A repetitive strain injury (RSI) is an injury to part of the

musculoskeletal The human musculoskeletal system (also known as the human locomotor system, and previously the activity system) is an organ system that gives humans the ability to move using their muscular and skeletal systems. The musculoskeletal system prov ...

nervous system In biology, the nervous system is the highly complex part of an animal that coordinates its actions and sensory information by transmitting signals to and from different parts of its body. The nervous system detects environmental changes ...

caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress disorders, cumulative trauma disorders (CTDs), and overuse syndrome.

Signs and symptoms

Some examples of symptoms experienced by patients with RSI are aching, pulsing pain, tingling and extremity weakness, initially presenting with intermittent discomfort and then with a higher degree of frequency.

Definition

Repetitive strain injury (RSI) and associative trauma orders are

umbrella term In linguistics, semantics, general semantics, and ontologies, hyponymy () is a semantic relation between a hyponym denoting a subtype and a hypernym or hyperonym (sometimes called umbrella term or blanket term) denoting a supertype. In other wor ...

s used to refer to several discrete conditions that can be associated with repetitive tasks, forceful exertions, vibrations, mechanical compression, sustained or awkward positions, or repetitive eccentric contractions. The exact terminology is controversial, but the terms now used by the United States Department of Labor and the National Institute of Occupational Safety and Health (NIOSH) are

musculoskeletal disorder Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g., ...

s (MSDs) and work-related muscular skeletal disorders (WMDs). Examples of conditions that may sometimes be attributed to such causes include tendinosis (or less often

tendinitis Tendinopathy, a type of tendon disorder that results in pain, swelling, and impaired function. The pain is typically worse with movement. It most commonly occurs around the shoulder (rotator cuff tendinitis, biceps tendinitis), elbow (tennis elbo ...

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparen ...

cubital tunnel syndrome Ulnar nerve entrapment is a condition where the ulnar nerve becomes physically trapped or pinched, resulting in pain, numbness, or weakness, primarily affecting the little finger and ring finger of the hand. Entrapment may occur at any point from ...

De Quervain syndrome De Quervain syndrome is mucoid degeneration of two tendons that control movement of the thumb and their tendon sheath. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On occasion, the ...

, thoracic outlet syndrome,

intersection syndrome Intersection syndrome is a painful condition that affects the lateral side of the forearm when inflammation occurs at the intersection of the muscle bellies of the abductor pollicis longus and extensor pollicis brevis cross over the extensor carpi ...

golfer's elbow Golfer's elbow, or medial epicondylitis, is tendinosis of the medial epicondyle on the inside of the elbow. It is in some ways similar to tennis elbow, which affects the outside at the lateral epicondyle. The anterior forearm contains several ...

(medial epicondylitis),

tennis elbow Tennis elbow, also known as lateral epicondylitis or enthesopathy of the extensor carpi radialis origin, is a condition in which the outer part of the elbow becomes painful and tender. The pain may also extend into the back of the forearm. Onse ...

(lateral epicondylitis),

trigger finger Trigger finger, also known as stenosing tenosynovitis, is a disorder characterized by catching or locking of the involved finger in full or near full flexion, typically with force. There may be tenderness in the palm of the hand near the last ...

(so-called stenosing tenosynovitis),

radial tunnel syndrome Radial tunnel syndrome (RTS) is caused by increased pressure on the radial nerve as it travels from the upper arm (the brachial plexus) to the hand and wrist. Symptoms and signs Radial tunnel syndrome causes posterolateral elbow pain that is simil ...

ulnar tunnel syndrome Ulnar tunnel syndrome, also known as Guyon's canal syndrome or Handlebar palsy, is caused by entrapment of the ulnar nerve in the Guyon canal as it passes through the wrist. Symptoms usually begin with a feeling of pins and needles in the ring ...

, and

focal dystonia Focal dystonia, or focal task specific dystonia, is a neurological condition, a type of '' dystonia'', that affects a muscle or group of muscles in a specific part of the body during specific activities, causing involuntary muscular contractions an ...

