REPETITIVE STRAIN INJURY

BY: RITAMBHARA YADAV (MPT 3RD SEM)

 INTRODUCTION

 RSI is a multifactorial complaints syndrome affecting the neck, upper back, shoulder,
upper and lower arm, elbow, wrist or hand, or a combination of these areas, which leads
either to impairment or to participation problems.
 The syndrome is characterized by disturbance in the balance between load and physical
capacity, preceded by activities that involve repeated movements or prolonged periods
spent with one or more of the relevant body parts in a fixed position as one of the
presumed etiological factors. (Health Council of the Netherlands, The Hague, 2000:
Publication No. 2000/22E, p. 18)
 RSI is an umbrella term for a number of specific injuries caused by the repeated
movement of a particular part of the body. Specifically, repetitive strain injury is known as
an occupational overuse syndrome that affects nerves tendons and muscles.
 Cumulative
trauma
disorder

Work-
related Occupational
overuse
upper limb syndrome
disorder

TERMINOLOGIES
Work-
regional related
musculoskeletal repetitive
disorder movement
injury

repetitive repetitive
motion stress
disorder injury
 PREVALANCE OF RSI

 15-25% of all computer users worldwide (both vocational and recreational) are estimated to have
RSI. By this estimate, over 5 million Indian computer users (out of an estimated 28 million) may
already be having RSI.
 RSI accounted for 66% of all work-related illnesses in USA (1999).
 A survey of 500 software professionals at Hyderabad in 2000 revealed that over 50% had symptoms
of established RSI.
 Preliminary results of our ongoing prospective study among over 35,000 Indian computer
professionals (2001-2008) found that over 75% reported musculoskeletal symptoms. This is the
largest study ever undertaken to identify the prevalence, causes and results of treatment of
Computer Related RSI.
 0.5 million workers affected in the UK also RSI IS 2nd most common cause of sickness absence in
many industries in the UK
 For Upper Limb (and neck) 5 million working days lost with average of 3 weeks lost time per person
 In a study done on Dentists of Tamil Nadu, Vyasarayani et al. concluded that 86.4% of the
surveyed dentist had RSI. The incidence of RSI was 80% among men and 85% among women.
Occurrence of RSI had a direct co-relation to the number of years of practice, the number of
hours they practice a day, and number of patients they treat in a day. It had an indirect
correlation to the number of hours of their sleep and their regular exercises.
SIGNS & SYMPTOMS

 SIGNS:
 Localised swelling
 Warmth & redness
 Loss of function
 Loss of ROM

 GENERALISED SYMPTOMS:
 tenderness or pain in the affected muscle or joint
 a throbbing or pulsating sensation in the affected area
 tingling, especially the hand or arm
 loss of sensation
 loss of strength
 Loss of Endurance
 Other symptoms depend on which part of the body is affected.
Warning signs of RSI

 Pain during typing

 Difficulty with ordinary chores
 Opening doors with shoulders or feet
 Stiffness, weakness, or lack of endurance
 Heaviness
 Lack of coordination, dropping things
 Cold hands
 Hyperawareness of hands
 Frequent self-massage or “cracking”

Harris RSI -- LISA '99

 CAUSES

 The overuse of muscles in our hands, wrists, arms, shoulders, neck and back
 The area is affected by repeated actions, which are usually performed on a daily
basis over a long period
 The repetitive actions are done in a cold place
 The individual has to use vibrating equipment
 Forceful movements are involved
 Static loading for longer periods of time
 Workstations are poorly organized
 Equipment is badly designed
 The individual commonly adopts an awkward posture for prolonged time
 Health status of the individual e.g. Muscle strength and recruitment pattern
 There are not enough rest breaks
 DIAGNOSIS
 There is no specific test to diagnose repetitive strain injury as the condition takes many forms. A
complicating factor is that some conditions, such as carpal tunnel syndrome, can have several
causes.
 Although, Specific conditions can be diagnosed by special tests for confirmation e.g. Cozen’s
test for Lateral epicondylitis or Phalen’s test for CTS

 Repetitive strain injuries are diagnosed by taking a medical history and performing a physical
examination. Symptoms may be the result of other conditions, and diagnostic tests may be
ordered, such as:
 Blood tests, to check for diabetes or inflammatory joint disease
 X-rays, to check for arthritis or fractures
 Nerve conduction studies (NCS) This test checks the function of nerves
 Electromyography checks the function of muscles for strength and recruitment pattern.
 CT or MRI to reveal whether a person’s condition requires surgical treatment.
 TYPES
TYPE TYPE
1 the symptoms can
be categorized as a
2 the symptoms are
not easily recognized
as a specific
specific condition
condition.

