Repetitive strain injury

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.{{Cite web|url = http://www.mountsinai.org/static_files/MSMC/Files/Patient%20Care/Occupational%20Health/RSI_12_with%20monroe.pdf|title = Repetitive Strain Injury: What is it and how is it caused?|access-date = 12 February 2016|publisher = Selikoff Centers for Occupational Health|archive-date = 3 February 2016|archive-url = https://web.archive.org/web/20160203122922/http://www.mountsinai.org/static_files/MSMC/Files/Patient%20Care/Occupational%20Health/RSI_12_with%20monroe.pdf|url-status = dead}}

Repetitive strain injury (RSI) and associative trauma orders are umbrella terms 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.{{cite journal |last1=Afsharnezhad |first1=Taher |first2=Maryam |last2=Nourshahi |first3=Siavash |last3=Parvardeh |title=Functional and Histopathological Changes in Muscle After 6-Weeks Repetitive Strain Injury: A 10-Week Follow Up of Aged Rats |journal=International Journal of Applied Exercise Physiology |volume=5 |issue=4 |year=2016 |pages=74–80 |url=http://www.ijaep.com/index.php/IJAE/article/view/114 |id={{ProQuest|1950381705 }} |access-date=25 June 2019 |archive-date=6 August 2020 |archive-url=https://web.archive.org/web/20200806203100/http://www.ijaep.com/index.php/IJAE/article/view/114 |url-status=dead }}{{cite journal |vauthors=van Tulder M, Malmivaara A, Koes B |title=Repetitive strain injury |journal=Lancet |volume=369 |issue=9575 |pages=1815–22 |date=May 2007 |pmid=17531890 |doi=10.1016/S0140-6736(07)60820-4 |url=https://www.researchgate.net/publication/6303661|citeseerx=10.1.1.589.3485 |s2cid=1584416 }} 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 disorders (MSDs) and work-related musculoskeletal disorders (WMDs).

Examples of conditions that may sometimes be attributed to such causes include tendinosis (or less often tendinitis), carpal tunnel syndrome, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, golfer's elbow (medial epicondylitis), tennis elbow (lateral epicondylitis), trigger finger (so-called stenosing tenosynovitis), radial tunnel syndrome, ulnar tunnel syndrome, and focal dystonia.{{Cite journal|title = Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults|journal = The Cochrane Database of Systematic Reviews|date = 2013|issn = 1469-493X|pmid = 24338903|pmc = 6485977|pages = CD008742|volume = 2013|issue = 12|doi = 10.1002/14651858.CD008742.pub2|first1 = Arianne P.|last1 = Verhagen|first2 = Sita M. A.|last2 = Bierma-Zeinstra|first3 = Alex|last3 = Burdorf|first4 = Siobhán M.|last4 = Stynes|first5 = Henrica C. W.|last5 = de Vet|first6 = Bart W.|last6 = Koes}}

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.{{cite web|url=http://www.rsi.org.uk/whatis/prevalence.html |title=Welcome to the RSI Awareness Website |publisher=Rsi.org.uk |date=17 November 2010 |access-date= 2014-07-17}} Specific sources of discomfort have been popularly referred to by terms such as Blackberry thumb, PlayStation thumb,{{cite journal |last1=Vaidya |first1=Hrisheekesh Jayant |title=Playstation thumb |journal=The Lancet |date=March 2004 |volume=363 |issue=9414| pages=1080 |doi=10.1016/S0140-6736(04)15865-0 |pmid=15051306|s2cid=26563611 }} Rubik's wrist or "cuber's thumb",{{cite journal |author=Waugh D |title=Cuber's thumb |journal=N. Engl. J. Med. |volume=305 |issue=13 |page=768 |date=September 1981 |pmid=7266622 |doi= 10.1056/nejm198109243051322}} stylus finger,{{cite web |url=http://ctsplace.com/5-injuries-made-possible-by-modern-technology.php/ |title=5 Modern Technology Strain Injuries | Carpal Tunnel Syndrome |publisher=Ctsplace.com |date=30 December 2012 |access-date=17 July 2014 |archive-date=15 June 2014 |archive-url=https://web.archive.org/web/20140615161631/http://ctsplace.com/5-injuries-made-possible-by-modern-technology.php/ |url-status=dead }} raver's wrist,{{cite web| url = http://medical-dictionary.thefreedictionary.com/Raver's+Wrist| title = Raver's Wrist}} and Emacs pinky.{{Cite web | url=http://xahlee.info/emacs/emacs/emacs_pinky.html | title=How to Avoid Emacs Pinky }} Extreme temperatures have also been reported as risk factor for RSI.{{cite journal|pmid=7718827|title=What do doctors mean by tenosynovitits and repetitive strain injury?|journal=Occupational Medicine (Oxford, England)|volume=45|issue=2|pages=97–104|year=1995|last1=Diwaker|first1=H. N.|last2=Stothard|first2=J.|doi=10.1093/occmed/45.2.97|doi-access=free}}

