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Repetitive Strain Injury - RSI

  • Date: 2009/02/17 (Rev. 2013/06/16)
  • Jamie Payne - www.ergonomic-resources.com
  • Synopsis : Information and treatment options for RSI repetitive strain injury from continuous use of computer keyboards and musical instruments.

Main Document

A repetitive strain injury (RSI) is cluster of conditions resulting from continuous use of tools such as computer keyboard, musical instrument and activities that demand repeated movements.

Although the cause of 'inflammation' associated with cumulative trauma have not been clearly elucidated, many factors including mechanical fatigue involving ligaments, tendons and soft tissues have been implicated.

The site of inflammation is the key to differential diagnosis.

Differential diagnosis can be used to diagnose Acromioclavicular degeneration, Ankle degeneration, Anterior cruciate laxity, Achilles tendon injuries and tendinitis, Knee degeneration, Neck pain, Shin splints, Suprascapular nerve compression, tendinopathy, Carpal tunnel syndrome, Elbow degeneration, and also Gamekeeper's thumb.

Common RSI conditions include:

Bursitis: inflammation and swelling of the fluid-filled sac near a joint at the knee, elbow or shoulder.

Ganglion : a cyst in a tendon sheath, usually occurring on the wrist.

Rotator cuff syndrome : inflammation of muscles and tendons in the shoulder.

Tendonitis : inflammation of a tendon.

Carpal tunnel syndrome : pressure on the median nerve passing through the wrist.

Diffuse RSI : nerve damage.

Dupuytren's contracture : a thickening of deep tissue that passes from the palm of the hand into the fingers.

Epicondylitis : inflammation of an area where bone and tendon join, an example of epicondylitis is tennis elbow.

Tenosynovitis : inflammation of the inner lining of the tendon sheath that houses the tendons that control the fingers and thumbs.

Trigger finger : inflammation of the tendon sheaths of fingers or thumb accompanied by swelling of the tendon.

A well known injury among this list is Carpal Tunnel Syndrome (CTS).

A small injury to the cartilage-like structure in the wrist joint is know as a Triangular Fibrocartilage Complex Injury (TFCC). Clicking sounds in the wrist, a reduced strength in grip and pain on the ulnar side of the wrist are all symptoms of TFCC. In patients with systemic sclerosis, wrist pain may also be caused by Osteonecrosis of the lunate bone in the wrist. This is an important cause of wrist pain in many people and especially those with scleroderma. If the presence of a scaphoid fracture cannot be determined with initial X-rays then a positive compression test can confirm that it is indeed fractured.

As the number of people using computers increases, the chances of developing RSI increases. The repetitive action of typing on a computer can cause painful symptoms in fingers and hands, such as a throbbing pain. RSI caused by typing on a computer is often called writer's cramp.

A definitive test for scaphoid instability is the scaphoid shift test, which uses pressure against the scaphoid tubercle.

The compression of the median never at the wrist is the cause of Carpal Tunnel Syndrome (CTS), or median neuropathy, this can lead to pain in the hand. Some cases of carpal tunnel syndrome are caused by repetitive activities, while occur without any known cause. There remains a correlation between a painful dorsal wrist ganglion and wrist joint abnormality, but the exact cause of the dorsal wrist ganglia is still a medical mystery. Scaphoid fractures and dynamic scapholunate instability are both injuries that can happen to the scapholunate ligament. The scapholunate ligament stabilizes the palmar rotation force of the scaphoid against the dorsal rotation force of the lunate and maintains the proximal pole of the scaphoid adjacent to the lunate.

De Quervain's tenosynovitis is an inflammation of the tendons in the wrist.

The affected tendons are on the side of the wrist near the thumb. When they swell, it can make movement of the wrist and thumb difficult. Diagnostic imaging and bone X-rays can lead to the diagnosis of this syndrome. Once the condition is diagnosed, appropriate treatment can begin.

Scapholunate injuries have been reported as occurring in association with distal radial fractures although their true prevalence and natural history are not known. Patients with rheumatoid disease or distal radius fractures commonly have distal lunate joint instability due to dysfunction of the distal radio-ulnar joint. Sports activities involving racquet's, bats and clubs cause 2 percent of all carpel fractions of the triangular shaped hamate bone which is composed of a body and hook.

Repetitive Strain Injuries are especially common among information workers, who work at a computer for long hours. Often, RSIs can be avoided by following a few simple ergonomic rules.

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