Repetitive strain injury
|Repetitive Strain Injury|
|Classification and external resources|
|ICD-10||M70, X50, Z57.7|
|ICD-9||E927.1, E927.3—E927.9, 727.2|
Repetitive strain injuries (RSIs) are "injuries to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions". RSIs are also known as cumulative trauma disorders, repetitive stress injuries, repetitive motion injuries or disorders, musculoskeletal disorders, and occupational or sports overuse syndromes.
Repetitive strain injury (RSI) and cumulative trauma disorders are umbrella terms used to refer to several discrete conditions that can be associated with repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained/awkward positions. Examples of conditions that may sometimes be attributed to such causes include edema, tendinitis, carpal tunnel syndrome, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, golfer's elbow (medial epicondylitis), tennis elbow (lateral epicondylitis), trigger finger (so-called stenosing tenosynovitis), radial tunnel syndrome, and focal dystonia.
While the recent prevalence of upper extremity RSIs has focused awareness on injuries to the fingers, hands and arms, they can occur in any body part and frequently affect the trunk, back and legs.
Specific sources of discomfort have been popularly referred to by terms such as Blackberry thumb, iPod finger, gamer's thumb, Rubik's wrist or "cuber's thumb", stylus finger, raver's wrist, and Emacs pinky, among others.
Although seemingly a modern phenomenon, RSIs have long been documented in the medical literature. In 1700, the Italian physician Bernardino Ramazzini first described RSI in more than 20 categories of industrial workers in Italy, including musicians and clerks. Carpal tunnel syndrome was first identified by the British surgeon James Paget in 1854. The Swiss surgeon Fritz de Quervain first identified De Quervain’s tendinitis in Swiss factory workers in 1895. The French neurologist Jules Tinel (1879-1952) developed his percussion test for compression of the median nerve in 1900.  The American surgeon George Phalen improved the understanding of the aetiology of carpal tunnel syndrome with his clinical experience of several hundred patients during the 1950s and 1960s.
RSIs are assessed using a number of objective clinical measures. These include effort-based tests such as grip and pinch strength, diagnostic tests such as Finkelstein's test for Dequervain's tendinitis, Phalen's Contortion, Tinel's Percussion for carpal tunnel syndrome, and nerve conduction velocity tests that show nerve compression in the wrist. Various imaging techniques can also be used to show nerve compression such as x-ray for the wrist, and MRI for the thoracic outlet and cervico-brachial areas.
The most-often prescribed treatments for early-stage RSIs include drug therapies such as anti-inflammatory medications combined with passive forms of physical therapy such as rest, splinting, massage and the like. Low-grade RSIs can sometimes resolve themselves if treatments begin shortly after the onset of symptoms. However, some RSIs may require more aggressive intervention including surgery and can persist for years.
General exercise has been shown to decrease the risk of developing RSI. Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive kyphosis, and potentially thoracic outlet syndrome.
Keyboards and keyboard alternatives
Keyboard layouts such as Dvorak and Colemak are promoted as alternatives to mitigate some of the strain arising from the standard QWERTY keyboard layout.[dubious ] Other solutions move the mode of input from one's hands entirely. These include the use of voice recognition software or pedals designed for ergonomics and gaming to supplant normal keyboard input.
- List of Repetitive Strain Injury software
- Carpal tunnel syndrome
- Sports Injury
- Public Employees Occupational Safety and Health Program of the New Jersey Department of Health and Senior Services
- van Tulder M, Malmivaara A, Koes B (May 2007). "Repetitive strain injury". Lancet 369 (9575): 1815–22. doi:10.1016/S0140-6736(07)60820-4. PMID 17531890.
- Waugh D (September 1981). "Cuber's thumb". N. Engl. J. Med. 305 (13): 768. PMID 7266622.
- <a href="http://medical-dictionary.thefreedictionary.com/Raver’s+Wrist">raver’s wrist</a>
- Ramazzini, De Morbis Artificum Diatriba (Diseases of Workers), Modena Italy,1700.
- Pearce JM (April 2009). "James Paget's median nerve compression (Putnam's acroparaesthesia)". Pract Neurol 9 (2): 96–9.
- Ahuja NK, Chung KC, "Fritz de Quervain, MD (1868-1940): stenosing tendovaginitis at the radial styloid process", J Hand Surg., vol.29 #6 pp. 1164–70.
- Tinel, J., “Nerve wounds” London: Baillère, Tindall and Cox, 1917
- Tinel, J., ‘’Le signe du fourmillement dans les lésions des nerfs périphériques’’, “Presse médicale”, 47, 388-389,1915
- Tinel, J. ‘’The "tingling sign" in peripheral nerve lesions’’ (Translated by EB Kaplan). In: M. Spinner M (Ed.), “Injuries to the Major Branches of Peripheral Nerves of the Forearm”, 2nd ed. pp 8-13, Philadelphia: WD Saunders Co, 1978.
- Ratzlaff, C. R.; J. H. Gillies, M. W. Koehoorn (April 2007). "Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity". Arthritis & Rheumatism (Arthritis Care & Research) 57 (3): 495–500. doi:10.1002/art.22610. PMID 17394178.
- Carolyn Kisner & Lyn Allen Colby, Therapeutic Exercise: Foundations and Techniques, at 473 (5th Ed. 2007).
- Berkeley Lab. Integrated Safety Management: Ergonomics. Website. Retrieved 9 July 2008.
- Repetitive Strain Injuries at the Open Directory Project
- Musculoskeletal disorders from the European Agency for Safety and Health at Work (EU-OSHA)
- Workrave application for prevention of RSI
- Amadio PC (January 2001). "Repetitive stress injury". J Bone Joint Surg Am 83–A (1): 136–7; author reply 138–41. PMID 11205849.
- Harvard RSI Action
- Prevention and Management of Repetitive Strain Injury
- Epidemiological and ergonomic study of occupational factors associated with syndromes of upper limb disorders in keyboard operators by M Hanson and others. Institute of Occupational Medicine Research Report TM/99/04
- Development of an aid to identifying task elements, which may predispose individuals to work related upper limb disorders by RA Graveling and others. Institute of Occupational Medicine Research Report TM/90/08
- Clinical epidemiological study of relations between upper limb soft tissue disorders and repetitive movements at work by CJ English and others. Institute of Occupational Medicine Research Report TM/88/19