Workers in certain fields are at risk of repetitive strains. Most occupational injuries are musculoskeletal disorders, and many of these are caused by cumulative trauma rather than a single event.[https://www.cdc.gov/niosh/docs/95-119/pdfs/95-119.pdf Cumulative Trauma Disorders in the Workplace]. U.S. CDC-NIOSH Publication 95-119. 1995. Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries.[https://www.cdc.gov/niosh/mining/works/coversheet995.html Mining Publication: Risk Profile of Cumulative Trauma Disorders of the Arm and Hand in the U.S. Mining Industry] U.S. CDC-NIOSH web site.{{Cite web|url=https://www.cdc.gov/niosh/topics/poultry|title=CDC - Poultry Industry Workers - NIOSH Workplace Safety and Health Topic|website=www.cdc.gov|access-date=2016-07-15}} 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.{{Cite journal|title=Upper extremity overuse injuries in pediatric athletes: Clinical presentation, imaging findings, and treatment|issue=6|pages=954–964|journal=Clinical Imaging|volume=39|doi=10.1016/j.clinimag.2015.07.028|pmid=26386655|date=November 2015|last1=Paz|first1=D. A.|last2=Chang|first2=G. H.|last3=Yetto|first3=J. M. Jr.|last4=Dwek|first4=J. R.|last5=Chung|first5=C. B.}}

Psychological factors include personality differences concerning 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. Studies show elevated urinary catecholamines (stress-related chemicals) in workers with RSI. Pain related to RSI may evolve into chronic pain syndrome, particularly for workers who do not have supports from coworkers and supervisors.{{cite journal|pmid=7832208|title=VDT-related musculoskeletal symptoms: interactions between work posture and psychosocial work factors|journal=American Journal of Industrial Medicine|volume=26|issue=5|pages=597–612|year=1994|last1=Faucett|first1=J.|last2=Rempel|first2=D.|doi=10.1002/ajim.4700260503}}

Age and gender are important risk factors for RSIs. The risk of RSI increases with age.{{cite journal|pmid=7670905|title=Occupational repetitive strain injuries and gender in Ontario 1986 to 1991|journal=Journal of Occupational and Environmental Medicine|volume=37|issue=4|pages=479–85|year=1995|last1=Ashbury|first1=F. D.|doi=10.1097/00043764-199504000-00021|s2cid=38426326}} Women are more likely affected than men because of their smaller frame, lower muscle mass and strength, and endocrine influences. In addition, lifestyle choices such as smoking and alcohol consumption 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.{{Cite journal|title=SAGE Journals: Your gateway to world-class journal research|journal = International Journal of Immunopathology and Pharmacology|volume = 24|issue = 1 Suppl 2|pages = 45–50|language=en|doi=10.1177/03946320110241s209|pmid = 21669137|year = 2011|last1 = Del Buono|first1 = A.|last2 = Battery|first2 = L.|last3 = Denaro|first3 = V.|last4 = MacCauro|first4 = G.|last5 = Maffulli|first5 = N.| s2cid=39663618 |doi-access = }}

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 tests that show nerve compression in the wrist. Various imaging techniques can also be used to show nerve compression such as x-ray for the wrist, and MRI 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.

