A repetitive strain injury (RSI) is an injury to part of the musculoskeletal or nervous system caused by repetitive use, vibrations, compression or long periods in a fixed position.[1] Other common names include repetitive stress injury, repetitive stress disorders, cumulative trauma disorders (CTDs), and overuse syndrome.[2]
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.[3]
Definition
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.[1][4][5] 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 muscular skeletal disorders (WMDs).[2]
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.[7] Extreme temperatures have also been reported as risk factor for RSI.[8]
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.[9] Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries.[10][11] 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.[12]
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 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 co-workers and supervisors.[13]
Non-occupational factors
Age and gender are important risk factors for RSIs. The risk of RSI increases with age.[14] 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 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.[15]
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 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.[12]
Treatment
Ergonomics: the science of designing the job, equipment, and workplace
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.[16][17] 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.[18] Commonly prescribed treatments for early-stage RSIs include analgesics, myofeedback, biofeedback, physical therapy, relaxation, and ultrasound therapy.[6] 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]
Although there are no "quick fixes" for RSI, there are effective approaches to its treatment and prevention.[19] 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.[20] 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.[21] Modifications of posture and arm use are often recommended.[6][22]
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.[23]Carpal tunnel syndrome was first identified by the British surgeon James Paget in 1854.[24] The April 1875 issue of The Graphic describes "telegraphic paralysis."[25]
Specific sources of discomfort have been popularly referred to by terms such as Blackberry thumb, PlayStation thumb,[31] Rubik's wrist or "cuber's thumb",[32] stylus finger,[33] and raver's wrist,[34] and Emacs pinky.[35]
1 2 Paz, D. A.; Chang, G. H.; Yetto, J. M. Jr.; Dwek, J. R.; Chung, C. B. (November 2015). "Upper extremity overuse injuries in pediatric athletes: Clinical presentation, imaging findings, and treatment". Clinical Imaging. 39 (6): 954–964. doi:10.1016/j.clinimag.2015.07.028. PMID26386655.
↑ Faucett, J.; Rempel, D. (1994). "VDT-related musculoskeletal symptoms: interactions between work posture and psychosocial work factors". American Journal of Industrial Medicine. 26 (5): 597–612. doi:10.1002/ajim.4700260503. PMID7832208.
↑ Del Buono, A.; Battery, L.; Denaro, V.; MacCauro, G.; Maffulli, N. (2011). "SAGE Journals: Your gateway to world-class journal research". International Journal of Immunopathology and Pharmacology. 24 (1 Suppl 2): 45–50. doi:10.1177/03946320110241s209. PMID21669137. S2CID39663618.
↑ Ratzlaff, C. R.; J. H. Gillies; M. W. Koehoorn (April 2007). "Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity". Arthritis & Rheumatism. 57 (3): 495–500. doi:10.1002/art.22610. PMID17394178.
↑ Kisner, Carolyn; Colby, Lyn Allen (2007). Therapeutic Exercise: Foundations and Techniques (5thed.). Philadelphia: F. A. Davis. p.473. ISBN978-0-8036-1584-7.
↑ Ahuja, N. K.; Chung, K. C. (2004). "Fritz de Quervain, MD (1868–1940): stenosing tendovaginitis at the radial styloid process". The Journal of Hand Surgery. 29 (6): 1164–70. doi:10.1016/j.jhsa.2004.05.019. PMID15576233.
↑ Tinel, J. (1917). Nerve wounds. London: Baillère, Tindall and Cox.
↑ Tinel, J. (1915). "Le signe du fourmillement dans les lésions des nerfs périphériques". Presse Médicale. 47: 388–389.
Carpal tunnel syndrome (CTS) is the collection of symptoms and signs associated with nerve compression of the median nerve at the carpal tunnel. Most CTS is related to idiopathic compression of the median nerve as it travels through the wrist at the carpal tunnel (IMNCT). Idiopathic means that there is no other disease process contributing to pressure on the nerve. As with most structural issues, it occurs in both hands, and the strongest risk factor is genetics.
The median nerve is a nerve in humans and other animals in the upper limb. It is one of the five main nerves originating from the brachial plexus.
De Quervain syndrome occurs when two tendons that control movement of the thumb become constricted by their tendon sheath in the wrist. This results in pain and tenderness on the thumb side of the wrist. Radial abduction of the thumb is painful. On occasion, there is uneven movement or triggering of the thumb with radial abduction. Symptoms can come on gradually or be noted suddenly.
Phalen's maneuver is a diagnostic test for carpal tunnel syndrome by an American orthopedist named George S. Phalen.
Nintendo thumb, also known as gamer's thumb and similar names, is a form of repetitive strain injury (RSI) caused by excessive playing video games with the traditional Nintendo controller. This injury mainly occurs due to repeated thumb movements while playing video games. The symptoms are blistering, paraesthesia, and swelling of the thumbs, though any finger can be affected. This can lead to stress on tendons, nerves, and ligaments in the hands, and further onto lateral epicondylitis, tendinitis, bursitis, and carpal tunnel syndrome. Similar injuries can occur with other gaming systems, such as PlayStation thumb from playing Sony PlayStation. The general recommendation for the treatment is to rest and stop the repetitive motion of the affected finger. In more severe and painful cases, using NSAIDs is also recommended.
