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Repetitive strain injury (RSI)Published by Bupa's health information team, healthinfo@bupa.com, August 2007. This factsheet is for people with repetitive strain injury (RSI), or who would like information about it. RSI, also known as work-related upper limb disorders, is a general term that refers to chronic pain in any part of your arms, including the elbow and wrist, hands, fingers, neck or shoulders. A chronic condition is one that lasts a long time, sometimes for the rest of the affected person's life. The term chronic refers to time, not to how serious a condition is. The pain results from repetitive movements or activities that require controlled posture.
What is RSI?The term repetitive strain injury (RSI) is generally used to describe a painful condition associated with doing a particular activity repeatedly or for long periods of time. RSI is often caused by typing or repetitive manual work, for example using vibrating machinery in a factory. RSI is an umbrella term and covers a number of musculoskeletal problems that affect the upper limbs. Although the term RSI is used to define this disorder, it does not fully describe this condition which varies widely between affected individuals. These include tenosynovitis, carpal tunnel syndrome, tennis elbow (epicondylitis), Dupuytren's contracture and cramp of the hand (writer's cramp). They are classed as type 1 RSI. Type 1 RSI includes recognised conditions that your doctor will be able to diagnose. For example, tennis elbow is caused by repeatedly using your arm in a twisting movement. This can damage the tendons in your elbow, making the outside of your elbow painful. Type 2 RSI means that your doctor can't find anything unusual when you are examined or that the pain you have doesn't stay in one particular area. This is also known as non-specific or diffuse pain. It's less clear how to treat this and there is little scientific evidence about which treatments are effective. There are different stages of RSI and if treated early enough, it may be possible for you to make a full recovery. It's harder to treat if your symptoms have gone unchecked for a while. You may also be more likely to experience further injury as a result. SymptomsYour main symptom will be pain - the painful area will vary depending on your specific condition. It will probably be most noticeable when you are carrying out the activity that caused it. However, the pain may progress so that it's present all the time, even when you are resting. This may result in you not being able to do routine work or household activities. The pain you have may be sharp or a dull ache. You may also experience:
You may have some swelling, but it's quite likely that you will have no physical signs even though your hand or arm feels painful. If you have pain all the time, it's likely that your sleep will be disrupted. You may also not be able to sleep well if you are worried about the possible consequences of RSI. This can lead to you feeling tired and stressed. Some people find that the pain is related to stress, often caused by work. It may be that you have to work under pressure, you don't have time to take breaks or that you don't enjoy your job very much - this can be associated with pain developing. Alternatively, it may be that you like your job and are motivated to work too hard - this could lead to RSI. CausesThere are a number of factors that put you at risk of developing RSI. These include:
It's important that your working environment (for example, your desk layout or assembly line), is designed so you can work with your body upright and without having to twist or stretch. If this isn't the case, you may be at risk of developing RSI or making an existing injury worse. For example, working with your arm raised above your head or sitting in a fixed position for long periods of time may put you more at risk of developing RSI. There are a wide variety of jobs that may lead to RSI, such as data-entry or typing, working on an assembly line or doing supermarket checkout work. Therefore, it's important for you to take steps to minimise the risks as much as possible. DiagnosisAs there are often specific features in type 1 RSI, your GP may be able to identify definite conditions such as carpal tunnel syndrome when you describe your symptoms and have an examination of your affected arm or arms. However, he or she may find it difficult to diagnose type 2 RSI. An X-ray may be done to rule out any other conditions that could be causing your joint pain, such as osteoarthritis. If your GP can't confirm a recognised condition, a diagnosis of type 2 RSI will be considered. TreatmentThere is no single treatment that works for all cases of RSI. However, there are often specific treatments that can be used in type 1 RSI. You can make changes to your working environment and practice to help improve the condition. It's a good idea to look at what you do and how you do it, and then modify the activity causing the problem. If you can, it's best to carry on working but reduce the amount of time that you spend on the activity causing the pain. If you can't stop the activity completely, try to take plenty of breaks. Your GP may prescribe anti-inflammatory painkillers but he or she is likely to recommend other treatment options. These are listed below.
Although you should try to rest the affected area regularly, it's not helpful for you to rest for prolonged periods as this can weaken your muscles. You may find that gently massaging and flexing the affected limb helps - this stimulates circulation and can help to prevent your muscles from weakening. If your doctor is able to diagnose a specific condition, you should follow the treatment that he or she recommends. This may involve steroid injections or possibly surgery. MedicinesMedicines are generally not helpful in treating RSI, although you may be recommended over-the-counter painkillers such as paracetamol or the anti-inflammatory medicine ibuprofen (eg Nurofen). Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Low doses of tricyclic antidepressants such as amitriptyline are also thought to have some specific painkilling effect in chronic pain conditions such as RSI. However, it's not generally a good idea to take painkillers as they dull the pain and so allow you to carry on doing the harmful activity. This could aggravate your RSI. You may be prescribed sleeping tablets for short-term use if you are having trouble sleeping. However, you should not take these for longer than a few days because of the risk of becoming dependent on them. PreventionIf you have been off work because of RSI, it's a good idea to return as soon as you can but if possible avoid the activity that causes the pain. You may need to modify your job when the pain is severe. You may find it helps to take regular breaks and alternate tasks to prevent long periods of repeating the same movement. Employers have a legal duty under the Health and Safety at Work etc Act 1974 and the Management of Health and Safety at Work Regulations 1999 to prevent work-related RSI and ensure that any existing cases of RSI don't get worse. You can contact your employer's occupational health advisers about adjusting your workstation so that it's ergonomically sound. This means making sure that your working environment is set up to be suitable and comfortable for you. The risk of an accident or injury occurring should be reduced as much as possible. If you work with display screen equipment, you should get guidance in how to arrange your screen, seat, keyboard and other resources correctly. Further information
Sources
Related topicsThis information was published by Bupa's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by Dr James Quekett Bsc MB ChB MRCGP DRCOG DFFP, partner/principal general practitioner at Rowcroft Medical Centre and Bupa doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: August 2007. Expected review date: August 2009.
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