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There are no quick fixes for repetitive strain injuries. Early diagnosis is critical to limiting damage. For upper limb RSIs, occupational therapists can create interventions that include teaching the correct approaches to functional task movements in order to minimize the risk of injury.{{Cite journal|last1=Cheung|first1=Therma W. C.|last2=Clemson|first2=Lindy|last3=O'Loughlin|first3=Kate|last4=Shuttleworth|first4=Russell|date=2016|title=Understanding decision-making towards housework among women with upper limb repetitive strain injury|url=https://onlinelibrary.wiley.com/doi/abs/10.1111/1440-1630.12254|journal=Australian Occupational Therapy Journal|language=en|volume=63|issue=1|pages=37–46|doi=10.1111/1440-1630.12254|pmid=26856801|issn=1440-1630|url-access=subscription}}{{cite journal | vauthors = Cook J | title = Work related repetitive movement problems. A successful management plan | journal = Aust Fam Physician | volume = 17 | issue = 2 | pages = 104–5 | date = February 1988 | pmid = 3358746 }} The RICE (Rest, Ice, Compression, Elevation) 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.{{Cite web|url=https://share.upmc.com/2014/08/rice-method-for-treating-injury/|title=How to Use the R.I.C.E Method for Treating Injuries|date=27 August 2014}} Commonly prescribed treatments for early-stage RSIs include analgesics, myofeedback, biofeedback, physical therapy, relaxation, intermittent vacuum therapy{{Cite web |url=http://www.rsi-kliniek.nl/vacuumtherapie |title=Vacuümtherapie - Een bewezen RSI-behandelmethode |access-date=2013-11-12 |archive-url=https://web.archive.org/web/20131112160952/http://www.rsi-kliniek.nl/vacuumtherapie |archive-date=2013-11-12 |url-status=dead }} and ultrasound 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.{{citation needed|date=October 2020}}

Although there are no "quick fixes" for RSI, there are effective approaches to its treatment and prevention.{{Cite journal|last=Copeland|first=CS|date=May–Jun 2014|title=It's All in the Wrist...Or Is It? Symptoms, Sources, and Solutions for Repetitive Stress Injury|url=http://claudiacopeland.com/uploads/3/5/5/6/35560346/_hjno_its_all_in_the_wrist...or_is_it__rsi.pdf|journal=Healthcare Journal of New Orleans}} One is that of ergonomics, the changing of one's environment (especially workplace equipment) to minimize repetitive strain.

A 2006 Canadian study found exercise in leisure time was strongly associated with decreased risk of developing an RSI.{{Cite journal|title=Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity|last=Ratzlaff|first=C. R.|author2=J. H. Gillies |author3=M. W. Koehoorn |journal=Arthritis & Rheumatism |volume=57 |issue=3 |date=April 2007 |pages=495–500 |pmid=17394178|doi=10.1002/art.22610|doi-access= }} Doctors sometimes recommend that those with RSI engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive kyphosis, and potentially thoracic outlet syndrome.{{cite book |first1=Carolyn |last1=Kisner |first2=Lyn Allen |last2=Colby |title=Therapeutic Exercise: Foundations and Techniques |page=473 |location=Philadelphia |publisher=F. A. Davis |edition=5th |year=2007 |isbn=978-0-8036-1584-7 }} Modifications of posture and arm use are often recommended.Berkeley Lab. [http://www.lbl.gov/ehs/pub811/hazards/ergonomics.html Integrated Safety Management: Ergonomics] {{webarchive|url=https://web.archive.org/web/20090805182457/http://www.lbl.gov/ehs/pub811/hazards/ergonomics.html |date=5 August 2009 }}. Website. Retrieved 9 July 2008.

Although seemingly a modern phenomenon, RSIs have long been documented in the medical literature. In 1700, the Italian physician Bernardino Ramazzini first described RSI in more than 20 categories of industrial workers in Italy, including musicians and clerks.{{cite book |last=Ramazzini |title=De Morbis Artificum Diatriba |trans-title=Diseases of Workers |location=Modena |year=1700 }} Carpal tunnel syndrome was first identified by the British surgeon James Paget in 1854.{{cite journal |last=Pearce |first=J. M. |date=April 2009 |title=James Paget's median nerve compression (Putnam's acroparaesthesia) |journal=Pract Neurol |volume=9 |issue=2 |pages=96–9 |doi=10.1136/jnnp.2008.166140 |pmid=19289560 |s2cid=30847057 }} The April 1875 issue of The Graphic describes "telegraphic paralysis."{{cite web |url=http://www.victorianlondon.org/disease/telegraphicparalysis.htm |title=Victorian London - Disease - 'telegraphic paralysis' }}

