Repetitive Strain Injury (RSI)

permission of Copyright Notice. All materials contained onthissite are protected by United States copyright law and may not bereproduced, distributed, transmitted, displayed, published orbroadcast withouttheprior written linked tobothphysicalandpsychosocial stressors. be to tend RSI as such Conditions positions. awkward or sustained or compression), (mechanical surfaces hard exertions, against forceful pressing tasks, vibrations, repetitive of result the be may that nervous systems and musculoskeletal the of injury an is that injury strain say repetitive Experts longer. much for continue may symptoms and signs injury,RSI ‘normal’ or sudden a to opposed activity.As leisure of kinds is typically related to an occupation (job), but may also be linked to some body, often somewhere in the upper the limbs (arms). Repetitive of strain injury part certain a of use repetitive by caused usually is RSI tissues. or painful uncomfortable conditions of the muscles, of tendons, nerves and other soft range a is disorder musculoskeletal regional and drome, syn- overuse syndrome, overuse occupational (CTD), disorder trauma cumulative injury,(RMD), disorder stress motion repetitive repetitive injuries, motion as repetitive known also RSI, or injury strain Repetitive can leadtoarmandneckstrainaswellspinalasymmetry. a at Staring injuries. computer screen can lead back to eye strain. Repetitive reaching for a mouse and neck severe to lead can posture Poor wrists. and hands your just than more affect can injury strain Repetitive results. problem chronic long-term, a and over, and over itself repeats it interrupted, is cycle this Unless touch. to numbness, hypersensitivity in or result tingling, can This nerves. neighboring pinch to begin and inflbecome tendons abrasion, this to Due pain. in resulting chafe, amed, sheath and tendon so rest, to time given aren’t they because brication lu- of out run tendons delicate cover that sheaths The work. free stress for necessary motion of range the decreasing contract, to tend muscles Injured fitears. and microscopic wrists, causing forearms, ngers, the of tendons and muscles the strain eventually times, of thousands upon thousands day, after day hour, after move- ments, repeated hour hand Fine harmful. be possibly could button mouse a clicking and typing innocu- as such activities ous seemingly One R.GAGNE, EET, CFE,NADEP Review ofproactivemeasurestoreducecostsandfutureinjuryrates Repetitive StrainInjury(RSI) Safety &Health. to their previous professions following surgery, according to the Bureau of Labor & Statistics and the National Institute for Occupational ONLYand loss work of more or days 31 in result cases tunnel carpal the Carpal all of 23% Tunnelreturned patients (CTS) Syndrome billion in direct costs. Carpal tunnel syndrome results in the highest number of days lost among all work related injuries. Almost half of $1 for accounting States, United the in annually releases tunnel carpal 463,637 with wrist, and hand the of surgery frequent most the who must undergo repetitive use of their hands and wrists in daily living. Furthermore, surgical treatment for carpal tunnel syndrome is fiand extremity.population upper general the the of of disorder percent affectsone process This population working the of percent ve shoulder). compression or nerve common most the is elbow syndrome tunnel Carpal syndrome. tunnel wrist, carpal is injury an such (the of example common One body upper workers’ to trauma repeated to exposure by caused were oc- reported, all illnesses of two-thirds cupational nearly Statistics, Labor of Bureau U.S. the to According compensation. workers in year a billion costing $20 and than more workers, American of thousands of hundreds affecting problem, health occupational costly and common most nation’s the are injuries strain repetitive (OSHA), Health Administration and Safety Labor,Occupational of Department U.S. the to According ABSTR may wonder how Fit2 ACT W RK SM or in the case of third party materials, orinthecase ofthird theowner party ofthat content. You may notalter orremove any copyright trademark, orother notice from copies ofthecontent. The mostcommonRSIsignsandsymptomsinclude: untreated. left if task) repetitive the during worsen (and time the all present be may symptoms though, Eventually, rests. person the when away go slowly may only occur when the individual is doing the repetitive task - they will fected, af- and what is caused the body problem in the the fiof part which rst on place. Initially,depending vary,symptoms symptoms and Signs Symptoms The followingareseenascausesofRSI: same tasksforsimilarperiods. the doing when don’t, others and RSI develop people some why know we do clear.Neither not is RSI for reason precise the but symptoms, to We know that often repetitive movements of a part of the body are linked Causes ekes lc o endur- of lack Weakness, the • in strength of Loss • the in sensation of Loss • (tingling) needles and Pins • A throbbing (pulsating) • sen- muscle affected the in Pain • affected the in Tenderness • • Therearenotenoughrestbreaks • Theindividualcommonlyadoptsanawkwardposture • Equipmentisbadlydesigned • Workstationsarepoorlyorganized • Forcefulmovementsareinvolved • Theindividualhastousevibratingequipment • Therepetitiveactionsaredoneinacoldplace • The area is affected by repeated actions, which are usually performed neck shoulders, arms, wrists, hands, our in muscles of overuse The • ance hand hand cially thehandorarm espe- area, affected the in sation intheaffectedarea or joint muscle orjoint on adailybasisoverlongperiod and back Original Paper Copyright ©2010Fit2WRK Median Nerve Car pal Ligame Compressed Median Nerve nt SM

Fit2WRK Clinical Educational Series • Volume 1.11 • www.fi t2wrk.com • 877-Fit-2WRK muscles and tendons swell. swell. tendons and muscles The RSI. 1 Typehave may tasks repetitive perform not do who people RSI 1 Type Experts oftenrefertotwomaintypesofRSI: often affects theneckaswell. RSI hands. or wrist elbow, forearm, the involves frequently it because Many health care professionals refer to RSI as ULD (upper limb disorder) Types ofRSI: condi- pathological discrete tions. any of characteristic be to not tend etc. They tendons, nerves, of distribution the crossing non-anatomical, and diffuse be to tend symptoms the syndrome, tunnel carpal to contrast In cifi cally theinnerliningoftendon sheath. Tenosynovitis Tendinitis shoulder. syndrome cuff Rotator jelly-like fl uid. sticky,a of consist insides their clear,and liquid of sacs thick, spongy or fiof appearance the rm have They feet. and hands, wrists, the in dons Ganglion elbowareexamples. golfer’s muscles and tendons where the bone and tendon join. Tennis elbow and Epicondylitis one orbothhandstobendintothepalmofhand. fithe of more or one causes It time. over toughen and on contract ngers hand deformity in which the connective tissue under the skin of the palm uncommon an is It fiand hands ngers. tion that affects the tracture con- Dupuytren’s wrong. be to found be physical can nothing professional, health care a by tion examina- on yet, and pain of com- plains patient the where are ditions RSI Diffuse als withCTStoexperiencenumbnessandpaininthehand. blood cannot fl ow freely through the hand to the fi ngers causing individu- dian nerve through the carpal tunnel in the wrist area. When constricted, Carpal tunnel syndrome (CTS) pain atthesiteofinflfeel will ammation. bursitis with People bursae). is bursa of plural fi(the sacs lled flare bursae - muscles and joints tendons, bones, between cushion uid- Bursitis Examples ofrepetitivestraininjuries: also callednon-specifi c painsyndrome. a person’s symptoms do not fi t into one of the (above listed) conditions,” swelling in the area where symptoms are felt. Often referred to as “when RSI 2 Type tunnel syndrome, Tendinitis (tendonitis), Tenosynovitis. hpes hn h bra s n md Te us at a a as acts bursa infl The is amed. bursa the when happens - - a condi- a - - fl- ten- or joints of uid-fitop on form to tend that swellings lled -alsoknownastendonitis,isthe infl ammation ofatendon. - usually caused by repetitive tasks, but not always; some always; not but tasks, repetitive by caused usually - - there is a feeling of pain but no obvious inflobvious or no ammation but pain of feeling a is there - - con- - otn cus s rsl o srnos vrs o the of overuse strenuous of result a as occurs often - - the sheath around the tendon becomes inflbecomes tendon the around sheath the - spe- amed, - infl ammation