The first description of RSIs came from an Italian physician - Bernardino Ramazzini in 1700. He described more than 20 categories of RSIs developed by the industrial workers of Italy.1
Today, the main focuses of RSI research and treatment are manual labor, office work and our perpetual use of modern devices; these are the biggest progenitors of repetitive strains in the modern world.
As Ramazzini put it more than 3 centuries ago:
"Incessant driving of the pen over paper causes intense fatigue of the hand and the whole arm because of the continuous and almost tonic strain on the muscles and tendons, which in course of time results in failure of power in the right hand."
The pen and paper have become the keyboard and screen, but the principle remains the same. This article will cover the general symptoms, causes and treatments of RSI.
Contents of this article:
Here are some key points about RSI. More detail and supporting information is in the main article.
- RSIs come in a vast array of different forms.
- Each RSI might require different courses of action to treat and prevent.
- The first medical practitioner to talk about RSIs did so in 1700.
- Modern technological devices have caused an upswing in RSIs.
- Repetitive motions in one anatomical region can affect musculature in a separate area of the body.
- Psychological stress and monotony can worsen the symptoms of RSIs.
- Workplace ergonomics can prevent a wide array of RSIs.
- In some cases, medication and even surgery can ease symptoms.
What is an RSI?
RSIs come in a variety of forms, can occur at any age and can affect most movable parts of the human body.
The term RSI covers a myriad of complaints. There are almost as many RSIs as there are movable parts of the human body. This article will focus predominantly on those that are caused by working environments, sports and modern technological devices.
RSIs are conditions associated with repetitive tasks, forceful exertions, vibrations, mechanical compression and sustained or awkward positions.
General terms applied to RSIs include repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CTD), occupational overuse syndrome, overuse syndrome and regional musculoskeletal disorder.
Other, more colloquial terms for modern RSIs include Blackberry thumb, iPod finger, PlayStation thumb, Rubik's wrist or cuber's thumb, stylus finger, raver's wrist and Emacs pinky.
Symptoms of RSI
Because there are so many potential causes of RSI, it follows that there are a huge number of potential symptoms. Below are some of the more general symptoms of RSI:
- Tenderness in the affected muscle or joint
- Pain in the affected muscle or joint
- A throbbing (pulsating) sensation in the affected area
- Tingling sensation in the affected area (especially the hand or arm)
- Loss of sensation
- Loss of strength.
Causes of RSI
Due to the nature of RSIs, the specific causes are incredibly varied. The following list includes the general types of actions and behaviors that are most likely to induce RSI:
- Overuse of a particular muscle or group of muscles
- Vibrating equipment
- Working in cold temperatures
- Poor posture or a non-ergonomically designed workspace
- Forceful activities
- Holding the same posture for prolonged periods
- Direct pressure to particular areas
- Carrying heavy loads
- Increased psychological stress has been shown to worsen RSI2
Diagnosis of RSI
RSIs can take many forms, including tennis elbow and rotator cuff syndrome.
Because of the nebulous array of potential symptoms and their diffuse etiologies, RSIs are generally diagnosed by asking questions.
The patient will be asked about the sort of repetitious tasks they carry out on a regular basis and the source and timing of the discomfort.
In general, RSIs are split into two groups:4
Type 1 RSI
If a doctor can diagnose a recognized medical condition, such as Raynaud's phenomenon or rotator cuff syndrome (see below), it is considered a type 1 RSI.
Symptoms usually include swelling and inflammation of specific muscles or tendons.
Type 2 RSI
If a doctor cannot diagnose a known medical condition from the symptoms, it is classed as a type 2 RSI. Type 2 RSIs have no obvious symptoms, just a general feeling of pain or discomfort.
Type 2 cases are sometimes referred to as non-specific pain syndromes.
