
• The repetitive actions are done in a cold place.
• The individual has to use vibrating equipment.
• Forceful movements are involved.
• Workstations are poorly organized.
• Equipment is badly designed.
• The individual commonly adopts an awkward posture.
• There are not enough rest breaks.

How is repetitive strain injury (RSI) diagnosed?

There is no objective way to diagnose RSI - there are no tests to confirm a diagnosis. Signs and symptoms could be caused by a wide range of factors.

A health care professional will usually diagnose RSI if the signs and symptoms can be linked to a specific repetitive task, and the symptoms lessen when the task is stopped.

If the patient develops a definable condition, such as frozen shoulder, carpal tunnel syndrome or tendinitis, it may or may not be linked to repetitive tasks.

What are the treatment options for repetitive strain injury (RSI)?

The National Health Service (NHS), UK, advises people to see their doctor as soon as they experience symptoms. Early treatment is more likely to result in effective outcomes.

A GP (general practitioner, primary care physician) will probably ask the patient to stop doing the repetitive movements which may be causing the symptoms. If this is not possible, as may be the case with work-related activities, the individual needs to tell his/her employer.

The aim of treatment is to help ease the pain, and to enable the patient to gain strength and mobility in the affected area.

Pain relief - a course of anti-inflammatory painkillers, such as ibuprofen or aspirin may help. Children under 16 years of age should not take aspirin. The following may also help:

• Use of heat (applying heat to the affected area)
• Cold packs
• Elastic supports
• Firm splints

Steroid injections - these may be administered if there is a well defined inflammation in the affected area.

Sleep - if the patient is having sleeping problems the doctor may prescribe a short course of sleeping tablets. Good sleep may help relax the patient and alter his/her perception and susceptibility to pain.

Physical therapy (UK: physiotherapy), exercise and relaxation techniques - a physical therapist (UK: physiotherapist) may help the patient adopt proper posture, as well as teaching him/her to strengthen muscles. Electrotherapy may also be used - small electrical impulses are placed at specific points of the body to help reduce pain. The following may also provide benefits:

• Walking
• Swimming
• A Danish study found that five exercises reduced neck pain for women office workers.
• Yoga
• Tai chi
• Mediation and relaxation techniques
• Some say the "Alexander Technique" helps

Scientists at the University of British Columbia, Canada, found that "physical activity is associated with a lower risk of work-related repetitive strain injury".

Occupational Therapy - by analyzing the following factors with the help of an occupational therapist, there may be ways of adopting measures to reduce symptoms:

• Working with a computer - is your equipment positioned properly. Are your seat, keyboard and mouse positioned in the best way to minimize strain on your hands, fingers, arms, back and neck. Adaptive technology, such as special keyboards, mouse replacements, pen tablets interfaces, and speech recognition software may help.
  
• Posture - are you sitting correctly?
  
• Breaks - when doing repetitive tasks are you getting enough breaks? There is software that reminds computer users it is time to have a break.
  
• Work environment - is there anything your employer might do to improve your working environment?
  
• Stress - is there anything you can do to alleviate (treat) your level of stress?

Many patients experience reduced symptoms, or total elimination of symptoms if prevention and treatment measures are carried out. Others, however, continue to suffer regardless. Unfortunately, there are cases of people having to leave/change their jobs.