of tendons and muscles in the in muscles infland - tendons of ammation Examples of Type 1 RSI include RSI 1 Type of Examples - caused by the compression of the me- : Carpal : ras ae os-one, o dnt xrie eual, o wr i a in work you regularly, exercise don’t you loose-jointed, are breaks, frequent take don’t you input, heavy especially use, computer constant factors. risk are: primary Examples three the of one possess already you if risk your aware of. While they may not cause RSI on their own, they can increase and technique, poor posture, overuse. poor are factors risk primary three The Who isatrisk? fi ngers andtheouterhalfofpalm. these in sensation of loss subsequent with stress, repetitive of result a as trapped become can too it nerve, fimedian little the and Like ngers. syndrome tunnel Ulnar palm, suchassmallpliers. the using grip strong a requiring tools certain of use the by or pounding repeated by directly damaged be can hand of the palm the through runs that nerve median the of branch The hand. and arm affect the in nerves other also can and wrist the than other locations in nerve median the Disorders Entrapment Nerve become infl amed -thetendonisalsoinfl fiamed. the of thumb sheaths or tendon ngers The position. bent a in catches Triggerfi nger detect median nerve compression in the carpal tunnel. Both tests are tests to Both tunnel. muscles carpal the and in nerves compression nerve of median detect waveforms electric the analyze tests The electro of types common tests: two diagnostic are There tests. diagnostic electro for fractures, or a need to confi rm the diagnosis, then the doctor may arrange ruled out. If, however, there is a history of pain, unusual been have symptoms, disorders underlying earlier or conditions medical similar when and history medical a with using along tests self-assessment accuracy and physical simple some identifi with be ed can syndrome tunnel Carpal Electro diagnosticTests (EDX) may takeanx-ray, forexample,tocheckarthritisorfracturedbones. acerbating the symptoms, laboratory tests will be performed. The doctor ex- be may condition medical underlying an that suspects doctor the If Laboratory Tests it andthelittlefi nger together. holds patient the as thumb the on pressing by weakness muscle for test indicated. is also CTS may minute, a physician within The develop toms symp- If praying). backward (like together pressed hands the of backs fiwith dangle wrists the lets the and and table down a pointing on ngers elbows the rests patient the test, so- Phalen’s wrist-flusing In called by tests. symptoms exion CTS reproduce and try to asked be also may Tinel’s(called patient shock-sensation The sign). mild or tingling a duce pro- to nerve median the over taps other physician the test, one and In problems. CTS between distinguish help that tests provocative called During a physical examination, the doctor will perform simple maneuvers Physical Examination as arthritis ordiabetes. such conditions, medical other any out rule also will physician The job. patient’s the and disorder the between association possible the ate One of the fi rst steps in a diagnosis of carpal tunnel syndrome is to evalu- Medical andPersonalHistory achieve, ifpossibleanaccuratediagnosisforcarpaltunnelsyndrome. and work person’s a beneficompensation worker’s affectsinvolve also to may important very is it ts, often syndrome tunnel carpal Because entrapments fromRSI? Nerve other or CTS ToDiagnose Performed Be TestsShould What lifestyle andifyoudon’tsleepwell. sedentary or stressful, unhealthy, an have you condition, medical ous seri- another or diabetes, arthritis, have you environment, high-pressure In addition to these, there are several other risk factors to be to factors risk other several are there these, to addition In - a condition in which one of your fiyour of thumb one your which or in ngers condition a - poor posture, poor technique, have a job that requires that job a have technique, poor posture, poor - a ev cnuto studies conduction nerve condition Original Paper - the ulnar nerve supplies sensation to the ring the to sensation supplies nerve ulnar the - in - repetitive work can cause pressure on pressure cause can work repetitive - which one of your and fi

ngers electromyography’s or your thumb .

