Repetitive strain injury

Repetitive strain injury (RSI) (also known as repetitive stress injury, repetitive
motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder
(CT), occupational overuse syndrome, overuse syndrome, regional musculoskeletal
disorder) is an injury of the musculoskeletal and nervous systems that may be caused by
repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against
hard surfaces), or sustained or awkward positions.[1] Different sections of this article
present contrasting perspectives regarding the causes of RSI.

Types of RSIs that affect computer users may include non-specific arm pain[2] or work
related upper limb disorder (WRULD). Conditions such as RSI tend to be associated
with both physical and psychosocial stressors.[3]

Causes
RSI is believed by many to be caused due to lifestyle without ergonomic care[citation needed],
E.g. While working in front of computers, driving, traveling etc. Simple reasons like
'Using a blunt knife for everyday chopping of vegetables', may cause RSI.

Other typical habits that some sources believe lead to RSI:[citation needed]

• Reading or doing tasks for extended periods of time while looking down.
• Sleeping on an inadequate bed/mattress or sitting in a bad armchair and/or in an
uncomfortable position.
• Carrying heavy items.
• Holding one's phone between neck and shoulder.
• Watching TV in incorrect position e.g. Too much to the left/right.
• Sleeping with head forward, while traveling.
• Prolonged use of the hands, wrists, back, neck, etc.
• Excessive playing of computer games.

Illness
Symptoms

The following complaints are typical in patients who might receive a diagnosis of RSI:[4]

• Short bursts of excruciating pain in the arm, back, shoulders, wrists, hands, or
thumbs (typically diffuse – i.e. spread over many areas).
• The pain is worse with activity.
• Weakness, lack of endurance.
In contrast to carpal tunnel syndrome, the symptoms tend to be diffuse and non-
anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be
characteristic of any discrete pathological conditions.

Frequency

A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the
most common problem areas being the back, shoulders, wrists, and hands.[5]

Physical examination and diagnostic testing

The physical examination discloses only tenderness and diminished performance on

effort-based tests such as grip and pinch strength—no other objective abnormalities are
present. Diagnostic tests (radiological, electrophysiological, etc.) are normal. In short,
RSI is best understood as an apparently healthy arm that hurts. Whether there is currently
undetectable damage remains to be established.

Definition
The term "repetitive strain injury" is most commonly used to refer to patients in whom
there is no discrete, objective, pathophysiology that corresponds with the pain
complaints. It may also be used as an umbrella term incorporating other discrete
diagnoses that have (intuitively but often without proof) been associated with activity-
related arm pain such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet
syndrome, DeQuervain's syndrome, stenosing tenosynovitis/trigger finger/thumb,
intersection syndrome, Golfer's elbow (medial epicondylosis), Tennis elbow (lateral
epicondylosis), and focal dystonia.

Finally RSI is also used as an alternative or an umbrella term for other non-specific
illnesses or general terms defined in part by unverifiable pathology such as reflex
sympathetic dystrophy syndrome (RSDS), Blackberry thumb, disputed thoracic outlet
syndrome, radial tunnel syndrome, "gamer's thumb" (a slight swelling of the thumb
caused by excessive use of a gamepad), "Rubik's wrist" or "cuber's thumb" (tendinitis,
carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's
Cube for speedcubing), "stylus finger" (swelling of the hand caused by repetitive use of
mobile devices and mobile device testing.), "Raver's wrist", caused by repeated rotation
of the hands for many hours (for example while holding glow sticks during a rave).

Although tendinitis and tenosynovitis are discrete pathophysiological processes, one must
be careful because they are also terms that doctors often use to refer to non-specific or
medically unexplained pain, which they theorize may be caused by the aforementioned
processes.

Treatment
rest,

exercise,

braces

massage

A variety of medical products also are available to augment these

therapies. Since the computer workstation is frequently blamed for
RSIs, particularly of the hand and wrist.

ergonomic adjustments of the workstation are often recommended.

