Repetitive strain injury
|Repetitive Strain Injury|
|Classification and external resources|
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". RSI is 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) is a syndrome incorporating several discrete conditions associated with activity-related arm pain such as edema, tendinitis, carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, stenosing tenosynovitis, intersection syndrome, golfer's elbow or medial epicondylitis, tennis elbow or lateral epicondylitis, radial tunnel syndrome, and focal dystonia.
RSI is also used as a generalized umbrella term for non-specific illnesses popularly referred to as Blackberry thumb, iPod finger, gamer's thumb, Rubik's wrist or "cuber's thumb", Trigger finger, Stylus Finger, Raver's Wrist, and others.
The recent prevalence of upper extremity RSIs has focused awareness on injuries to the fingers, hands and arms. However, RSIs can occur in any body part and frequently affect the trunk, back and legs.
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 Dequervain’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.
Since workstation design often contributes to RSIs, ergonomic adjustments of the workstations are often recommended.
Adjunct Intervention 
Modifications of posture and arm use (ergonomics) are often recommended. Specially designed tools such as pliers are now widely available for production line workers to minimise the risks of repetitive strain injuries. The handles of such pliers are bent so that the workpiece is aligned with the arm, wrist and hand. The handles are also designed to maximise grip using both thermoplastics and rubber.
Adaptive software 
There are several kinds of software designed to help in repetitive strain injury. Among them, there are speech recognition software, and break timers. Break timers software reminds the user to pause frequently and perform exercises while working behind a computer. There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.
Adaptive hardware 
||This section needs additional citations for verification. (January 2012)|
Adaptive technology ranging from special keyboards, mouse replacements to pen tablet interfaces might help improve comfort.
Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or joystick, or switching from using a mouse to a stylus pen with graphic tablet may provide relief, but in chronic RSI they may result only in moving the problem to another area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a trackpad or pointing stick, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice (which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.
Ergonomic accessories for the mouse can also make a difference. An accessory developed recently includes finger pads to create a softer surface for clicking as well as for helping the joints bend more when clicking. Additionally the accessory developed by the gel pads on mouse manufacturer includes a palm pad on the mouse to help the hand achieve a more grasping position further increasing overall ergonomics.
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. Exotic keyboards by manufacturers such as Datahand, OrbiTouch, Maltron and Kinesis are also available. One can even use digital pens to avoid the strain coming from typing itself[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.
See also 
- 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
- J. Barondes, chair, "Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremity", National Research Concil, 2001 (National Academy Press, Washington D. C.).
- Douglas Waugh MD, Can Med Assoc Journ.,125:1023-1024,
- <a href="http://medical-dictionary.thefreedictionary.com/Raver%e2%80%99s+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