Examples of RSIs
The list of conditions that can potentially be brought on by repetitive actions is long. A few of these conditions are included in the list below. It is worth noting that many of these conditions can be caused by a number of factors, RSI being just one:
- Edema: fluid build-up in cavities
- Tendinosis: cellular degeneration of collagen within the tendons through overuse (a separate condition from tendinitis)5
- Carpal tunnel syndrome: painful compression of a nerve as it passes across the front of the wrist
- Raynaud's disease: the collapse of blood vessels in the extremities when cold or stressed; this condition can be brought on by work involving vibration - jackhammer operators, for instance, are prone
- Cubital tunnel syndrome: pressure on the nerve in the "funny bone" area. This might be brought on by repeated or prolonged pressure on the area in question, or from stretching the nerve for long periods of time6
- De Quervain syndrome: a painful condition affecting the tendons on the thumb side of the wrist, often associated with overuse of the wrist7
- Thoracic outlet syndrome: blood vessels or nerves become trapped between the collar bone and first rib. Mostly affects people who have occupations involving heavy usage of the upper extremities against resistance8
- Intersection syndrome: a painful inflammation of specific muscles within the forearm caused by repeated flexion and extension of the wrist. Weightlifters, rowers, racket sport players, horseback riders and skiers are particularly prone9
- Dupuytren's contracture: a thickening of deep tissue in the palm of the hand and fingers that, if left unchecked, leads to permanently bent fingers. Users of vibrating tools can be at risk10
- Rotator cuff syndrome: damage to any of the tendons that hold the shoulder joint in place, particularly common in work where prolonged overhead activity is necessary11
- Medial epicondylitis: also known as golfer's elbow this affects the inside of the lower arm near the elbow. Overplaying certain sports or repetitive twisting motions can lead to this condition
- Lateral epicondylitis: also known as tennis elbow, affects the outer part of the elbow
- Stenosing tenosynovitis: otherwise known as trigger finger, a finger may become stuck in the bent position and, when straightened, does so with a snap. Also known as "texting tendonitis"12
- Radial tunnel syndrome: dull ache at the top of the forearm. Overuse of the arm to push or pull, or overuse of the hand and wrist can irritate the nerve and cause pain.
Because of the wide variety of causes and symptoms of RSIs, treatment for these conditions can be just as varied. In general, the following categories of intervention are the most commonly used:
- Medication: anti-inflammatory painkillers (such as aspirin or ibuprofen), muscle relaxants, antidepressants and sleeping tablets (if sleeping is affected by the issue)
- Heat or cold: applying heat packs or ice packs, or using an elastic support or splint
- Physiotherapy: including exercises and advice
- Steroid injections: these are only advised if there is inflammation associated with a specific medical condition
- Surgery: as a last resort and where relevant, surgery can be used to correct problems with specific tendons and nerves.12
Preventing general RSIs
There are a number of simple ways to reduce the risk of RSI when working in an office.
The key to stopping the progression of most RSIs is to stop whatever it is that is causing them. This, of course, is not always possible if your work is the primary factor.
The following list contains a number of methods worth entertaining to ensure you remain RSI free:
- Breaks: taking regular breaks from any repetitive task you are carrying out can be helpful. If your role requires being next to a computer, it can be useful to set alarms to remind you to take short breaks
- Stand up: remember to stand up and stretch frequently. Extend your back, arms and fingers
- Eye break: occasionally give your eyes a moment's respite by staring at objects in the distance; this allows the muscles used to focus the eye to rest
- General health: outside of work, try to eat healthily, exercise to keep your body resilient and do not smoke as this reduces blood flow.
Preventing office-based RSIs
Although there are numerous ways in which RSIs can be generated, the most common in modern societies are using a computer or sitting at a desk.
Below are some rough guidelines that, if followed, could help prevent the most common complaints:
- Ergonomics: ensure that desk, chair and screen are aligned in an ergonomic fashion. Employers will have access to official guidelines
- Posture: do not slouch - ears and back should form a straight line with the pelvis
- Wrists: arms, wrists and fingers should be aligned when typing, rather than having bent wrists
- Typing: avoid hitting the keys too hard while typing; if possible, learn to touch type so that each finger takes its fair share of pressure and there is no need to constantly look down at the keyboard. One option to consider is voice-activated software to further minimize typing
- Shortcuts: learn keyboard shortcuts to save any additional typing and mouse movements
- Mouse: do not grip too tightly; slowing the speed can reduce muscle tension in your hand
- Temperature: ensure the office is heated to an appropriate temperature
- Telephone: if telephone usage is common, use a headset rather than clamping the receiver between the head and the shoulder while typing.13
A group of experts has advised that people working in office environments stand for at least 2 hours a day during working hours, as part of a number of recommendations to protect those engaged with typically sedentary forms of work.
In this Spotlight, we investigate what the health-conscious office worker needs to be wary of if they are going to complete their 9-5 with both body and mind intact, and if there are any ways for them to maintain peak fitness during their employment.
RSIs have been with us for centuries and they are likely to be with us for centuries more. But, with advancements in our knowledge of their etiology and care, the risks may slowly be on the wane.