What is repetitive strain injury (RSI)?

A repetitive strain injury (RSI) is a condition that occurs due to repetitive motions, such as assembly-line work, computer work, or activities like playing musical instruments, sewing, or playing tennis. Such injuries affect muscles, nerves, tendons, and other soft tissues and may be very painful. RSI is also called cumulative trauma disorder, occupational overuse syndrome, regional musculoskeletal disorder, repetitive motion injury, repetitive motion disorder, and repetitive stress injury.

RSI may be caused by a number of actions, such as awkward or sustained positions, mechanical compression (pressing against hard surfaces), and repetitive tasks. Types of RSI include bursitis, carpal tunnel syndrome, epicondylitis, ganglion cyst, tendinitis, tenosynovitis, and trigger finger.

Overview

Experts have identified two types of RSI. Type 1 includes carpal tunnel syndrome and tendinitis and is usually caused by repetitive tasks. Type 2 is often called non-specific pain syndrome. Patients feel pain but a medical exam does not find evidence of inflammation or swelling.

Some examples of RSI include the following:

• 
  
  Bursitis
  is inflammation of the bursa, which is a sac filled with fluid. Bursae cushion bones, joints, tendons, and muscles.




• 
  
  Carpal tunnel syndrome (CTS)
  occurs when the median nerve is compressed in the carpal tunnel, which is in the wrist area. Individuals with CTS may experience numbness and pain in the hand.




• 
  Epicondylitis, which includes tennis elbow and golfer's elbow, results from overusing the muscles and tendons in a joint. Rotator cuff syndrome is a similar condition that occurs in the shoulder.




• 
  Tendinitis is inflammation of a tendon.




• A condition commonly called writer's cramp is a type of RSI caused by computer use. Experts say this condition has been on the rise for some time as computer work has become more common.

RSI often affects parts of the arm—including the elbow, forearm, hand, and wrist—and is frequently related to workplace activities. Some causes of RSI include overuse of muscles in the arms, back, hands, neck, shoulders, and wrists; repetitious actions, often performed daily for a long time; a cold work environment; vibrating equipment; poorly designed equipment and/or poorly organized work areas; forceful movement; infrequent rest breaks; and awkward posture.

Not everyone who performs the same job or does the same activities gets RSI. Experts are not sure why RSI affects some people but not others. Researchers are examining psycho-social factors in the workplace, such as stress, to see if they factor into RSI development. One theory is that stress causes tension in the muscles, which might cause pain sensitivity.

Signs, Symptoms, and Treatment

An individual reports symptoms, such as pain. Other people, including medical professionals, may observe symptoms, such as a rash or swelling. Symptoms may be transitory. For example, they may only be experienced at certain times, such as when the patient moves a body part in a certain way. Sometimes they become worse over time and become constant. Common RSI signs and symptoms include pain and tenderness, throbbing, tingling (also called pins and needles), and loss of sensation and/or strength.

Early treatment may prevent further damage, but serious injury may be permanent. The goal of treatment is usually pain relief as well as improved mobility and strength. Pain may be treated with anti-inflammatory painkillers, such as ibuprofen, and with heat or cold packs. Elastic wraps may be used to support the affected area, and splints may be needed to immobilize the area. In some cases, steroid injections may also be used to treat inflammation.

Some patients may benefit from physical therapy, which often includes exercises such as walking and swimming. Physical therapists sometimes offer patients tips regarding posture to help them prevent further injury. Patients may also benefit from yoga, tai chi, and other activities as well as meditation. Electrotherapy, which targets painful areas with small electrical impulses, may offer pain relief. However, some patients with severe injuries may need surgery.

Occupational therapy (OT)
involves assessing the workplace or activity that led to the RSI. Occupational therapists may discuss work environment issues, such as chair height, keyboard position, and equipment such as mouse devices and pen tablets. OT may also include identifying stressors in the workplace and examining work habits, such as scheduling regular breaks from the activity.

Prevention

Experts have identified a number of ways to avoid RSI. Computer station RSI may be the result of poor posture. Chairs should be adjusted so users' forearms are horizontal with their desks. Thighs should be level and feet should be flat on the floor or on a footrest. The top of the computer screen should be level with an individual's eyes.

Computer keyboards may cause strain for the user. New types of keyboards have been developed to allow users to more naturally position their hands. New software features such as autocorrect may eliminate frequent keystrokes to correct mistakes. Combination keystrokes should be made using both hands rather than by contorting the fingers of one hand to hit both keys. A keyboard should be adjusted so it tilts away from the user, and the wrists should not rest on a wrist pad. Workers should occasionally stretch their fingers and wrists.

A standard mouse also may cause or aggravate RSI, so some users may benefit from trying out other types of equipment or using keyboard shortcuts instead of the mouse. Mouse tool software or voice recognition software may eliminate the need for a mouse altogether.

Experts believe that people should take ten-minute breaks every hour when performing repetitive activities. Workers might schedule tasks such as photocopying throughout the day to take breaks from repetitive actions like typing. They might also just take time to stretch their fingers and hands or get up and walk around to help loosen the muscles in the shoulders and neck.

Bibliography

"NINDS Repetitive Motion Disorders Information Page." National Institute of Neurological Disorders and Stroke. National Institute of Neurological Disorders and Stroke. 11 Jul. 2013. Web. 30 Jan. 2015. http://www.ninds.nih.gov/disorders/repetitive_motion/repetitive_motion.htm

Nordqvist, Christian. "What Is Repetitive Strain Injury (RSI)? What Causes Repetitive Strain Injury?" Medical News Today. MediLexicon International Limited. 19 Jan. 2010. Web. 30 Jan. 2015. http://www.medicalnewstoday.com/articles/176443.php

"Prevent RSI." National Health Service. Gov.UK. 10 Oct. 2013. Web. 2 Feb. 2015. http://www.nhs.uk/Livewell/workplacehealth/Pages/rsi.aspx

"Preventing RSI." Harvard RSI Action. Harvard University. Web. 2 Feb. 2015. http://www.rsi.deas.harvard.edu/preventing.html

"Repetitive Strain Injury (RSI)—Prevention." National Health Service. Gov.UK. 17 Dec. 2013. Web. 2 Feb. 2015. http://www.nhs.uk/Conditions/Repetitive-strain-injury/Pages/Prevention.aspx