Ergonomics

Modifications of posture and arm use (ergonomics) are often recommended.[6]

Ergonomics: the science of designing the job, equipment, and workplace

Adaptive software

Main article: List of Repetitive Strain Injury software

There are several kinds of software designed to help in Repetitive Strain Injury. Among
them, there are speech recognition software, and break timers. Break timers software
reminds the user to pause frequently and perform exercises while working behind a
computer. There is also automated mouse-clicking software that has been developed,
which can automate repetitive tasks in games and applications.

Adaptive hardware

Adaptive technology ranging from special keyboards, mouse replacements to pen tablet
interfaces might help improve comfort.

Mouse

Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or
joystick, or switching from using a mouse to a stylus pen with graphic tablet may provide
relief, but in chronic RSI they may result only in moving the problem to another area.
Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may
take some time to get used to as well. Switching to a trackpad or pointing stick, which
requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice
(which do not require a surface to operate) might offer an alternative where the user's arm
is in a less stressful thumbs up position rather than rotated to thumb inward when holding
a normal mouse. Also, since they do not need a surface to operate ("air mice" function by
small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.

Keyboards and keyboard-alternatives

Exotic keyboards by manufacturers such as Datahand, OrbiTouch, Maltron and Kinesis

are available. Also one can use digital pens and voice recognition.

DataHand Professional II Keyboard, right side

Medical products
 This section needs additional citations for verification.
Please help improve this article by adding reliable references. Unsourced material may be
challenged and removed. (September 2010)

A number of medical treatments, including non-narcotic pain medications, braces, and

therapy. Although some professionals consider these to be palliative, others consider
them to be effective.[7][8]

Pain medications, particularly non-steroidal anti-inflammatory drugs (NSAIDs), are most

often used to eliminate pain. The major problem with such drug use with RSIs is that the
pain can be masked, and therefore the patient returns to the activities which strained the
tissues in the first place before the tissues have had time to heal. So a balance must be
struck where pain is reduced, yet not so much that the tissues will be reinjured with
continued over-use.

Medical devices are available which help the strained tissues to heal faster. Several types
of devices are available, and are classified as either passive or active devices. Passive
devices generally immobilize the limb allowing the body to heal itself, while active
devices enhance the body's healing capacity[citation needed].

Braces, particularly wrist braces, are by far the most often used products for RSIs[citation
needed]
. They stabilize the hand and allow healing to occur without further stressing the
joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.

Exercise

Exercise decreases the risk of developing RSI.[9]

• Doctors[citation needed] sometimes recommend that RSI sufferers engage in specific

strengthening exercises, for example to improve posture.
• In light of the fact that a lifestyle that involves sitting at a computer for extended
periods of time increases the probability that an individual will develop excessive
kyphosis, theoretically the same exercises that are prescribed for thoracic outlet
syndrome or kyphotic postural correction would benefit an RSI sufferer.[10]
• Some sources[who?] recommend motoric exercises and ergo-aerobics to decrease
chances of strain injury. Ergo-aerobics target touch typists and people who often
use computer keyboard.

Resuming normal activities despite the pain

Psychologists Tobias Lundgren and Joanne Dahl have asserted that, for the most difficult
chronic RSI cases, the pain itself becomes less of a problem than the disruption to the
patient's life caused by

• avoidance of pain-causing activities

• the amount of time spent on treatment
They claim greater success from teaching patients psychological strategies for accepting
the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day
activities and focus on aspects of life other than RSI.[8]

Psychosocial factors
Population studies

Studies have related RSI and other upper extremity complaints with psychological and
social factors. A large amount of psychological distress showed doubled risk of the
reported pain, while job demands, poor support from colleagues, and work dissatisfaction
also showed an increase in pain, even after short term exposure.[11]

For example, the association of Carpal tunnel syndrome with arm use is commonly
assumed but not well-established.[12] Typing has long been thought to be the cause of
carpal tunnel syndrome,[13] but recent evidence suggests that, if anything, typing may be
protective.[14] Another study claimed that the primary risk factors for Carpal tunnel
syndrome were "being a woman of menopausal age, obesity or lack of fitness, diabetes or
having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the
thumb, smoking, and lifetime alcohol intake."[15]

Psychological exacerbation of symptoms

There are three common mechanisms, by which a normally functioning human mind
increases pain and pain-related disability.

