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Orthopedics => Tendinitis => Repetitive Strain Injury (RSI)
Repetitive Strain Injury (RSI)
Repetitive Strain Injury (RSI), group of work-related disorders, usually of the upper limbs, caused by repetitive muscle contractions and soft-tissue damage, for example of tendons, during actions such as typing. It is also known as work-related upper limb disorder or over-use injury.
There has been much debate about whether the complaint is a genuine medical condition; many doctors take the view that RSI is a psychosomatic disease although the affected individuals do experience real symptoms and disabilities. Many believe that it is a stress-related disorder.
Characterized by pain, inflammation, fatigue, upper limb weakness, stiffness, and cramp, RSI normally has a gradual onset but can also come on suddenly. Initially, individuals experience fatigue or pain in arms, wrists, or fingers at the end of a day's work, which is alleviated by overnight rest. This pain and incapacity later becomes constant even when the job is halted.
RSI is generally regarded as a complex phenomenon, covering a wide range of ailments. It may include carpal-tunnel syndrome, tendinitis, and tennis elbow, when it is clear that these conditions have resulted from repetitive movements. RSI tended to affect six times more women than men, probably because of the high proportion of women employed as secretaries and in similar occupations.
Numerous lawsuits in Australia and the United States concerning RSI were made in the late 1980s, with several arising later in Britain. These have aroused concern and recommendations for modification of working habits and the working environment. The increase in the number of individuals who spend their whole day using a computer keyboard in the past two decades has been suggested as an explanation for the sudden appearance of RSI. It is thought that this is due to the greater speeds and more intricate, tendon-intensive movements involved in typing and mouse-clicking at a computer keyboard. The damage to soft tissues may build up slowly over weeks and months as a result, often without symptoms, so that the sufferer is unaware of the injury until it is well established.
However, similar complaints have been described throughout history. Scrivener's palsy, or writer's cramp, was the name given to a condition described in 1864 that was caused by writing for prolonged periods of time (writers were known as scriveners). Cases have been described that have been caused by playing musical instruments, overuse of a computer mouse, or excessive playing of computer games. Workers most at risk of developing RSI include secretaries, supermarket check-out staff, production-line workers, typists, hairdressers, telephonists, and other workers who use a computer keyboard, such as journalists and administrators. Musicians, for example, pianists, are also in a high-risk occupation.
In order to reduce the chances of developing RSI, attention should be paid to the working environment and the number of hours spent performing the repetitive action. Work rotation, where some time is spent performing other tasks, such as filing, has been recommended. The computer terminal should be positioned correctly to avoid neck and eye strain and the office should be well lit. Increased stress at work; monotony; boredom; bad posture; pressure to achieve targets; and lack of job satisfaction have all been suggested as factors that make a person more prone to develop RSI. Treatment is generally by rest, physiotherapy, and, where appropriate, changing work routines or even the job itself. Some doctors prescribe anti-inflammatory drugs, such as ibuprofen; some conditions, such as tennis and golfer's elbow, are treated with localized injections of corticosteroid drugs, whose effectiveness is variable, or in some cases (particularly carpal-tunnel syndrome) by surgery.
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