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Introduction 

Repetitive strain injury (RSI) is a general term used to describe the pain felt in muscles, nerves and tendons caused by repetitive movement and overuse.

It's also called work-related upper limb disorder or non-specific upper limb pain.

The condition mostly affects parts of the upper body, such as the forearm, elbow, wrist, hands, neck and shoulders. The symptoms can vary, but often include:

  • pain or tenderness

  • stiffness

  • tingling or numbness

  • cramp

If you develop these symptoms and you think it may be related to your job, speak to your employer or occupational health representative about your concerns and ways you could modify your tasks to relieve the symptoms.

See your GP if symptoms persist despite attempts to alter how you work.

 

What causes RSI?

RSI is usually associated with doing a particular activity repeatedly or for a long period of time. It often occurs in people who work with computers or carry out repetitive manual work.

Certain things are thought to increase the risk of RSI, including:

  • doing a high-intensity activity for a long time without rest

  • poor posture or activities that require you to work in an awkward position

  • stress

  • cold temperatures

 

How RSI is treated

The first step in treating RSI is usually to identify and modify the task or activity that is causing the symptoms. If necessary, you may need to stop doing the activity altogether.

To relieve symptoms, your GP may advise taking a course of anti-inflammatory painkillers (such as aspirin or ibuprofen), or using a heat or cold pack, elastic support or splint.

You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles. Some people find that other types of therapy help to relieve symptoms, including massage, yoga and osteopathy.

RSI can be divided into two types. Type I is when the pain is the result of a specific medical condition, such as carpal tunnel syndrome or tennis elbow. Type II is when no specific cause can be found and is often referred to as non-specific upper limb pain.

 

How to prevent RSI

Employers have a legal duty to prevent work-related RSI and make sure that the symptoms of anyone who already has the condition do not get worse.

Most employers will carry out a risk assessment when you join a company to check your work area is suitable and comfortable for you.

There are also things you can do to help reduce your risk of RSI, such as maintaining a good posture at work, taking regular breaks from long or repetitive tasks, and trying relaxation techniques if you are stressed.

 

Symptoms of repetitive strain injury (RSI) 

The symptoms of repetitive strain injury (RSI) usually develop gradually. They can range from mild to severe.

Symptoms can vary, but often include:

  • pain, aching or tenderness

  • stiffness

  • throbbing

  • tingling or numbness

  • weakness

  • cramp

At first, you might only notice symptoms when you are carrying out a particular repetitive action, for example when you are at work. When you have finished work and are resting, your symptoms may improve. This is the first stage of symptoms and may last for several weeks or longer.

If nothing is done about them, the symptoms of RSI are likely to get worse and cause longer periods of pain. You may also get swelling in the affected area, which can last for several months.

Without treatment, the symptoms of RSI can become constant. At this stage the condition may be irreversible.

 

What to do if you think you have RSI

If you develop these symptoms and you think it may be related to your job, speak to your employer or occupational health representative about your concerns and ways you could modify your tasks to relieve the symptoms.

See your GP if symptoms persist despite attempts to alter how you work.

 

Causes of repetitive strain injury (RSI) 

Repetitive strain injury (RSI) is related to the overuse of muscles and tendons in the upper body, especially the hands, wrists, forearms, elbows, shoulders, back or neck.

Things that can put you at risk of RSI include:

  • repetitive activities

  • doing a high-intensity activity for a long time without rest

  • poor posture or activities that require you to work in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting RSI and can make the symptoms worse. Stress can also be a contributing factor.

RSI is most commonly caused by a repeated action carried out on a daily basis. A variety of jobs can lead to RSI, such as working at an assembly line, at a supermarket checkout or typing at a computer.

It is important that your working environment, for example your desk space, is laid out so that you can work comfortably. Your employer is under a legal duty to try to prevent work-related RSI and ensure that anyone who already has the condition does not get any worse.

 

Diagnosing repetitive strain injury (RSI) 

There is no single test to check for repetitive strain injury (RSI) as the symptoms can be caused by a variety of things. Often no clear problems are found despite extensive tests.

RSI is often diagnosed when symptoms develop after a repetitive task and fade when the task is stopped.

Your GP will examine the area where you have pain and will ask about your symptoms and medical history. This will help them determine if you have RSI and what type you have.

 

Types of RSI

RSI is often split into two categories depending on your symptoms:

  • Type 1 RSI – When a doctor can diagnose a recognised medical condition from your symptoms. It is usually characterised by swelling and inflammation of the muscles or tendons.

  • Type 2 RSI – When a doctor cannot diagnose a specific medical condition, usually because you have no obvious symptoms other than pain. This is also known as non-specific upper limb pain.

 

Type 1 RSI

There are several medical conditions and injuries that can be classed as type 1 RSI. These include the following:

  • bursitis – inflammation and swelling of the fluid-filled sac near a joint such as the elbow or shoulder

  • nerve entrapment, such as carpal tunnel syndrome (pressure on the median nerve passing through the wrist)

  • Dupuytren's contracture – a thickening of deep tissue in the palm of the hand and into the fingers

  • epicondylitis – inflammation of an area where bone and tendon join in the elbow, causing either tennis or golfer's elbow

  • rotator cuff syndrome – inflammation of the tendons in the shoulder

  • tendonitis – inflammation of a tendon

  • tenosynovitis – inflammation of the inner lining of the tendon sheath that covers the tendons, most commonly in the hand, wrist or forearms

  • trigger finger – where swelling in a tendon running along one of the fingers makes it difficult to bend and straighten the affected finger

  • ganglion cyst – a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers

  • Raynaud's disease – a condition where the blood supply to extremities such as the fingers is interrupted, especially when exposed to cold

  • thoracic outlet syndrome – compression of the nerves or blood vessels that run between the base of the neck and the armpit

  • writer's cramp (a type of dystonia) – a condition that occurs from overuse of the hands and arms

However, while the conditions above can be caused by work activities, many of them (including carpal tunnel syndrome and Dupuytren's contracture) can also develop as a result of other factors.