Fit2WRK Clinical Educational Series • Volume 1.11 • www.fi t2wrk.com • 877-Fit-2WRK right back. The long-term success rate of Splints and Anti-Infl and Splints ammatory of rate success long-term The back. right come symptoms the eliminated, is dysfunction of cause “real” the unless Splinting and increasetheirfl exibility anddexterity. Stretching can causeatrophyofmusclesand increasetheseverityofdisorder work. Tootime-offfrom taking without practical inactivity not much often is affected area is important, but avoid stressing the joint. In conservation, this Rest for RepetitiveStrainInjuries: utilized being are that techniques treatment conservative of list a is Below strain repetitive injuries arerest,exercise,bracesandmassage. for treatments prescribed often most The years. for sist per- to known been have RSIs some care, such However,without ously). fifiat (mildly exercised then and rest enough is given rst area vigor- more then the rst, provided spontaneously resolve will RSIs most own, their On Treatment a rave). during sticks glow holding ample the hands for many of hours (for ex- rotation repeated by caused testing.), device use of mobile devices and mobile repetitive by caused hand the of cubing), speed for Cube Rubik’s a of use repetitive with associated ments ail- other or syndrome, tunnel pal thumb” “cuber’s or wrist” “Rubik’s gamepad), a of use excessive by caused thumb thumb” syndrome, tunnel radial syndrome, outlet thoracic puted dis- thumb, Blackberry (RSDS), syndrome dystrophy sympathetic refl ex as such pathology fi able unveri- by part defi in terms ned general non-specifi or illnesses c other for term umbrella an or tive alterna- an as used also is RSI Did youknow… rologists orPhysiatristswithextensiveexperienceinthisarea.” Neu- certifilicensed Board and by ed performed is read over test fiand done, performed a test nally every of control quality ensure is there we Then test. of types these interpret and perform order, cessful: suc- and accurate more testing diagnostic electro the make to elements According the RMG’s Medical Director, Dr. Mark Lee, RMG focuses on 3 RMG (www.RMGRehab.com). or Group, Management Rehab is testing diagnostic electro of utilization and application the expand helping is that company One States. United offi physician ces many in performed country.the across the across utilization their in growing are tests Such is testing of type This surgery CTS. unnecessary for avoid to order in important extremely is causes nerves in the neck or elbow or thoracic outlet syndrome. Ruling out other pinched as such problems, other to attributed be should but CTS mimic that symptoms of causes detect also can They syndrome. true tunnel carpal not are that cases of 95% eliminate and have syndrome, who tunnel carpal people of percentage high a detect can and accurate fairly the Affected Area. a lgt wlig f the of swelling slight (a “First, we train the physicians and staff on how to properly to how staffon and physicians the train we “First, syu fi“stylus nger” n Analgesics and Routines tniii, car- (tendinitis, rvrs wrist” “raver’s are implemented to help reduce hypertonic muscles hypertonic reduce help to implemented are (swelling This is often the fithe often is This the Moving recommendation. rst “gamers’ a hl “ak smtm fr wie but while, a for symptoms “mask” help may , . conduction/velocity isnormalandthesymptomsdisappear. nerve treated/corrected, is imbalance muscle the If speed. slower much a at travel to “signal” nerve the causing vessels, blood nerve(s) underlying that muscles extensor “open” the hand. The underdeveloped tight, restrictive fl weak, the exor muscles compress/impinge the and hand the “close” flthat tighter muscles and exor shorter stronger, the between imbalance” though it does not correct the real cause of dysfunction; which is a “muscle Therapy VitaminB6 ing theinjuryevenfurther. tinue to increase the strength and rigidityof the fl exor muscles; exacerbat- con- only will and imbalance, muscle the caused that motion same exact the duplicate devices squeezing and gripping Using hand. the of “closing” flstatic and repetitive require performing that from activities veloped exion floverde- the already strengthen commonly and is that group muscle exor exercise they but Injuries, Strain Repetitive and Syndrome TunnelCarpal Devices Gripping and Squeezing repetitive straininjuries,especiallyifwornduringthedaytime. and syndrome tunnel carpal of symptoms the increase often braces wrist o in position wrist from dropping into fl exion so that the wrist stays in the the keep straight, to