. A general worldwide increase since the 1970s in RSIs of the arms, hands, neck, and shoulder has been attributed to the widespread use in the workplace of keyboard entry devices, such as typewriters and computers, which require long periods of repetitive motions in a fixed posture. Extreme temperatures have also been reported as risk factor for RSI.

Risk factors

Occupational risk factors

Workers in certain fields are at risk of repetitive strains. Most occupational injuries are

musculoskeletal disorders Musculoskeletal disorders (MSDs) are injuries or pain in the human musculoskeletal system, including the joints, ligaments, muscles, nerves, tendons, and structures that support limbs, neck and back. MSDs can arise from a sudden exertion (e.g., li ...

, and many of these are caused by cumulative trauma rather than a single event. Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries. Jobs that involve repeated motion patterns or prolonged posture within a work cycle, or both, may be repetitive. Young athletes are predisposed to RSIs due to an underdeveloped musculoskeletal system.

Psychosocial factors

Factors such as personality differences to work-place organization problems. Certain workers may negatively perceive their work organization due to excessive work rate, long work hours, limited job control, and low social support. Previous studies shown elevated urinary

catecholamine A catecholamine (; abbreviated CA) is a monoamine neurotransmitter, an organic compound that has a catechol (benzene with two hydroxyl side groups next to each other) and a side-chain amine. Catechol can be either a free molecule or a su ...

s (stress-related chemicals) in workers with RSI. Pain related to RSI may evolve into

chronic pain syndrome Chronic pain is classified as pain that lasts longer than three to six months. In medicine, the distinction between acute and chronic pain is sometimes determined by the amount of time since onset. Two commonly used markers are pain that continues ...

particularly for workers who do not have supports from co-workers and supervisors.

Non-occupational factors

Age and gender are important risk factors for RSIs. The risk of RSI increases with age. Women are more likely affected than men because of their smaller frame, lower muscle mass and strength, and due to endocrine influences. In addition, lifestyle choices such as smoking and

alcohol consumption An alcoholic beverage (also called an alcoholic drink, adult beverage, or a drink) is a drink that contains ethanol, a type of alcohol that acts as a drug and is produced by fermentation of grains, fruits, or other sources of sugar. The cons ...

are recognizable risk factors for RSI. Recent scientific findings indicate that obesity and diabetes may predispose an individual to RSIs by creating a chronic low grade inflammatory response that prevents the body from effectively healing damaged tissues.

Diagnosis

RSIs are assessed using a number of objective clinical measures. These include effort-based tests such as grip and pinch strength, diagnostic tests such as Finkelstein's test for De Quervain's tendinitis, Phalen's contortion, Tinel's percussion for carpal tunnel syndrome, and

nerve conduction velocity In neuroscience, nerve conduction velocity (CV) is an important aspect of nerve conduction studies. It is the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors ...

tests that show nerve compression in the wrist. Various imaging techniques can also be used to show nerve compression such as

x-ray An X-ray, or, much less commonly, X-radiation, is a penetrating form of high-energy electromagnetic radiation. Most X-rays have a wavelength ranging from 10 picometers to 10 nanometers, corresponding to frequencies in the range 30&nb ...

for the wrist, and

MRI Magnetic resonance imaging (MRI) is a medical imaging technique used in radiology to form pictures of the anatomy and the physiological processes of the body. MRI scanners use strong magnetic fields, magnetic field gradients, and radio waves ...

for the thoracic outlet and cervico-brachial areas. Utilization of routine imaging is useful in early detection and treatment of overuse injuries in at risk populations, which is important in preventing long term adverse effects.

Treatment

There are no quick fixes for RSI. Early diagnosis is critical to limiting damage. For Upper Limb Repetitive Strain Injury (RSI), Occupational Therapists create interventions that include education to facilitate ergonomics. This will minimize the possibility of an upper limb strain injury by learning the correct approach during facilitating functional task movements. The

RICE Rice is the seed of the grass species '' Oryza sativa'' (Asian rice) or less commonly ''Oryza glaberrima'' (African rice). The name wild rice is usually used for species of the genera '' Zizania'' and '' Porteresia'', both wild and domesticat ...

treatment is used as the first treatment for many muscle strains, ligament sprains, or other bruises and injuries. RICE is used immediately after an injury happens and for the first 24 to 48 hours after the injury. These modalities can help reduce the swelling and pain. Commonly prescribed treatments for early-stage RSIs include

analgesics An analgesic drug, also called simply an analgesic (American English), analgaesic (British English), pain reliever, or painkiller, is any member of the group of drugs used to achieve relief from pain (that is, analgesia or pain management). It ...

