Repetitive strain injury (RSI), also known as Cumulative Trauma Disorder (CTD), occupational overuse syndrome, non-specific arm pain or work related upper limb disorder (WRULD), is a diagnosis used for hand and arm pain that is believed to be caused by chronic misuse, for instance, while using a computer. Conditions such as RSI tend to be associated with both physical and psychosocial stressors.
The following complaints are typical in patients that might receive a diagnosis of RSI:
- Pain in the arm (typically diffuse—i.e. spread over many areas).
- The pain is worse with activity.
- Weakness, lack of endurance.
In contrast to carpal tunnel syndrome, the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be characteristic of any discrete pathological conditions. A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.
Physical Examination and Diagnosis
The physical examination discloses tenderness and diminished performance on effort-based tests such as grip and pinch strength. Often tendon stress tests show muscles as weak and spinal joint problems are often found by chiropractors in those with RSI. Diagnostic tests such as x-ray, are normal.
The term “repetitive strain injury” is most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints. It may also be used as an umbrella term incorporating other discrete diagnoses that have (intuitively but often without proof) been associated with activity-related arm pain such as Carpal tunnel syndrome, Cubital tunnel syndrome, Thoracic Outlet Syndrome, DeQuervain’s syndrome, Stenosing tenosynovitis/Trigger finger/thumb, Intersection syndrome, Golfer’s elbow (medial epicondylosis), Tennis elbow (lateral epicondylosis), and Focal dystonia.
Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as Reflex sympathetic dystrophy syndrome (RSDS), Blackberry thumb, disputed Thoracic Outlet Syndrome, Radial tunnel syndrome, “Gamer’s thumb” (a slight swelling of the thumb caused by excessive use of a gamepad), “Rubik’s wrist” or “cuber’s thumb” (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik’s Cube for speedcubing), “Stylus Finger” (Swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), “Raver’s wrist”, caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave).
Modifications of posture and arm use (ergonomics) are often recommended.
Adaptive technology ranging from special keyboards, mouse replacements and pen tablet interfaces to speech recognition software might be necessary.
Pause software reminds the user to pause frequently and perform exercises while working behind a computer. One such program is Workrave, an open-source 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.
To find out how to set up your workstation watch this short video on the NHS Choices website Healthy back at work.
Switching to a much more ergonomic mouse, such as a RollerMouse, thumb trackball, vertical mouse or joystick, or switching from using a mouse to using a stylus pen with graphic tablet may provide relief, but in chronic RSI they may only result in moving the problem to a different area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a trackpad such as a Smart Cat trackpad, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice (which do not require a surface to operate) might offer an alternative where the user’s arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate (“air mice” function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop or armrest.
Keyboards and Keyboard-alternatives
- Switching to a much more ergonomic keyboard layout such as Dvorak or Colemak may help.
- Exotic keyboards by manufacturers such as DataHand, OrbiTouch, Maltron and Kinesis are available.
- Dragon NaturalSpeaking is the most popular dictation software. Some RSI sufferers have hired human typists.
Here are some great links for this equipment
- Clickless Mouse
- Thumb mouse
- Vertical Mouse
- Local Brighton supplier
- Break reminder software
One of the most effective therapies for RSI is Low Level Laser. Our physio, combines a series of specific exercises with the laser and the results are very encouraging. People often report relief starting over the first few sessions and, combined with ergonomic advice, can go on for permanent improvements.
Some RSI problems can be made worse by problems in the neck and upper back. Not only can joint problems in the spine cause neck pain and headaches but muscle spasm in these areas can cause referred pain into the arms. If the nerves that exit the spine get irritated, muscles in the arm and hand can weaken increasing the likelihood of RSI.
A number of medical treatments including non-narcotic pain medications and braces exist. Heat, cold, alternating hot and cold, or TENS are sometimes applied to the hands and forearms. Biofeedback may be used to measure tension in specific muscles, or to track overall stress levels.
Unless effective therapy is started early, recovery can take up to many months without performing activities that might exacerbate the symptoms, and that joint should never be put under severe or constant stress.
Exercise for RSI
Exercise decreases the risk of developing RSI:-
- Pulling fingers back gently
- Shaking hands out
- Massaging forearms
- Squeezing shoulder blades together
- Fingers opening against elastic band
- Squeezing a squidgy ball
- Neck side bend with stretch
- Shoulder rolling
Preventing RSI is easy. A few simple steps will minimise the risk of RSI and if you do start to get symptoms then you know what to do.
The important points to remember are:-
- Set up the equipment properly
- Take regular breaks
- Manage stress levels
- Get treatment early
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.
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