meant neutral are only.devices can nighttime These during worn but if assist injuries, strain repetitive and syndrome tunnel carpal treating in Wrist low. extremely is Medications these injuries. of treatment successful the in result will that levels resistance varied and ments, move- elbow and wrist biome- hand, chanical correct the providing in fail all they But Injuries. Strain Repetitive and Syndrome TunnelCarpal of dysfunction the treat to order in motion correct the provide almost that market the on vices de- exercise extension of number a are Devices: Exercise Extension petitive straininjuries. re- and syndrome tunnel carpal causes that imbalance muscle the correcting on cles of the fi ngers, it will have little effect mus- abductor the and wrist, and elbow fithe extend ngers, that muscles tensor ex- the for exercises strengthening with immediately followed unless but Massage other formofinjury, or butdoesnogoodwhenusedalone. syndrome, tunnel carpal tendonitis, of case acute an infl in ammation reduce help can Ultrasound group. muscle extensor the of strengthening the and flgroup, the muscle of exor stretching work, soft-tissue includes Ultrasound ing 3x,endingincold.Heataloneisnotrecommended. mately three (3) minutes of approxi- heat followed by is one (1) minute protocol of cold alternat- treatment Typical therapist. occupational or physical Baths Contrast areas ofinjury.) all for suggested is treatment of form (This techniques. strengthening and rected through a conservative physical therapy program utilizing stretching cor- / addressed immediately be to needs injury the utilized, are injections steroid injury.If original the caused that tasks same the perform to tinues be easily damaged further (Usually due can to being overstretched), if which the individual consistency,con- “rubber-like” a develop to tendons the cause injections Steroid effective. not and painful usually are but scribed, irritation of the stomach lining.) Steroid Injections into the wrist may be to pre- leads often Anti-infl of medications use ammatory (Extended function. dys- of cause underlying the correct not do again but nerve, median the Anti-Infl ammatory is good to have the fl exor muscles massaged and stretched-out, is rder to reduce impingement of the carpal tunnel. But instead, But tunnel. carpal the of impingement reduce to rder okay if used in conjunction with a treatment program that program treatment a with conjunction in used if okay (Hot/Cold) (contrast baths) are often recommended by a by recommended often are baths) (contrast (Hot/Cold) Medications can help increase the health of damaged nerves, al- nerves, damaged of health the increase help can Original Paper to reduce swelling and relieve pressure on There ot hmevs s h cr-l for cure-all the as themselves tout Braces and Splints are not effective not are Splints and

Fit2WRK Clinical Educational Series • Volume 1.11 • www.fi t2wrk.com • 877-Fit-2WRK           Ten easywaystoreduceyourriskofdevelopingRSI In general, your doctor/therapist should prescribe treatment that fo- that treatment prescribe should doctor/therapist your general, In Use two hands to type combination key strokes, such as those involv- Exercise regularly. Include strengthening, stretching, and aerobic ex- Use an ergonomically optimized workstation to reduce strain on your TAKEcomputer.up your get using so, when or BREAKS hour Every Don’t stretch for the hard-to-reach keys, e.g. BACKSPACE,e.g. keys, hard-to-reach the for stretch Don’t ENTER, Use good posture. If you can’t hold good posture, it probably means probably it posture, good hold can’t you If posture. good Use Only use the computer as much as you have to. Don’t email people email Don’t to. have you as much as computer the use Only Let your hands fl oat above the keyboard when you type, and move and type, flyou hands when your keyboard Let the above oat workstation, orpoortypingtechnique. bad a posture, poor typing, excessive strengthen- overcome can and ing/stretching therapy physical of amount no that however, ber Remem- ones. weak strengthen and muscles, tight overly stretch to coupled with a home exercise program. The therapist, focus of this program is physical a to itself. visits heal of consist will typically body should Treatment your time, with that, so function, anatomical your improving and posture, your correcting on focused be should it Rather, aspect. one be may that focused although management, be pain on not should treatment the words, other In symptoms themselves. the than rather symptoms, your of cause the on cuses get