Tarsal tunnel syndrome (TTS) is a nerve entrapment syndrome causing a painful foot condition in which the tibial nerve is compressed as it travels through the tarsal tunnel. This tunnel is found along the inner leg behind the medial malleolus. The posterior tibial artery, tibial nerve, and tendons of the tibialis posterior, flexor digitorum longus, and flexor hallucis longus muscles travel in a bundle through the tarsal tunnel. Inside the tunnel, the nerve splits into three segments. One nerve (calcaneal) continues to the heel, the other two continue on to the bottom of the foot. The tarsal tunnel is delineated by bone on the inside and the flexor retinaculum on the outside.
The flexor retinaculum is a fibrous band on the palmar side of the hand near the wrist. It arches over the carpal bones of the hands, covering them and forming the carpal tunnel.
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, or they can arise from making the same motions repeatedly repetitive strain, or from repeated exposure to force, vibration, or awkward posture. Injuries and pain in the musculoskeletal system caused by acute traumatic events like a car accident or fall are not considered musculoskeletal disorders. MSDs can affect many different parts of the body including upper and lower back, neck, shoulders and extremities. Examples of MSDs include carpal tunnel syndrome, epicondylitis, tendinitis, back pain, tension neck syndrome, and hand-arm vibration syndrome.
In the human body, the carpal tunnel or carpal canal is the passageway on the palmar side of the wrist that connects the forearm to the hand.
Ulnar nerve entrapment is a condition where pressure on the ulnar nerve as it passes through the cubital tunnel causes nerve dysfunction (neuropathy). The symptoms of neuropathy are paresthesia (tingling) and numbness primarily affecting the little finger and ring finger of the hand. Ulnar neuropathy can progress to weakness and atrophy of the muscles in the hand. Symptoms can be alleviated by attempts to keep the elbow from flexing while sleeping, such as sticking one’s arm in the pillow case, so the pillow restricts flexion.
Work-related musculoskeletal disorders are disorders of the muscles, skeleton, and related tissues. They are of the most common occupational disorders around the world. They had been recognised as an issue since Bernardino Ramazzini's time in the 17th century. They have been known by many names including repetitive strain injury, occupational overuse syndrome and cumulative trauma disorders.
Radial tunnel syndrome (RTS) is caused by increased pressure on the radial nerve as it travels from the upper arm to the hand and wrist.
Ulnar neuropathy is a disorder involving the ulnar nerve. Ulnar neuropathy may be caused by entrapment of the ulnar nerve with resultant numbness and tingling. It may also cause weakness or paralysis of the muscles supplied by the nerve.
Musculoskeletal injury refers to damage of muscular or skeletal systems, which is usually due to a strenuous activity and includes damage to skeletal muscles, bones, tendons, joints, ligaments, and other affected soft tissues. In one study, roughly 25% of approximately 6300 adults received a musculoskeletal injury of some sort within 12 months—of which 83% were activity-related. Musculoskeletal injury spans into a large variety of medical specialties including orthopedic surgery, sports medicine, emergency medicine and rheumatology.
Nerve compression syndrome, or compression neuropathy, or nerve entrapment syndrome, is a medical condition caused by chronic, direct pressure on a peripheral nerve. It is known colloquially as a trapped nerve, though this may also refer to nerve root compression. Its symptoms include pain, tingling, numbness and muscle weakness. The symptoms affect just one particular part of the body, depending on which nerve is affected. The diagnosis is largely clinical and can be confirmed with diagnostic nerve blocks. Occasionally imaging and electrophysiology studies aid in the diagnosis. Timely diagnosis is important as untreated chronic nerve compression may cause permanent damage. A surgical nerve decompression can relieve pressure on the nerve but cannot always reverse the physiological changes that occurred before treatment. Nerve injury by a single episode of physical trauma is in one sense an acute compression neuropathy but is not usually included under this heading, as chronic compression takes a unique pathophysiological course.
Injuries to the arm, forearm or wrist area can lead to various nerve disorders. One such disorder is median nerve palsy. The median nerve controls the majority of the muscles in the forearm. It controls abduction of the thumb, flexion of hand at wrist, flexion of digital phalanx of the fingers, is the sensory nerve for the first three fingers, etc. Because of this major role of the median nerve, it is also called the eye of the hand. If the median nerve is damaged, the ability to abduct and oppose the thumb may be lost due to paralysis of the thenar muscles. Various other symptoms can occur which may be repaired through surgery and tendon transfers. Tendon transfers have been very successful in restoring motor function and improving functional outcomes in patients with median nerve palsy.
Computer-induced health problems can be an umbrella term for the various problems a computer user can develop from extended and incorrect computer use. A computer user may experience many physical health problems from using computers extensively over a prolonged period of time in an inefficient manner. The computer user may have poor etiquette when using peripherals, for example incorrect posture. Reportedly, excessive use of electronic screen media can have ill effects on mental health related to mood, cognition, and behavior, even to the point of hallucination.
This article is about physical therapy in carpal tunnel syndrome.
Ergonomic hazards are physical conditions that may pose a risk of injury to the musculoskeletal system due to poor ergonomics. These hazards include awkward or static postures, high forces, repetitive motion, or short intervals between activities. The risk of injury is often magnified when multiple factors are present.
There are unique occupational health issues in the casino industry, many of which are attributed to repetitive tasks and long-term exposures to hazards in the casino environment. Among these issues are cancers resulting from exposure to second-hand tobacco smoke, musculoskeletal injury (MSI) from repetitive motion injuries while running table games over many hours, and health issues associated with shift work. Safety and regulatory agencies in the United States have implemented regulatory measures to address the specific risks associated with workers in the casino industry, and have made efforts to identify additional possible risks to casino workers, including noise-induced hearing loss and heavy metal poisoning from exposure to dust from coins.
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