, myofeedback, biofeedback, physical therapy, relaxation, and

ultrasound Ultrasound is sound waves with frequencies higher than the upper audible limit of human hearing. Ultrasound is not different from "normal" (audible) sound in its physical properties, except that humans cannot hear it. This limit varies ...

therapy. Low-grade RSIs can sometimes resolve themselves if treatments begin shortly after the onset of symptoms. However, some RSIs may require more aggressive intervention including surgery and can persist for years. Although there are no "quick fixes" for RSI, there are effective approaches to its treatment and prevention. One is that of

ergonomics Human factors and ergonomics (commonly referred to as human factors) is the application of psychological and physiological principles to the engineering and design of products, processes, and systems. Four primary goals of human factors learnin ...

, the changing of one's environment (especially workplace equipment) to minimize repetitive strain. General exercise has been shown to decrease the risk of developing RSI. Doctors sometimes recommend that those with RSI engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive

kyphosis Kyphosis is an abnormally excessive convex curvature of the spine as it occurs in the thoracic and sacral regions. Abnormal inward concave ''lordotic'' curving of the cervical and lumbar regions of the spine is called lordosis. It can result ...

, and potentially thoracic outlet syndrome. Modifications of posture and arm use are often recommended.

History

Although seemingly a modern phenomenon, RSIs have long been documented in the medical literature. In 1700, the Italian physician

Bernardino Ramazzini Bernardino Ramazzini (; 4 October 1633 – 5 November 1714) was an Italian physician. Ramazzini, along with Francesco Torti, was an early proponent of the use of cinchona bark (from which quinine is derived) in the treatment of malaria. His m ...

first described RSI in more than 20 categories of industrial workers in Italy, including musicians and clerks.

Carpal tunnel syndrome Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with median neuropathy at the carpal tunnel. Most CTS is related to idiopathic An idiopathic disease is any disease with an unknown cause or mechanism of apparen ...

was first identified by the British surgeon

James Paget Sir James Paget, 1st Baronet FRS HFRSE (11 January 1814 – 30 December 1899) (, rhymes with "gadget") was an English surgeon and pathologist who is best remembered for naming Paget's disease and who is considered, together with Rudolf Virch ...

in 1854. The April 1875 issue of ''

The Graphic ''The Graphic'' was a British weekly illustrated newspaper, first published on 4 December 1869 by William Luson Thomas's company Illustrated Newspapers Ltd. Thomas's brother Lewis Samuel Thomas was a co-founder. The premature death of the latt ...

'' describes "telegraphic paralysis." The Swiss surgeon Fritz de Quervain first identified De Quervain's

in Swiss factory workers in 1895. The French neurologist Jules Tinel (1879–1952) developed his percussion test for compression of the median nerve in 1900. The American surgeon George Phalen improved the understanding of the aetiology of

with his clinical experience of several hundred patients during the 1950s and 1960s.

Society

Specific sources of discomfort have been popularly referred to by terms such as Blackberry thumb, PlayStation thumb, Rubik's wrist or "cuber's thumb", stylus finger, and raver's wrist, and Emacs pinky.

Citations

External links

*
Musculoskeletal disorders
from the European Agency for Safety and Health at Work (

EU-OSHA The European Agency for Safety and Health at Work (EU-OSHA) is a decentralised agency of the European Union with the task of collecting, analysing and disseminating relevant information that can serve the needs of people involved in safety and h ...

) * {{DEFAULTSORT:Repetitive Strain Injury Musculoskeletal disorders Occupational diseases Overuse injuries Physical ergonomics