anewone(myfavoriteisDr. GripGelInk) hard, too press to you requires pencil or pen your If writing. are you should be able to easily pull the writing utensil out of your hand when ing theSHIFT andCONTROL keys. idea, torestyourelbows/wristswhenyouarenottyping. and back muscles are probably too weak. It is OK, and in fact a good shoulder your then fithis, diffiyou do it If to nd wrist. cult and hand work, the of most instead of the smaller, weaker, does and more vulnerable muscles in your back and shoulder, arm, big your the in lets muscles This times. all at straight joint wrist the keeping hard-to-reach keys, typing or mouse your moving when arm entire your in LaTeX, wherenon-letter keysareusedextensively. ease. This is crucial when you are programming or typing something with key desired the press may you that so hand entire your move SHIFT, and CONTROL... basically everything but the letters. Instead, you typetoavoidunnecessaryediting. friendlier.before it’s Think - hands your for better only not It’s them. to talk and phone the up pick or hall the down walk could you when ercises. Ifi nd yogaandPilatesespeciallyhelpful. body. necessary forgoodposture. muscles support the of some develop adjust or chair, or to workstation your need probably you posture, good maintain to perpetually struggling are you If typing. from break a take to you for time it’s As explainedinabove. eyes). your rest (to object off far a at window the out look and tight, water,of drink are a muscles get whatever around, stretch walk and hn rtn, vi gipn te rtn uesl ihl. Someone tightly. utensil writing the gripping avoid writing, When el couldhelpyourorganization,visit; www.Fit2WRK.com or call 1-877-Fit-2WRK. ties and 44 states nationally. For additional information on how the Fit2WRK Mod- facili- 400 to close in USPh through available is model integrated This USPh. by The information noted above is a summary of one of the components of Fit2WRK physician isalsoanintegralpartofthecareprocess. right the course of and therapy physical in partner right your Choosing how to ultimately treat and diagnose is important and critical in and recovery. exposure your control to how Understanding texting. and devices cellular pads, and computers mobile as such devices assisted nology tech- of usage our of advent the with likely most is increase This rise. the on are that conditions painful and common both are CTS and RSI In Conclusion 2. a b c Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB (February JB Jupiter SG, Lee L, Malhotra J, Kadzielski D, Ring c b a 2. fac- psychosocial and mechanical of Role Silman. Hunt, Macfarlane, 1. 11.Lozano-Calderón S, Anthony S, Ring D (April 2008). “The quality and 10.Nahit ES, Pritchard CM, Cherry NM, Silman AJ, Macfarlane GJ (June YourBeyond Living Therapy Commitment Using & Pain: Acceptance 9. Carolyn Kisner & Lyn 8. Allen Colby, Therapeutic Exercise: Foundations “Work- 2007). (April Koehoorn W. M. Gillies, H. J. R.; C. Ratzlaff, 7. YourBeyond Living Therapy Commitment Using & Pain: Acceptance 6. Bone J injury”. stress “Repetitive 2001). (January PC Amadio b a 5. Berkeley Lab. Integrated Safety Management: Ergonomics. Website. 4. “Twooffiof thirds 3. On- Mail | injury strain repetitive staffsufferfrom ce References tors intheonsetofforearmpain:BMJ.2000 J HandSurg Am 33 strength of evidence for etiology: example of carpal tunnel syndrome”. http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=11409134. employed workers”. J. Rheumatol. 28 (6): 1378–84. PMID 11409134. chological distress on regional musculoskeletal pain: a study of newly psy- and factors psychosocial inflrelated “The work 2001). of uence to EaseChronicPainbyJoanneDahland Tobias Lundgren and Techniques, at473(5thEd.2007). doi:10.1002/art.22610. PMID17394178. 495–500. (3): 57 Research) & Care (Arthritis Rheumatism & Arthritis Activity”. Physical Leisure-Time and Injury Strain Repetitive Related to EaseChronicPainbyJoanneDahland Tobias Lundgren http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=11205849. Joint Surg Am 83-A (1): 136–7; author reply 138–41. PMID 11205849. Retrieved 9July2008. html. Retrieved2009-08-17. article-1024097/Two-thirds-offi ce-staff-suffer-Repetitive-Strain-Injury. http://www.dailymail.co.uk/health/ 2008-06-04. Dailymail.co.uk. line”. mid=15687162. http://www.ejbjs.org/cgi/pmidlookup?view=long&p 15687162. PMID doi:10.2106/JBJS.D.01907. 374–80. (2): 87 Am Surg Joint Bone J pain”. arm idiopathic with associated factors “Psychological 2005). Original Paper

Fit2WRK Clinical Educational Series • Volume 1.11 • www.fi t2wrk.com • 877-Fit-2WRK