What is repetitive strain injury

Repetitive strain injury (RSI) is a general term used to describe the pain felt in muscles, nerves and tendons caused by repetitive movement and overuse. Repetitive strain injury (RSI) is also known as work-related upper limb disorder, or non-specific upper limb pain.

Repetitive strain injury can be caused by a variety of tasks at work, such as forceful or repetitive activity, or by poor posture.

Repetitive strain injury is usually associated with doing a particular activity repeatedly or for a long period of time.

Repetitive strain injury mostly affects parts of your upper body, such as the:

• forearms and elbows
• wrists and hands
• neck and shoulders

The first step in treating repetitive strain injury is usually to identify and modify the task or activity that is causing the symptoms. If necessary, you may need to stop doing the activity altogether.

If you develop symptoms of repetitive strain injury and think it may be related to your job, speak to your employer or occupational health representative.

It may be possible to modify your tasks to improve your symptoms.

See your doctor if symptoms continue, despite attempts to change how you work.

To relieve symptoms, your doctor may recommend taking acetaminophen (paracetamol) or a short course of a non-steroidal anti-inflammatory drug, such as ibuprofen. They may also suggest using a hot or cold pack, elastic support or splint.

You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles. Some people find that other types of therapy help to relieve symptoms, including massage, yoga and osteopathy.

What causes repetitive strain injury?

Repetitive strain injury is related to the overuse of muscles and tendons in the upper body.

Certain things are thought to increase the risk of repetitive strain injury, including:

• repetitive activities
• doing a high-intensity activity for a long time without rest
• poor posture or activities that involve working in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting repetitive strain injury and can make the symptoms worse. Stress can also be a contributing factor.

Jobs that involve repetitive movements can lead to repetitive strain injury, such as working on an assembly line, at a supermarket checkout or on a computer.

Your work environment should be as comfortable as possible. You should ideally have a workplace assessment so that any adjustments needed can be made.

Your employer has a legal duty to try to prevent work-related repetitive strain injury and ensure anyone who already has the condition doesn’t get any worse.

Risk factors for repetitive strain injury

Occupational environments which involve repetitious activities can often predispose a patient to repetitive strain injury. High performance athletes and performing artistes are particularly susceptible groups. Race, age and sex are controversial in terms of determining predisposition. repetitive strain injury can also often be associated with depression.

Injuries associated with repetitive vibration exposure are also particularly susceptible. Also, the greater the force involved, the greater the likelihood of developing an overuse injury.

Repetitive strain injury prevention

Most employers carry out a risk assessment when you join a company to check that your work area is suitable and comfortable for you. You can request an assessment if you haven’t had one.

There are also things you can do to help reduce your risk of getting repetitive strain injury, such as:

• maintaining good posture at work
• taking regular breaks from long or repetitive tasks – it’s better to take smaller, more frequent breaks than one long lunch break
• trying breathing exercises if you’re stressed

If you work at a computer all day, make sure your seat, keyboard, mouse and screen are positioned so they cause the least amount of strain.

These practical tips can help reduce your risk of developing repetitive strain injury and other related disorders that can arise from working with computers.

Making sure your desk equipment is properly set up and adjusted to your specifications is the first step in preventing repetitive strain injury.

Get advice on how to sit correctly to make sure you’re sitting in the right position and your desk is set up the right way.

The standard keyboard and mouse are adjustable devices with settings that you can change in the same way you might adjust your office chair.

Various types of non-standard keyboards are available. They may improve the positioning of your hands.

Some people find the standard mouse uncomfortable as it involves twisting the wrist. Alternative mice and other pointing devices are worth investigating.

You could also consider speech recognition software, which allows you to control your phone or a computer application by using your voice.

Ask your workplace about getting a workstation assessment.

Your mouse

• Changing the settings to slow your mouse down can greatly reduce muscle tension in your hand.
• Use keyboard shortcuts instead of the mouse to navigate and execute commands.
• The mouse keys feature allows you to use the arrow keys on your keyboard’s number pad to move the pointer around the screen.
• Download mousetool free software. It takes away the need to click on the mouse, which many people find painful. You may need to get permission from your employer to download the software.

Your keyboard

• You can adjust the keyboard’s key repeat rate to avoid mistakes that you then have to go back and correct.
• Use StickyKeys, a Windows function that allows you to press one key at a time to write capital letters and other multi-key commands to avoid having to hold a modifier key down, such as Shift, Ctrl or Alt while pressing another key.
• Predictive text and autocorrect features guess what you want to type and save you unnecessary keystrokes.

Take regular breaks

Don’t sit in the same position for long periods. Short, regular breaks can help prevent repetitive strain injury and other upper limb disorders.

It lets the muscles relax while others take the strain. This can prevent you becoming stiff and tense.

Most jobs provide opportunities to take a break from the screen, such as photocopying or printing. Try to make use of them.

If there are no such natural breaks in your job, your employer should plan for you to have rest breaks.

Repetitive strain injury symptoms

The symptoms of repetitive strain injury can range from mild to severe and usually develop gradually. They often include:

• pain, aching or tenderness
• stiffness
• throbbing
• tingling or numbness
• weakness
• cramp

At first, you might only notice symptoms when you’re carrying out a particular repetitive action.