• Psychological distress (depression and anxiety) make pain seem worse.[16] Chronic
pain, regardless of its source, leads to a cycle of increasing depression and
reduced physical activity. Reduced physical activity reduces pain in the short term
but increases it in the long term.[17]
• Misinterpretation or over-interpretation of pain signals. Psychologists refer to this
as pain catastrophizing (the tendency to think the worst when one feels pain),[4]
and it is worsened by reliance on patient support groups and internet sites for
diagnosis.[18] Gate Control Theory, part of the most accepted medical theory of
pain, states that, when we are worried about a particular body part, the brain can
actually signal to the spinal cord (via outgoing neurons) that it should be more apt
to interpret nerve impulses from that body part as pain and pass them on to the
brain.[19] In patients with chronic arm pain, the brain may even learn to
automatically trigger pain whenever the limb is moved, as a defense mechanism
to prevent further movement[20]
• A sense that something is seriously wrong that does not lessen with normal test
results and reassurance from health professionals.[21] Psychologists call this
heightened illness concern or health anxiety. (This is commonly seen in
psychosomatic illnesses.[22]) The typical RSI patient presents with a strong
intuition that their pain indicates existing and ongoing tissue damage.[21] One
explanation is that they have a strong "pain alarm"—pain tends to be accepted as
 a sign of danger and they have difficulty modulating this intuitive uneasiness with
pain.[4]

Psychosomatic cases

Some doctors and medical researchers believe that stress is the main cause, rather than a
contributing factor, of a large fraction of pain symptoms usually attributed to RSI. The
most famous advocate of this point of view, Dr. John E. Sarno, Professor of
Rehabilitation Medicine at the New York University Medical School considers that RSI,
back pain, and other pain syndromes, although they sometimes have a physical cause, are
more often a manifestation of tension myositis syndrome, a psychogenic disorder in
which stress causes the autonomic nervous system to reduce blood flow to muscles,
causing pain and weakness.[23]

RSI shares many characteristics with known psychosomatic disorders:

• Freud and other psychiatrists believe that diffuse, difficult to describe symptoms
likely indicated a psychosomatic root cause for an illness, especially if they
moved around the body.[22] (Only some RSI cases fit this description.)
• Psychosomatic illnesses typically display symptoms whose origins are
unverifiable but which seem consistent with the time period's understanding of
physical (non-psychosomatic) disease processes. When an objective test invented
which is able to prove the psychosomatic origins of a specific illness, that illness
typically disappears and is replaced by new, undiagnosable sets of symptoms.[22]
• Patients and their advocates usually reject the suggestion that their disease may be
non-physical in origin. Doctors frequently avoid giving psychosomatic diagnosis,
for fear of angering patients or prompting them to switch doctors.[22]
"Psychosomatic" is often misunderstood to mean "faking it" or "imaginary".[22]
Other psychosomatic diseases have been known to cause severe pain, paralysis,
seizures,[22] observable physical damage, even death.[24]

A common theme among different subtypes of RSI is a stigmatization and demonization

of hand use. Illness concepts that stigmatize hand use have the potential to create more
illness as well-documented in the experience with the Australian RSI epidemic.[7] RSI
was first diagnosed in Australia in the 1980s. (Only later was it diagnosed in the US and
Britain.) In the early Australian experience, RSI cases increased rapidly over several
years, leading to widespread media coverage and worker protests. After a widely
publicized court case in which a judge ruled an alleged RSI victim had no bodily injury
and could not receive damages, complaints dropped off rapidly. Many observers felt that
the media coverage and social mobilization against the epidemic had actually helped
spread it by causing psychosomatic symptoms in worried workers.[25] This pattern has
been seen in other psychosomatic illnesses.[22]

See also
• List of Repetitive Strain Injury software
• Carpal tunnel