What is Repetitive Strain Injury (RSI)?

Repetitive Strain Injury (RSI): Diagnosis and Management

Repetitive Strain Injury (RSI) is a group of musculoskeletal disorders caused by repetitive movements, forceful exertions, awkward postures, and other ergonomic hazards that primarily affect tendons, muscles, joints, and peripheral nerves in the upper extremities, neck, and back. 1

Definition and Pathophysiology

• RSI occurs when recurrent overuse leads to microtrauma in tissues, resulting in local pain, tenderness, weakness, inflammation, and limited function 2
• The condition develops when normal tissue cannot withstand repetitive loading, causing an accumulation of load-induced microdamage that exceeds the body's natural repair capacity 3
• RSI represents an occupational hazard that emerges when new technologies or work processes are introduced without proper consideration for human performance limitations 4

Common Types of RSI

RSI encompasses several specific disorders including:

• Carpal tunnel syndrome - compression of the median nerve at the wrist 2
• Trigger finger - inflammation of finger flexor tendons 2
• Tennis elbow (lateral epicondylitis) - inflammation at the lateral epicondyle 2, 5
• Thoracic outlet syndrome - compression of neurovascular structures 2, 5
• Tension neck syndrome - muscle strain in the neck region 5
• Shoulder impingement syndrome - inflammation of rotator cuff tendons 2
• Myofascial pain disorders - painful trigger points in muscles 2

Risk Factors

Occupational Factors

• Repetitive movements, especially when combined with force 1
• Awkward or static postures maintained for extended periods 1
• Inadequate rest periods between repetitive activities 6
• High-speed work with insufficient recovery time 4
• Poor ergonomic setup of workstations 6, 4

Individual Factors

• Poor posture and body mechanics 2
• Inadequate physical conditioning 5
• Previous musculoskeletal injuries 1
• Contributory habits (e.g., jaw or hand clenching) 2

Diagnosis

Diagnosis of RSI relies primarily on:

• Detailed occupational history focusing on repetitive movements and ergonomic factors 5
• Physical examination to identify specific areas of tenderness, weakness, and limited range of motion 5
• Specific diagnostic maneuvers for particular conditions (e.g., Phalen's test for carpal tunnel syndrome) 5
• Ruling out other conditions such as rheumatologic diseases, acute joint inflammation, and single-event traumatic injuries 5

Management Approach

Immediate Interventions

• The most important first step in RSI management is identifying and eliminating aggravating factors through proper ergonomic assessment and workplace modifications 2, 6
• Rest the affected area to prevent further tissue damage 2, 5
• Apply ice packs for acute pain or heat for chronic symptoms 2
• Use NSAIDs or topical pain-relief agents to reduce inflammation and pain 2

Physical Rehabilitation

• Begin gentle stretching exercises once pain is controlled 2
• Gradually introduce strengthening exercises to improve tissue resilience 2
• Implement joint protection techniques and proper body mechanics 2

Advanced Interventions

• For persistent symptoms, consider injection of local anesthetic-corticosteroid mixture for temporary pain relief 2
• Physical therapy with specialized modalities may be beneficial for resistant cases 5
• In severe cases that don't respond to conservative treatment, surgical intervention may be necessary for specific conditions like advanced carpal tunnel syndrome 5

Prevention Strategies

• Ergonomic assessment and modification of workstations 6, 4
• Implementation of proper work techniques and postures 6
• Regular breaks and job rotation to avoid prolonged repetitive tasks 4
• Strengthening and flexibility exercises to improve tissue resilience 2
• Early reporting of symptoms to prevent progression to chronic conditions 6

Common Pitfalls in RSI Management

• Failure to identify and address underlying ergonomic issues, leading to symptom recurrence 6, 4
• Overlooking psychosocial factors that may contribute to symptom persistence 2
• Inadequate pain control before initiating rehabilitation exercises 2
• Returning to regular work activities too quickly before complete recovery 5
• Not distinguishing between work-related RSI and injuries from outside activities 2

Recovery Expectations

• Recovery time varies significantly depending on severity, ranging from weeks to months 2
• Early intervention generally leads to better outcomes 5
• Some cases may require permanent workplace modifications to prevent recurrence 6
• A coordinated approach involving medical management and workplace interventions yields the best results 6