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Repetitive Stress Injury

Alternate Names

  • RSI
  • repetitive stress syndrome

Definition

Repetitive stress injury (RSI) is caused by repeated or excessive movement of the shoulders and arms.

Risks

What are the causes and risks of the injury?

Causes of repetitive stress injury include:
  • repetitive and excessive use of the muscles of the upper limbs. This includes activities such as typing, sewing, heavy lifting, playing tennis, sawing wood, and using a cash register
  • poor posture when carrying out these activities
  • poorly designed work conditions and work stations
  • pregnancy
If RSI is not successfully treated, nerve and tissue damage may cause a decrease in feeling and range of motion. The individual may experience chronic pain or soreness in the affected area. Disability or loss of employment may also occur.
Specific RSI conditions include:
  • carpal tunnel syndrome, which causes pain and other symptoms in the hand and wrist
  • tendonitis, which is an inflammation of the tendons in any part of the body
  • bursitis, which is an inflammation of the sac that cushions a joint
  • ganglions, which are cysts that may occur on a tendon

Prevention

What can be done to prevent the injury?

Avoiding overexertion of the arms and shoulders can prevent many cases of RSI. Warming up and stretching the muscles before activity, and using proper body mechanics during the activity, may also reduce the risk of injury.
Ergonomics is the practice and study of arranging work equipment to allow for more comfort and less strain on the body. There are many ergonomic products, such as wrist pads, height adjusters on keyboard holders, and wrist support braces. These products are intended to decrease the stress on muscles, tendons, tissues, and nerves of the arms.
Taking regular breaks during repetitive activities, and doing strengthening exercises may help. Learning proper methods of sitting, positioning the feet, lifting, and bending may also decrease the risk of RSI. Many causes cannot be prevented.

Diagnosed

How is the injury recognized?

The diagnosis of repetitive stress injury begins with a complete medical history and physical examination. The healthcare professional may order tests, such as:
  • x-rays and other imaging scans, such as an MRI
  • a nerve conduction velocity test (NCV) to check for nerve damage
  • blood tests, including a complete blood count (CBC), to rule out infection
  • a biopsy of any fluid or growths to rule out infection, tumor, or cancer

Treatments

What are the treatments for the injury?

Minor pain or injury may require RICE therapy:
  • rest or reduced activity
  • ice or cold packs applied to the affected area
  • compression of the area, such as with ace bandages or wrist splints
  • elevation
Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen (i.e., Advil, Motrin) and naproxen (i.e., Naprosyn, Aleve, Anaprox, Naprelan), may be used to reduce inflammation and discomfort. In some cases, a corticosteroid may be injected into the affected area.
Physical therapy or strength training exercises may help increase the strength of the tendons and muscles. Ultrasound may be used to warm the muscles and improve blood flow. If conservative treatment is not successful, surgery may be necessary.

Side Effects

What are the side effects of the treatments?

NSAIDs can cause stomach upset and allergic reactions. Surgery can be complicated by bleeding, infection, or reactions to anesthesia.

After Treatment

What happens after treatment for the injury?

In mild cases of repetitive stress injury, no further treatment is needed for minor pain and inflammation. For more serious disease or injury, treatment may continue. Physical therapy and daily strengthening exercises may be recommended.
Any new or worsening symptoms should be reported to the healthcare professional.

Sources

Harrison's Principles of Internal Medicine, 1998, Fauci et al.

Complete Guide to Symptoms, Illness, and Surgery, Griffith, 2000

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