Repetitive strain injury

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Repetitive strain injury

ICD-10
ICD-9
OMIM	[1]
DiseasesDB	11373
MedlinePlus	[2]
eMedicine	pmr/97
MeSH	{{{MeshNumber}}}

A repetitive strain injury (RSI), also called repetitive stress injury, cumulative trauma disorder or ocupational overuse syndrome, is any of a loose group of conditions from overuse of the computer, guitar, knife or similar motion or tool. It is an occupational overuse syndrome affecting muscles, tendons and nerves in the arms and upper back; hence it is also known as work related upper limb disorder or WRULD. 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, massages 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. In this case 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
• Tendonitis
• Tenosynovitis
• Thoracic Outlet Syndrome
• Radial tunnel syndrome
• Gamekeeper's thumb

Warning signs

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

• Recurring pain 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, fatigue.
• 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.

Prevention

The following applies to typing or computer use. RSI is best prevented in its early stages before it becomes difficult to control.

• Pay attention to pain and fatigue. Stop using the computer before you begin to feel symptoms.
• Pay attention to posture. The head and back should form a straight line from the ears to the pelvis. The shoulders and head should not be hunched forward. (Note: Recent studies indicate this is actually the worst position for your spinal cord, with a reclining posture putting the least stress on the discs, no mention of how it affects the rest of the body has been made in the studies)
• Take regular breaks. One option is to install software that reminds you to take breaks (RSI software). There are also subscription services available which offer a library of exercises designed to be done in 5 minutes or less.
• Do not rest your wrists on a pad.[3] Hold your wrists straight, rather than bent up, down, or to the side.
• Try different input devices rather than the mouse and keyboard; variety is good. Consider speech recognition, graphics tablets, tablet PCs or trackballs.
• Keep in good shape, with regular aerobic exercise and adequate sleep. Drink enough water, and do not smoke. This will help improve strength and bloodflow in the affected muscles.
• Learn a systematic muscle-relaxation technique such as diaphragmatic breathing, qigong, or progressive muscle relaxation to help keep neck and shoulder muscles relaxed.

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 the report of pain, even after short term exposure.

Some believe that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to RSI. The main advocate of this point of view, Dr. John Sarno, considers that RSI, back pain and other pain syndromes, although they sometimes have a physical cause, are more often a manifestation of Tension Myositis Syndrome, a psychosomatic disorder resulting from continued stress. Sarno has reported a high success rate in curing patients through gaining a greater awareness of the role of emotions in triggering symptoms. The technique is based around accepting that the unconscious mind is using pain to divert the person from painful emotions. Many people report being cured from RSI through reading one of Sarno's books and putting the theory into practice.

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.

• The sufferer should gather as much information as possible on their disorder. 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. Consider reading books (see references) as well as asking several experts for advice. Occupational therapists, physical therapists, physiatrists, surgeons, and alternative medicine practitioners may all be involved in the diagnosis and treatment plan.
• 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 the patient should not self-prescribe, 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). These should be prescribed by a medical professional, as overuse of the strained muscles and tendons can worsen symptoms.

• Surgery. This should only be used as a last resort; it is not always effective, and the above methods have been known to heal even some very serious RSI conditions provided they are properly applied.
• Mind/Body approach. In the mind/body approach, RSI is not seen as a structural injury, but as a psychosomatic condition. That is not to say that the pain is imagined or 'all in the mind'. Rather, the pain is a way the subconscious diverts attention from painful emotions. In the work of John E. Sarno, this syndrome is called Tension Myositis Syndrome (TMS) and is treated by communicating with the subconscious which is causing the pain. It is possible to make a complete recovery using this approach, which can be self-applied once the sufferer reads Sarno's book and understands the condition.

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
• The Mindbody Prescription: Healing the Body, Healing the Pain; John Sarno (1998) (ISBN 0-446-67515-6)

External links

• Musculoskeletal Disorders from European Agency for Safety and Health at Work (EU-OSHA)
• Success stories from RSI sufferers who have found permanent relief from this chronic condition.
• RSI Action a national charity campaigning for greater prevention measures.
• Decrease Keyboard Repetitive Strain Injury by using a personal productivity tool for Windows.