What is the treatment for a repetitive strain injury to the wrist?

Treatment for Repetitive Strain Injury of the Wrist

The most effective treatment for repetitive strain injury (RSI) of the wrist involves functional support, exercise therapy, and activity modification, with surgical intervention reserved only for cases that fail conservative management. 1

Initial Assessment and Management

• Obtain radiographs of the wrist as the initial imaging to rule out fractures, using a standard three-view examination (posteroanterior, lateral, and 45° semipronated oblique view) 2, 1
• If initial radiographs are negative but symptoms persist, consider follow-up imaging including repeat radiographs in 10-14 days, MRI without IV contrast, or CT without IV contrast 2, 1
• Apply ice for 15-20 minutes every 2-3 hours to reduce swelling and pain 1
• Compress the area with an elastic bandage and elevate the wrist above heart level 1
• Immobilize with a wrist splint in neutral position during the acute phase 1
• Administer appropriate analgesics for pain control 1, 3

Subacute Management

• Gradually transition from complete rest to controlled movement to prevent stiffness 1
• Continue with intermittent ice application as needed for pain and swelling 1
• Begin gentle range of motion exercises when pain allows 1, 4
• Implement functional support (braces, tapes) which has been shown to prevent recurrent sprains (RR 0.30,95% CI 0.21 to 0.43) 2
• Start exercise therapy as soon as possible to prevent recurrence and promote healing 2, 1

Exercise Therapy

• Include coordination and balance training which has been shown to prevent recurrent injuries 2
• Incorporate proprioceptive training as part of neuromuscular rehabilitation 2
• Implement home-based exercises that can be integrated into regular activities 2
• Focus on eccentric strengthening exercises which have been shown to reduce symptoms and promote tendon healing 2

Activity Modification

• Early recognition of symptoms and immediate reduction or cessation of the causal activity is crucial 4
• Modify workplace ergonomics to prevent reinjury 5
• Gradually return to daily activities as symptoms improve 1
• Delay return to sports or heavy manual labor until no pain with resistance is achieved 1

Advanced Interventions

• Consider corticosteroid injections for acute pain relief, though they do not change long-term outcomes 2
• Deep transverse friction massage may be recommended to reduce pain 2
• For persistent symptoms despite conservative management, consider MRI or ultrasound to evaluate for occult fractures or soft tissue injuries 1

Surgical Management

• Surgery should be considered only after failure of well-managed conservative treatment 2
• Surgical techniques typically include excision of abnormal tendon tissue and performance of longitudinal tenotomies to release areas of scarring and fibrosis 2
• Despite good clinical outcomes after surgery, functional treatment remains the preferred method to avoid unnecessary invasive treatment and risk of complications 2

Common Pitfalls to Avoid

• Failure to obtain appropriate imaging to rule out fractures 1
• Prolonged immobilization leading to stiffness and contracture 1
• Returning to activities too soon, which may lead to prolonged symptoms or reinjury 1
• Overlooking workplace modifications that can prevent many of these injuries 5
• Delaying treatment, as long-term morbidity associated with RSI is preventable with early intervention 6