The Swiss surgeon Fritz de Quervain first identified De Quervain's tendinitis in Swiss factory workers in 1895.{{cite journal |last1=Ahuja |first1=N. K. |last2=Chung |first2=K. C. |title=Fritz de Quervain, MD (1868–1940): stenosing tendovaginitis at the radial styloid process |journal= The Journal of Hand Surgery|volume=29 |issue=6 |pages=1164–70 |doi=10.1016/j.jhsa.2004.05.019 |pmid=15576233 |year=2004 }} The French neurologist Jules Tinel (1879–1952) developed his percussion test for compression of the median nerve in 1900.{{cite book |last=Tinel |first=J. |title=Nerve wounds |url=https://archive.org/details/nervewoundssympt00tineuoft |location=London |publisher=Baillère, Tindall and Cox |year=1917 }}{{cite journal |last=Tinel |first=J. |title=Le signe du fourmillement dans les lésions des nerfs périphériques |journal=Presse Médicale |volume=47 |pages=388–389 |year=1915 }}{{cite book |last=Tinel |first=J. |chapter=The 'tingling sign' in peripheral nerve lesions |translator-first=E. B. |translator-last=Kaplan |editor-first=M. |editor-last=Spinner |title=Injuries to the Major Branches of Peripheral Nerves of the Forearm |edition=2nd |pages=[https://archive.org/details/injuriestomajorb0000spin/page/8 8–13] |location=Philadelphia |publisher=WD Saunders Co |year=1978 |isbn=0-7216-8524-2 |chapter-url-access=registration |chapter-url=https://archive.org/details/injuriestomajorb0000spin |url=https://archive.org/details/injuriestomajorb0000spin/page/8 }} The American surgeon George Phalen improved the understanding of the etiology of carpal tunnel syndrome with his clinical experience of several hundred patients during the 1950s and 1960s.{{Cite web |url=https://www.frontlinemedcom.com/fmc-acquires-turner-white-communications/ |title=FMC Acquires Turner White Communications |date=2 August 2017 |access-date=25 June 2019 |archive-date=30 November 2020 |archive-url=https://web.archive.org/web/20201130012117/https://www.frontlinemedcom.com/fmc-acquires-turner-white-communications/ |url-status=dead }}

• Computer vision syndrome
• Ergonomic keyboard
• List of repetitive strain injury software
• Maltron
• Microsoft ergonomic keyboards

{{Reflist}}

• [http://osha.europa.eu/topics/msds Musculoskeletal disorders] from the European Agency for Safety and Health at Work (EU-OSHA)
• {{Cite journal |author=Amadio PC |title=Repetitive stress injury |journal=J Bone Joint Surg Am |volume=83-A |issue=1 |pages=136–7; author reply 138–41 |date=January 2001 |pmid=11205849 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=11205849 |doi=10.2106/00004623-200101000-00018 |url-access=subscription }}{{Dead link|date=February 2022 |bot=InternetArchiveBot |fix-attempted=yes }}

{{Medical resources

| DiseasesDB = 11373

| ICD11 = {{ICD11|FB50.1}}, {{ICD11|PB56}}, {{ICD11|QD84.3}}

| ICD10 = {{ICD10|M70}}, {{ICD10|X50}}, {{ICD10|Z57.7}}

| ICD9 = {{ICD9|E927.1}}, {{ICD9|E927.3}}–{{ICD9|E927.9}}, {{ICD9|727.2}}

| OMIM =

| MedlinePlus =

| ICDO =

| eMedicineSubj = pmr

| eMedicineTopic = 94

| MeshID = D012090

}}

{{Occupational safety and health}}

{{Authority control}}

{{DEFAULTSORT:Repetitive Strain Injury}}

Category:Musculoskeletal disorders

Category:Occupational diseases

Category:Overuse injuries

Category:Physical ergonomics

Category:Health risks of performing arts