Symptoms may be
vague or shifting,
The muscles and
with few or no visible
tendons swelling and
or measurable signs,
inflammation is seen
such as swelling or
nerve damage.
CARPEL TUNNEL SYNDROME

 Pain in the wrist and hand as

well as numbness in the
fingers are the symptoms of
Carpal Tunnel Syndrome.
 They are also the symptoms
for a number of other
repetitive stress injuries. The
numbness in Carpal Tunnel
Syndrome is localized to the
thumb and first two fingers.
 Carpal Tunnel Syndrome
often weakens your thumb
and therefore your grip.
 Pain and numbness are also
more prevalent during the
night.
 TENDINITIS

 Tendinitis, is an inflammation or irritation of a tendon. Chronic strain,

overuse or misuse of a tendon leading to a repetitive stress injury, or a
serious acute injury can lead to a weakness, tear or swelling of the
tendon tissue resulting in pain and stiffness near the tendon.
  Bursitis is the irritation or
inflammation of a bursa,
BURSITIS which is a fluid filled sac
located around joints and
that reduce friction and
ease movement as
tendons or muscles pass
over bones or skin.
 Pain in the area of the
bursa is the main
symptom. Tenderness,
swelling and warmth
around the area are
other symptoms.
 Bursitis can also cause
reduction in or loss of
motion at the affected
joint.
 Bursitis usually occurs in
the shoulder, knee,
elbow, hip, heel and
thumb.
EPICONDYLITIS

 often occurs as a result of strenuous

overuse of the muscles and tendons
where the bone and tendon join.
Tennis elbow and golfer’s elbow are
examples.
 The most common symptoms of
tennis elbow are: –
 Pain over the outside of the elbow
 Pain when lifting objects
 Pain radiating down the forearm
TRIGGER FINGER

 A common complaint that

causes pain and locking of the
fingers.
 The tendons run part of their
course through a sheath called
the flexor tendon sheath. When
a patient has the trigger finger
condition, this mechanism of
movement is inhibited.
 The tendon sheaths of the
fingers or thumb become
inflamed - the tendon also gets
inflamed.
BLACKBERRY THUMB

 BlackBerry Thumb generated quite a media buzz

over the last few years. Dr. Greaney explained
that the human body can withstand a finite
amount of use.
 Overuse injuries, such as RSI, occur because of
insufficient recovery time between demands,
such as frequent use of the thumb on a PDA or
BlackBerry. “These types of injuries occur when
mechanical fatigue in tendons and ligaments
cause small tears in the connective tissue”
 This condition is worsened by the fact that the
connective tissue has not repaired itself, yet
continues to be placed under stress. The
cumulative effect of stress on the region causes
the mechanical or chemical activation of pain
receptors, resulting in pain and dysfunction.”
VIBRATION WHITE FINGER
SYNDROME

 Vibration White Finger is a repetitive stress injury due to

vibrations e.g. drilling, where the small blood vessels in the
fingers periodically spasm.
 The spams cause constriction of the blood supply to the
fingertips turning the fingers white.
 Soon after, the available oxygen in the blood is used up
and the fingers turn blue.
 Once the spasms subside the fingers turn red as
oxygenated blood returns to the finger tips.
 PREVENTION

 Preventative measures that may be recommended for work related RSI include:
 Using wrist rests or adjusting a computer keyboard for typing
 Adjusting a chair and desk, so feet rest flat on the floor
 Using an appropriate chair, if sitting for long periods of time
 Taking breaks from repetitive tasks
 Using padding or gloves to reduce the effects of vibration from power tools
 Using a headset for prolonged telephone use
 Maintaining good posture
 Avoiding standing or sitting in one position for long periods of time
 Using less force when carrying out taskS
 Repetitive strain injuries can also be caused by playing sport or taking part in
hobbies. Preventative measures can include:

 Doing warm up exercises before playing sport

 Changing equipment, such as a tennis racket with a properly fitted grip and flexible
strings
 Improving or changing technique
 Being aware of ergonomic factors in the home and with hobbies
 Taking regular breaks from repetitive movements during activities such as knitting or
woodworking
 TREATMENT

 On their own, most RSIS will resolve spontaneously provided the area is fi rst given enough rest
and then exercised (mildly at first, then more vigorously). However, without such care, some RSIs
have been known to persist for years. The most often prescribed treatments for repetitive strain
injuries are rest, exercise, braces and massage.
 Below is a list of conservative treatment techniques that are being utilized Below is a list of
conservative treatment techniques that are being utilized for Repetitive Strain Injuries: for
Repetitive Strain Injuries:
 Rest the Affected Area. This is often the first recommendation. Moving the affected area is important, but
avoid stressing the joint. In conservation, this is often not practical without taking time-off from work. Too
much inactivity can cause atrophy of muscles and increase the severity of the disorder.
 Vitamin B6 Therapy can help increase the health of damaged nerves, although it does not correct the
real cause of dysfunction; which is a “muscle imbalance”
 Splinting and Analgesics may help “mask” symptoms for a while, but unless the “real” cause of
dysfunction is eliminated, the symptoms come right back. The long-term success rate of Splints and Anti-
Infl amatory Medications is extremely low. Wrist Braces and Splints are not effective in treating carpal
tunnel syndrome and repetitive strain injuries, but can assist neutral position in order to reduce
impingement of the carpal tunnel.
 PT MANAGEMENT

 Stretching Routines are implemented to help reduce hypertonic muscles and increase
their flexibility and dexterity.
 Contrast Baths (Hot/Cold) (contrast baths) are often recommended by a physical or
occupational therapist. Typical treatment protocol is approximately three (3) minutes of
heat followed by one (1) minute of cold alternating 3x, ending in cold. Heat alone is not
recommended.
 Ultrasound is beneficial if used in conjunction with a treatment program that includes
soft-tissue work, stretching of the tight or shortened muscle group, and the strengthening
of the weak muscle group. Ultrasound can help reduce inflammation in an acute case
of tendonitis, carpal tunnel syndrome, or other form of injury
 Massage is done to release trigger points or points of increased stress
 Structured strengthening protocol for specific disorder must be incorporated for
treatment and prevention of recurrence.