 

Type 2 RSI

If your symptoms don't immediately suggest you have one of the above conditions, you may be referred for further tests to check for other conditions.

For example, you may be given an X-ray to test for osteoarthritis or blood tests to rule out inflammatory joint diseases.

If no other condition is found after having tests, you may be diagnosed with type 2 RSI, which is also known as non-specific upper limb pain syndrome or diffuse RSI.

 

Treating repetitive strain injury (RSI) 

Treatment for repetitive strain injury (RSI) depends on your symptoms and whether a specific condition has been diagnosed.

The first step is usually to speak to your employer or occupational health representative about ways you could modify your tasks to relieve the symptoms. Small changes to your lifestyle and working environment can often help.

Think about your working environment and what activity may be causing the problem. Try to take steps to reduce how much time you spend doing this activity or change how you do it.

If you can't stop doing it completely, take regular, short breaks to stretch and move about. Software packages that remind you to take regular breaks from the keyboard can be useful.

It can also be helpful to get advice from an occupational health representative at work on how to set up your work station.

Some people with symptoms of RSI find that including exercise in their daily routine, such as walking or swimming, also helps ease their symptoms.

See preventing RSI for more advice about reviewing your work activities.

 

Treatment options

See your GP if your symptoms persist despite attempts to modify your work activities. There is no single treatment for RSI, but a number of treatments are available that can help people with the condition.

If your doctor can diagnose a specific medical condition, well-established treatments can often be recommended. These include self-help measures, medication, or even surgery in some cases.

Some of these treatments may also help even if your doctor cannot diagnose a specific medical condition from your symptoms, although evidence of their effectiveness in these cases is limited.

Possible treatment options for RSI include:

  • medication, including anti-inflammatory painkillers (such as aspirin or ibuprofen), muscle relaxants, antidepressants and sleeping tablets (if your RSI is preventing you from sleeping)

  • heat or cold packs, elastic supports or a splint

  • physiotherapy, including advice on posture and stretches or exercises to help strengthen or relax your muscles

  • steroid injections to reduce inflammation in an affected area (this is only recommended if an area has definite inflammation caused by a specific condition, such as carpal tunnel syndrome)

  • surgery to correct specific problems with nerves or tendons (for example if you are diagnosed with carpal tunnel syndrome or Dupuytren's contracture) if other treatments haven't helped

Physical and complementary therapies

"Hands-on" therapies, including physiotherapy, massage and osteopathy, may be available after a referral from your GP, but in some cases there may be a long wait for an appointment.

If you wish to consider private treatment, make sure your therapist is registered with a professionally recognised organisation.

Many long-term sufferers of RSI use other types of complementary therapies and relaxation techniques, such as yoga, acupuncture and the Alexander technique, to help relieve the symptoms of RSI.

However, while some people with RSI do find these helpful, you should be aware that there is little scientific evidence to suggest these approaches are consistently effective for RSI.

 

Preventing repetitive strain injury (RSI) 

Preventing repetitive strain injury (RSI) or relieving your symptoms involves understanding what causes the problem. This includes your work, hobbies, general stress and posture.

Many repetitive strain injuries develop over a long period of time rather than suddenly.

Aspects of your working environment are likely to have the most impact on your RSI. Employers have a legal duty to prevent work-related RSI and make sure that the symptoms of anyone who already has the condition do not get worse.

Most employers will carry out something called a risk assessment or workstation assessment when you join a company. This is to check your work area is suitable and comfortable for you and that the risk of accident and injury is as low as possible. You can request an assessment if you have not had one.

 

Reviewing your work activities

Use the following as a guide to review your own work situation before you talk to your employer:

  • If you work at a computer all day, make sure your seat, keyboard, mouse and screen are positioned so that they cause the least amount of strain to your fingers, hands, wrists, neck and back. See tips on preventing RSI for more detailed advice about using a mouse and keyboard at work.

  • Sit at your desk with a good posture. Adjust your chair so that your forearms are horizontal with the desk and your eyes are the same height as the top of your computer screen. See how to sit at a desk correctly for more information.

  • Try to take regular breaks if you do a repetitive task at work. It is better to take smaller breaks more frequently than just one long break at lunch. You may find it useful to use a software package that reminds you to take regular breaks from the keyboard.

Speak to your employer if there is anything relating to your working environment that you feel could be improved.

You can review other aspects of your lifestyle yourself, such as your hobbies or general stress levels. The most important thing is to notice the factors that are causing or aggravating your RSI and make changes accordingly. See relieving stress for advice about ways you can help yourself relax.

More information on RSI and work-related upper limb disorders prevention can be found on the RSI Awareness website.

 

Upper limb disorder

Upper limb disorder