repetitive stress injury

repetitive stress injury or repetitive strain injury (RSI), injury caused by repeated movement of a particular part of the body. Often seen in workers whose physical routine is unvaried, RSI has become epidemic since computers have entered the workplace in large numbers. Many RSIs develop when the sheaths that cover muscle tendons swell and press on nerves. Constant typing can cause one form of RSI, carpal tunnel syndrome, a sometimes disabling pain and tingling in the thumb and first two fingers. It is caused by swelling and pressure on the median nerve passing through the wrist. Other common problems are rotator cuff injury, from overuse of the shoulder; tennis elbow, inflammation of a tendon in the elbow from overuse of the forearm; and back injuries from repeated heavy lifting. A 1998 report by the National Academy of Sciences in the United States called RSI a serious national problem, with financial costs ranging up to $20 billion annually.

Treatment of RSI usually begins with attempts to change the conditions that caused the injury. Often, exercises and anti-inflammatory drugs are prescribed; in some cases surgery is necessary. Many workers' compensation cases and lawsuits relating to RSI have been brought against employers and product manufacturers. To avoid the high costs of RSI, some businesses have introduced ergonomic workstations and enforced rest periods.

A repetitive strain injury (RSI), also called cumulative trauma disorder (CTD), occupational overuse syndrome, or work related upper limb disorder (WRULD), is any of a loose group of conditions resulting from overuse of a tool, such as a computer keyboard or musical instrument 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 workers, computer workers, store checkout clerks, and professional musicians. 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 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:

• Focal dystonia
• 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
• Blackberry thumb
• Epicondylitis
• Golfer's elbow
• Tennis elbow

• Tendinitis
• Tenosynovitis
• Thoracic Outlet Syndrome
• Radial tunnel syndrome
• Gamekeeper's thumb
• "Gamer's thumb" (a slight swelling of the thumb caused by excessive use of a gamepad)
• "Rubik's wrist" or "cuber's thumb" (tendonitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's Cube for speedcubing)
• "Raver's wrist", caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave). With the decline of trance, techno and other forms of hard dance music from 2000 onwards this ailment has become more rare.

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 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. 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, treatments often require the patient to make significant changes to his or her work habits or work environment. Partial or complete cessation of hand activity might be necessary for some period of time in order for healing to begin. (Occupational therapists, physical therapists, physiatrists, surgeons, and alternative medicine practitioners all offer diagnosis and treatment plans.

The medical professional may prescribe orthopedic hand braces, but warn against self-prescription, or further injury might result. Medications that may be prescribed include 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. Self-massage products like the Armaid have been developed specifically to target areas typically affected by RSI. Active release techniques are effective in reducing RSI symptoms by releasing the tension of the muscles and nerves of the injured area. You would need to visit a certified ART provider to receive this treatment. Stretches (for less acute pain and general maintenance).

Many doctors will prescribe occupational therapy or physical therapy to rebuild strength and flexibility. Some people with RSI find relief in specific movement therapies such as t'ai chi ch'üan, yoga, or the Alexander technique Exercise decreases the risk of developing RSI. Also, doctors often recommend that RSI sufferers engage in specific strengthening exercises, for example to improve posture. Surgery is generally used as a last resort and is not always effective.

In the mind/body approach, RSI is not seen as a structural injury, but as a psychosomatic condition. Some people with RSI have had success with treatments based on this theory, but it has not been widely accepted or systematically studied.

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/or perform practices 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. Switching to a much more ergonomic keyboard layout such as Dvorak or Colemak. Switching to a much more ergonomic mouse, such as a vertical mouse or joystick mouse. Such mice may provide relief, but in chronic RSI they may only result in moving the problem to a different area. Switching from using a mouse to using a stylus pen with graphic tablet. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to. However, it has the side benefit of improving hand-eye coordination. Switching to a trackpad such as a Smart Cat trackpad, which requires no gripping or tensing of the muscles in the arms.

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.

External links

• Sorehand RSI website and a highly used email discussion list

("Sorehand" has apparently been removed from the server, it will not respond)

• Computing RSI Tips Prevention tips for PC related Repetitive Strain Injury
• Musculoskeletal disorders from the European Agency for Safety and Health at Work (EU-OSHA)
• Harvard RSI Action Harvard RSI Action
• Ergonomic posture advice
• RSI Awarenness website
• Tendon injury related to RSI