But without treatment, the symptoms of repetitive strain injury may eventually become constant and cause longer periods of pain. You may also get swelling in the affected area, which can last for several months.

Repetitive strain injury diagnosis

Repetitive strain injury (RSI) may be diagnosed when symptoms develop after a repetitive task and fade when the task is stopped. Your doctor will examine the area where you have pain and ask about your symptoms and medical history.

If your symptoms suggest you have swollen and inflamed tissue, you may have an underlying medical condition, such as:

• Bursitis – inflammation and swelling of the fluid-filled sac near a joint, such as the elbow or shoulder
• Nerve compression or entrapment, such as carpal tunnel syndrome
• Dupuytren’s contracture – a thickening of the tissues in the hand, which causes one or more fingers to bend into the palm
• Epicondylitis – inflammation of the area where bone and tendon join, such as the elbow
• Rotator cuff syndrome – inflammation of the tendons and muscles around the shoulder
• Tendonitis – inflammation of a tendon
• Tenosynovitis – inflammation of the sheath that covers the tendons, most commonly in the hand, wrist or forearms
• Trigger finger – where swelling in a tendon running along one of the fingers makes it difficult to either bend or straighten the affected finger
• Ganglion cyst – a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers
• Raynaud’s phenomenon – a condition where the blood supply to extremities such as the fingers is interrupted, especially when exposed to cold
• Thoracic outlet syndrome – compression of the nerves or blood vessels that run between the base of the neck and the armpit
• Writer’s cramp (a type of dystonia) – a condition caused by overuse of the hands and arms

If your symptoms don’t immediately suggest one of the above conditions, you may be referred for further tests.

For example, you may be given an X-ray to test for osteoarthritis, or blood tests to rule out inflammatory joint conditions.

If no other condition is found after having tests, you may be diagnosed with “non-specific upper limb pain syndrome”.

Repetitive strain injury treatment

Treatment for repetitive strain injury (repetitive strain injury) depends on your symptoms and whether a specific condition has been diagnosed.

Workplace health

If your repetitive strain injury is caused by repetitive activity at work, the first step is to speak to your employer or occupational health representative.

It may be possible to modify your tasks to relieve the symptoms. Small changes to your lifestyle and working environment can often help.

Think about your working environment and what activity may be causing the problem. Take steps to reduce how much time you spend doing this activity or change how you do it.

If you can’t stop doing it completely, take regular, short breaks to stretch and move about. Software packages that remind you to take regular breaks from the keyboard can be useful.

Exercise

Some people with symptoms of repetitive strain injury find that including exercise in their daily routine, such as walking or swimming, also eases their symptoms.

Treatment options

See your doctor if your repetitive strain injury symptoms continue, despite attempts to modify your work activities. A number of treatments are available that may help.

If you have a specific medical condition, well-established treatments can often be recommended. These include self-help measures, medication, or even surgery, in some cases.

Some of these treatments may help even if a specific medical condition can’t be diagnosed from your symptoms. However, in these cases, their effectiveness may be limited.

Possible treatment options for repetitive strain injury include:

• medication – including paracetamol, short-term use of anti-inflammatory medicines, such as ibuprofen, or pain receptor-blocking medications, such as some forms of antidepressants, if you’re getting severe symptoms or interrupted sleep
• cold packs, elastic supports or a splint. Put ice or a cold pack on the area for 10 to 20 minutes at a time to ease pain. Put a thin cloth between the ice and your skin. If your doctor gave you a splint, use it exactly as directed.
  
• physiotherapy – including advice on posture and stretches or exercises to help strengthen or relax your muscles
• steroid injections to reduce inflammation in an affected area (these are only recommended if an area has definite inflammation caused by a specific condition, such as carpal tunnel syndrome)
• surgery to correct specific problems with nerves or tendons (for example, if you are diagnosed with carpal tunnel syndrome or Dupuytren’s contracture) if other treatments haven’t helped

Physical and complementary therapies

“Hands-on” therapies, including physiotherapy, massage or osteopathy, may be available after a referral from your doctor, but in some cases there may be a long wait for an appointment.

If you decide to have private treatment, make sure your therapist is registered with a professionally recognized organization.

Many people who have repetitive strain injury for a long time try other types of complementary therapies and relaxation techniques to help relieve their symptoms, such as:

• yoga
• acupuncture
• the Alexander technique

However, while some people with repetitive strain injury find these helpful, there’s little scientific evidence to suggest they’re consistently effective for repetitive strain injury.

It can also be helpful to get advice from an occupational health representative at work on how to set up your work station.

Repetitive strain injury prognosis

Repetitive strain injury occasionally may be resolved permanently with treatment. However most patients often have recurrences of varying severity. In most cases, the patient returns to the activity in question, either due to occupational circumstance or personal preferences. This prompts a recurrence of symptoms. High motivation and commitment to optimizing individual biomechanics, and maintaining an active prevention program (usually including a home exercise program) are common features in patients who remain problem-free, despite returning to the same or similar activities. In cases of defined nerve compression, the surgical release usually is followed by resolution of the symptoms, with low recurrence rates.