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 provid ...

nervous system In biology, the nervous system is the complex system, highly complex part of an animal that coordinates its behavior, actions and sense, sensory information by transmitting action potential, signals to and from different parts of its body. Th ...

caused by repetitive use, vibrations, compression or long periods in a fixed position. Other common names include repetitive stress injury, 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 Hypernymy and hyponymy are the wikt:Wiktionary:Semantic relations, semantic relations between a generic term (''hypernym'') and a more specific term (''hyponym''). The hypernym is also called a ''supertype'', ''umbrella term'', or ''blanket term ...

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 musculoskeletal disorders (WMDs). Examples of conditions that may sometimes be attributed to such causes include tendinosis (or less often

tendinitis Tendinopathy is 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 ( tenn ...

carpal tunnel syndrome Carpal tunnel syndrome (CTS) is a nerve compression syndrome associated with the collected signs and symptoms of Pathophysiology of nerve entrapment#Compression, compression of the median nerve at the carpal tunnel in the wrist. Carpal tunn ...

, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, golfer's elbow (medial epicondylitis),

tennis elbow Tennis elbow, also known as lateral epicondylitis is an enthesopathy (attachment point disease) of the origin of the extensor carpi radialis brevis on the lateral epicondyle. It causes pain and tenderness over the bony part of the lateral epi ...

(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, ulnar tunnel syndrome, and focal dystonia. 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. 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, raver's wrist, and

Emacs Emacs (), originally named EMACS (an acronym for "Editor Macros"), is a family of text editors that are characterized by their extensibility. The manual for the most widely used variant, GNU Emacs, describes it as "the extensible, customizable, s ...

pinky. 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., l ...

, 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

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

catecholamine A catecholamine (; abbreviated CA), most typically a 3,4-dihydroxyphenethylamine, 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. Cate ...

s (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.

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

endocrine The endocrine system is a messenger system in an organism comprising feedback loops of hormones that are released by internal glands directly into the circulatory system and that target and regulate distant organs. In vertebrates, the hypotha ...

influences. In addition, lifestyle choices such as

smoking Smoking is a practice in which a substance is combusted, and the resulting smoke is typically inhaled to be tasted and absorbed into the bloodstream of a person. Most commonly, the substance used is the dried leaves of the tobacco plant, whi ...

and

alcohol consumption Drinks containing alcohol (drug), alcohol are typically divided into three classes—beers, wines, and Distilled beverage, spirits—with alcohol content typically between 3% and 50%. Drinks with less than 0.5% are sometimes considered Non-al ...

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 the speed at which an electrochemical impulse propagates down a neural pathway. Conduction velocities are affected by a wide array of factors, which include age, sex, and various medical conditio ...

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 (also known in many languages as Röntgen radiation) is a form of high-energy electromagnetic radiation with a wavelength shorter than those of ultraviolet rays and longer than those of gamma rays. Roughly, X-rays have a wavelength ran ...

for the wrist, and

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

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 repetitive strain injuries. Early diagnosis is critical to limiting damage. For upper limb RSIs,

occupational therapist Occupational therapists (OTs) are health care professionals specializing in occupational therapy and occupational science. OTs and occupational therapy assistants (OTAs) use evidence-based practice, scientific bases and a Holism, holistic perspec ...

s can create interventions that include teaching the correct approaches to functional task movements in order to minimize the risk of injury. The

RICE Rice is a cereal grain and in its Domestication, domesticated form is the staple food of over half of the world's population, particularly in Asia and Africa. Rice is the seed of the grass species ''Oryza sativa'' (Asian rice)—or, much l ...

(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. Commonly prescribed treatments for early-stage RSIs include

analgesics An analgesic drug, also called simply an analgesic, antalgic, pain reliever, or painkiller, is any member of the group of drugs used for pain management. Analgesics are conceptually distinct from anesthetics, which temporarily reduce, and in s ...

, myofeedback,

biofeedback Biofeedback is the technique of gaining greater awareness of many physiology, physiological functions of one's own body by using Electronics, electronic or other instruments, and with a goal of being able to Manipulation (psychology), manipulate ...

physical therapy Physical therapy (PT), also known as physiotherapy, is a healthcare profession, as well as the care provided by physical therapists who promote, maintain, or restore health through patient education, physical intervention, disease preventio ...

, relaxation, intermittent vacuum therapy and

ultrasound Ultrasound is sound with frequency, frequencies greater than 20 Hertz, kilohertz. This frequency is the approximate upper audible hearing range, limit of human hearing in healthy young adults. The physical principles of acoustic waves apply ...

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 Ergonomics, also known as human factors or human factors engineering (HFE), is the application of Psychology, psychological and Physiology, physiological principles to the engineering and design of products, processes, and systems. Primary goa ...

, 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. 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 Spinal column, spine as it occurs in the Thoracic spine, thoracic and sacrum, sacral regions. Abnormal inward concave ''lordotic'' curving of the Cervical spine, cervical and Lumba ...

, 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 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 a nerve compression syndrome associated with the collected signs and symptoms of Pathophysiology of nerve entrapment#Compression, compression of the median nerve at the carpal tunnel in the wrist. Carpal tunn ...

was first identified by the British surgeon James Paget 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 with Thomas's brother, Lewis Samuel Thomas, as a co-founder. The Graphic was set up as ...

'' describes "telegraphic paralysis." The

Swiss Swiss most commonly refers to: * the adjectival form of Switzerland * Swiss people Swiss may also refer to: Places * Swiss, Missouri * Swiss, North Carolina * Swiss, West Virginia * Swiss, Wisconsin Other uses * Swiss Café, an old café located ...

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 etiology of

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

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 businesses, governments and spe ...

) * {{DEFAULTSORT:Repetitive Strain Injury Musculoskeletal disorders Occupational diseases Overuse injuries Physical ergonomics Health risks of performing arts