Musculoskeletal diseases: Repetitive strain injury

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Repetitive strain injury

Repetitive strain injury (RSI) is a term that refers broadly to a range of conditions that are usually caused or aggravated by repetitive motions, forceful movements, awkward postures, and ergonomic hazards (such as poor workstation design). RSI is characterized by discomfort or persistent pain in the muscles, tendons, joints, and other soft tissues. The sites commonly affected are the hands, elbows, shoulders, and back, although the lower limbs may also be involved. This section will provide health states for individuals who are suffering from RSI involving the hand, elbow, or shoulder. The health state presented above for chronic low back pain is also representative of functional limitations associated with RSI involving the back.

In 2000/2001, over two million Canadians had a repetitive strain injury serious enough to limit their normal activities, and 55% of these injuries were caused by work-related activities.¹⁸ Contributing factors include excessive work rates (and inadequate rest breaks); badly designed equipment, tools, machinery, and furniture; poor workstation layout that requires bending, twisting or stretching to perform a single task; chairs, desks and benches that are not suitable to a person’s height; and lack of job variation.

There is no gold standard test for diagnosing RSI; diagnoses are generally made based on the symptoms. Symptoms can vary, but often include pain, numbness, tingling and a feeling of heaviness, restricted movement and weakness in or around the muscles of the affected site. In the first stage, the affected limb aches and is weak while being used, but this is relieved by adequate rest. As the condition progresses, symptoms persist even at night. Eventually, muscles and tissues will become more tender, resulting in severe pain and potentially, loss of use. Rest and/or sleep may be disturbed and the ability to perform even light duties may be restricted. If this stage persists for months or years, depression may develop, as well as anxiety due to the possibility of permanent damage. It is important to note, however, that many RSI cases are only acute and self-limited, resolving themselves once the precipitant (i.e., the problem-causing activity) is discontinued and never evolving into a chronic condition with ongoing pain and functional limitations. If the symptoms do not spontaneously subside after the offending activity is removed, a number of treatment options exist, including NSAIDs; physical treatment such as splinting, casting, icing, elevation, and compression; and avoiding activities that cause discomfort. Cortisone injections can also be helpful in the initial acute phase. Some other common treatments include physiotherapy, vibration, massage, and acupuncture. Corrective surgery is rare and typically used only as a “last resort.” Permanent damage may result if nothing is done to eliminate or reduce the injury or its cause. In general, the longer the duration of symptoms prior to discontinuation of the problem-causing activity, the higher the risk of developing a more treatment-resistant condition. The following descriptions apply only to established chronic cases of RSI, which have a long-term impact on population health.

Repetitive strain injury of the hand, chronic
No ICD-9 code

Description

An RSI of the hand is characterized by pain, numbness, tingling, muscle weakness, and occasionally, swelling in the wrist, hand, or fingers. It can affect one or both hands, depending on the cause of the injury and which hand is overused. It may become difficult to hold objects or tools in the hand(s), affecting the ability to function at work or at home. Symptoms include numbness, tingling, an aching sensation and pain in the hand and fingers and sometimes wrist, often worse at night. Disturbed sleep results in occasional periods of fatigue. Carpal tunnel syndrome (ICD-9 code: 354.0) is the most common RSI of the hand; tendonitis (inflamed and sore tendons of the hand) is also common, such as de Quervain tenosynovitis (ICD-9 code: 727.04) which affects the thumb.

Classification

3

2

1

2

1

3

Repetitive strain injury of the elbow, chronic
No ICD-9 code

Description

In chronic RSI of the elbow, pain results from overuse of the wrist, either repetitive extension (tennis elbow) or flexion (golfer’s elbow) of the wrist. Pain often radiates down the forearm, making it difficult to extend and flex the wrist, resulting in physical limitations. It can also decrease grip power. The two most common injuries are “tennis elbow,” affecting the extensor muscles of the wrist and causing pain on the outside of the elbow, or “golfer’s elbow,” affecting the flexor muscles of the wrist and causing pain on the inner part of the elbow (both are medically termed epicondylitis, but can also be called tendonitis; ICD-9 code: 726.32).

Classification

3

2

1

2

1

2

Repetitive strain injury of the shoulder, chronic
No ICD-9 code

Description

In chronic RSI of the shoulder, the shoulder is painful to move (especially lifting the arm at or above the level of the shoulder) and it may feel stiff and weak. Movement of the shoulder is initially limited because of pain, but if this persists for a long time, and the shoulder is not moved by doing stretching or range of motion exercises, the shoulder may permanently lose some of its mobility. Decreased use of the arm over time can lead to further muscle weakness. Sleep may be disturbed, resulting in periods of fatigue. Examples of RSIs to the shoulder are rotator cuff tendonitis (inflammation of the tendons that move the shoulder [rotator cuff] or bursitis (inflammation of the subacromial bursae adjacent to the rotator cuff tendons), and injury (rupture of one or all of the rotator cuff tendons). These are caused by repetitive overhead movements of the shoulder (such as throwing a baseball, swimming the crawl, or repetitive lifting of the arms).

Classification

Archived Content

Health State Descriptions for Canadians 82-619-MIE