A Repetitive Strain Injury (RSI) is caused when there is an injury in the soft tissues or tendons because of the repeated movements of fingers and wrist. The repetitive microtrauma to the joints, bones and tendons are most common reasons for these injuries. However, repetitive strain injury may occur all over the body. Runner’s knee, Little League elbow, shin splints, rotator cuff impingement and tendinitis in swimmer’s shoulder, Achilles tendinitis, lateral epicondylitis in tennis elbow, and infrapatellar tendinitis in jumper’s knee could be the examples of repetitive strain injury. Thus, individuals performing sports activities may be at higher risk for repetitive strain injury.
Types of Repetitive Strain Injury (RSI)
Given below are few of the most common types of repetitive strain injuries.
- Carpal Tunnel Syndrome: Carpal tunnel syndrome is a condition in which the median nerve, a major nerve in the upper extremity that travels down the arm and enters the hand through a very small gap called carpal tunnel located in the central part of the wrist, gets compressed in the carpal tunnel. This causes irritation of the nerve leading to tingling or pain. Typically, this disease affects the thumb, index, and middle fingers. Athletes participating in golf, bowling, and tennis are generally affected with carpal tunnel syndrome though the most common cause remains keyboarding activity.
Watch 3D Video of Wrist Pain Due to Carpal Tunnel Syndrome
- Cubital Tunnel Syndrome: Cubital tunnel syndrome is a condition that involves the ulnar nerve, a major nerve in the upper extremity. Ulnar nerve supplies movement directions to the forearm muscles and sensory information from the hand. In case of cubital nerve syndrome, the ulnar nerve gets compressed near the elbow causing wrist and hand weakness, numbness and pain. The main fingers involved are little and ring fingers.
- Wrist Tendinitis: Wrist tendinitis is a form of wrist tendinopathy. Wrist tendinitis is a comparatively common condition in which a tendon or tendons of the wrist are damaged due to overuse resulting in swelling and inflammation of the affected tendons. Wrist tendinitis generally occurs because of the wear and tear related to overuse injuries such as in sports injuries, but it also can occur due to trauma as a result of some accident.
- DeQuervain’s Tenosynovitis: DeQuervain’s tenosynovitis is a condition of inflammation of tendons in the thumb that leads to tenosynovitis. The repeated rubbing of the swollen tendons and their coverings adjacent to their narrow tunnels results in de Quervain’s Tenosynovitis. This leads to severe pain at the base of the thumb and this pain further gets extended to the lower arm. The tendons involved in the thumb are abductor pollicis longus and extensor pollicis brevis tendons. This is found more frequently in racket sports like badminton, squash, ten pin bowling, tennis and canoeing. DeQuervain’s tenosynovitis is also known as washerwoman’s sprain and mother’s wrist. Golfers thumb could also be taken as an example for de Quervain’s tenosynovitis.
- Writer’s Cramp: Writer’s Cramp is a type of repetitive strain injury, which results in twisting movements, hand tremors and involuntary muscle spasms of the fingers. Writer’s cramp is most commonly seen in writers, hence the name writer’s cramp. However, this condition can also be seen in office workers, musicians, cherry picking etc.
- Gamekeeper’s Thumb: Gamekeeper’s thumb is also called as stenosing tenosynovitis of the thumb or trigger thumb. Generally a gamekeeper’s thumb begins with inflammation of tendons situated within a protective shield known as the tendon sheath. When the tendon becomes inflamed, nodular and swollen, this leads to catching of either of the pulleys by the swollen tendon creating difficulty for the tendon to slide inside the sheath and hence flexing the thumb towards the palm. This is more frequently seen in skiers and hence is also known as skier’s thumb.
- Ganglion: A ganglion is a cyst of extra fluid from a joint or a tendon and is particularly frequent around the wrist and hand. A ganglion cyst could be a sign of irritation in an underlying ligament, tendon or joint with often mild problem. A ganglion cyst is also called as Bible cyst. The main cause of the cyst is still not known but the suspected reasons could be the incidence of mechanical changes and tendon or joint irritation. The cysts may change their size and may also disappear totally. These cysts can either be painful or not. The condition of the wrist ganglion is completely noncancerous relieving the risk of spreading in other regions.
- Bursitis: Bursitis could be explained as an inflammation of a bursa that is a sac filled with fluid adjacent to the joints that acts like a cushion for the joint. A bursa is a sac that is filled with lubricating fluid situated between tissues like muscles, tendons, skin and bone that lessens irritation and friction between the tissues. The bursa causes pain in the wrist when subjected to continual trauma resulting in swelling and inflammation. This could strongly affect athletes such as cyclists who frequently put the entire weight of their body on their hands.
Causes of Repetitive Strain Injury (RSI)
Repetitive strain injury can be caused by various factors. However, few of the common causes may include:
- Using vibrating equipment.
- Performing forceful activities.
- Exposure to cold temperatures.
- Repeated usage of the muscles.
- Extended periods of continuous work without any break in between.
- Working in a wrong posture.
- Continuously staying in the same posture for a long time.
- Continuous carrying of heavy loads.
- Direct blow or pressure to the body.
- Racket sports may also cause repetitive strain injuries.
- Inadequate use of equipment or poor sporting technique.
- Repetitive strain injuries can also be caused due to stress.
Signs and Symptoms of Repetitive Strain Injury (RSI)
Repetitive Strain Injury (RSI) Symptoms May Include-
- Severe pain caused in the muscles or joints affecting the upper back, neck, shoulders, arms, wrists, hands and fingers.
- Change in color of the skin.
- Numbness, tightness, burning, tingling, swelling and soreness can also be found with a feeling of dullness in the affected part.
- Feeling tired is a major symptom of repetitive strain injury.
- Change in the shape of the affected area.
- Sleeping patterns get affected.
Treatment for Repetitive Strain Injury (RSI)
Basic Measures To Treat Repetitive Strain Injury (RSI) May Include
- Using wrist brace can help in the initial stages for providing comfort and support.
- Avoiding aggravating activities.
- Cold and heat packs are very helpful to relieve pain and stiffness.
- Taking frequent breaks and moving about.
- Stretching the wrists and arms periodically.
- Occupational therapy and soft tissue massage is also effective in treatment.
- Acupuncture and massage therapies may also be helpful.
- Anti-inflammatory medication like ibuprofen is recommended.
- Corticosteroid injections are used in some cases.
- Surgery may be recommended in few extreme cases where conservative treatment is not helpful.
Physical Therapy (PT) for Repetitive Strain Injury (RSI)
Physical Therapy is important in speeding up the healing process and to get optimal results. Physical therapy also decreases the likelihood of recurrences in the future. Physical therapy may commonly include:
- Soft tissue massage.
- Electrotherapy such as ultrasound.
- Joint mobilization.
- Heat and ice treatments.
- Bracing or splinting.
- Exercises to improve strength and flexibility.
- Activity modification and training.
- Appropriate plan for return to activity.
Exercises for Repetitive Strain Injury (RSI)
- Stretching and strengthening exercises are really helpful for prevention from recurrence of symptoms.
- Exercises also help in correcting the posture.
- Yoga also helps in regaining the lost strength.
Investigations for Repetitive Strain Injury (RSI)
Repetitive strain injury is really difficult to diagnose as there may be many reasons for its cause. Being a soft tissue injury, they are invisible on x-ray. Therefore, it’s better to go for a treatment as soon as the symptoms arise only then one could be able to get rid of this problem. If not the condition becomes worse. Generally an EMG is done to identify involvement of any muscle or tendon.