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Health Hazards
Repetitive Strain Injury
The aim of these notes is not to enable you to self-diagnose, but to make
you aware of the various problems so you can recognise the symptoms and
take preventative action.
Some very important points to note
 | You should use this understanding to help avoid problems and catch
possible problems at an early, sub-clinical stage. |
| Prevention is very much better than cure. |
| Self-diagnosis is often very difficult, as problems in the neck can cause
pain in the elbow and a back problem regularly manifests itself as pain in the
legs. |
| Terminology |
Repetitive Strain Injury (RSI) is an umbrella term, a
shorthand to refer to various musculo-skeletal injuries which are normally
related to some activity. |
| Acronyms |
If you are into acronyms you can choose from
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Cumulative Trauma Disorders (CTD) |
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Work-related Upper Limb Disorders (WRULD) |
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Occupational Overuse Injuries. (OOI) |
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| The medical terms include: |
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Carpal Tunnel
Syndrome is the most common medical diagnosis for those
suffering from RSI. |
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Tendonitis commonly results from
overuse and consequent inflammation of the tendon in the wrist,
forearms, elbow or shoulder. |
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Tenosynovitis or Trigger Finger is
the swelling of the tendon sheath in the finger or thumb, causing pain
when these tendons move and often an audible creaking. This might be
part of a rheumatic disease but a bacterial infection is another
possible cause. |
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Bursitis is the inflammation of a
bursa. A bursa is a small sac of fibrous tissue lined with synovial
membrane and filled with fluid, and used to reduce friction. They form
at joints and where tendons pass over bones and this can happen in
response to unusual pressure or friction. The inflammation causes joint
pain and stiffness. |
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Epicondylitis is caused by
inflammation of the tendons, often the result of tiny ruptures to the
muscle around the funny bone, which attaches the forearm muscles to the
elbow on the inside of the elbow. |
These medical conditions as are categorised as 'distinct'. Giving
something a name, especially if it is a 'syndrome', does not imply that it
is understood or even recognised by all medical practitioners. If people
report pain in multiple areas they are suffering from 'diffuse' RSI. |
| Layman’s terms |
Tennis Elbow is Lateral Epicondylitis. You are
affected if the outer part of the elbow, where all the extensor muscles of
the hand attach, becomes painful and tender. It could also be called
plasterer's or painter's elbow, as it can be caused by repeated bending
of the wrist leading to overuse and possible tiny ruptures of the forearm
muscles and tendon of the elbow where the forearm muscles are attached. But
it can also result from a specific strain or knock. It is very similar to
golfer's elbow, found in keen golfers, which affects the inside of the
elbow.
Golfer's Elbow is Medial Epicondylitis. Here it is the
inner part of the elbow that becomes painful and tender to touch. Among
golfers it is caused by the rotation of the wrists during a swing, when the
muscles on the inside of the forearm are stressed. All the flexor muscles,
which pull the palm towards the arm, attach to the inner part of the elbow.
So it can also affect keyboard or mouse users, if there is too much strain
on the arms as a result of a bad working environment.
Revision or Student Elbow is caused by pressure on the nerves and
blood supply passing through the protective channel in the elbow and is
very similar to Tennis Elbow. The cure is to give up revision or to avoid
resting on the elbows.
The keyboard operator can be afflicted by all these 'sporting'
ailments simultaneously! This inflammation of the tendons produces a
stabbing pain and is treated, under medical supervision, with strong
pain-killers and/or anti-inflammatory drugs. However, time to recover, which
can take weeks, and modified working practices are the only true cure. |
| What Causes Repetitive Strain Injury (RSI)? |
Many things have been blamed including:
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Physiological causes such as
vitamin deficiencies, wrist shape, neck and spine bone shape, plus
overall physical and mental health have all been implicated. |
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Women appear to be at a higher
risk, possibly because of the desk-based nature of traditional female
work but studies have shown an increase in symptoms while taking oral
contraceptives, during pregnancy and after the menopause. |
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But poor posture, bad work habits,
long hours, stressful work, physical stress, heavy workloads and an
improper exercise regime coupled with lack of regular breaks are all
known to cause RSI. |
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| Explanation for RSI |
The arm and hand are wonderful and complex structures. But
their skeletal structure makes it difficult to localise problems. Muscles
are often remote from the digit they act on, connected by tendons. They have
evolved to cope with a range of tasks. It is perhaps the modern tendency to
repeat a limited range of movements that causes problems, thus the strong
recommendation to take breaks and vary the tasks carried out.
The most general explanation for the cause of RSI is repeated compression
in areas where the nerves or blood supply are susceptible to pinching during
sustained activity. If this damage is not given time to recover and, if
necessary, heal, then an RSI might result. |
| The vulnerable elbow |
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| What Can Computer Users Do? |
| Be alert for early symptoms. Common ones include:
 | Tenderness and pain in the neck, shoulder, upper back, arm, elbow
and hands |
| Swelling in the hands and forearms |
| Muscle twitches or spasms |
| Tingling and loss of sensation in the hand or arm |
| Unexplained weakness and strength in the hands and arms, such as
when gripping handles |
| Decreased sensitivity or unusual sensations such as numbness or loss
of feeling in the hand |
| Stiffness or locking of the fingers, hands and possibly arms when
working |
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| As the problem starts with mild pain, which might be perceived simply
as tiredness during the working day, be alert. The point at which
tiredness becomes pain is subjective. Initially the condition goes away
overnight. But if you do not heed these warnings, the pain in your hands,
wrists and arms might become persistent. RSI is a progressive condition. |
| Time how long you can type without feeling any symptoms and record
this time. Then set this as a limit and make sure you always work less
than this, then take a break. As far as RSI is concerned, a change is
often as good as a rest, so shuffle some papers, read through what you
have written or perform a different task to allow time to rest your arms
and hands. |
| Make sure your work area is ergonomically sensible. Check out
your
working environment. |
| Become self-conscious about your posture until you establish good
habits and eliminate bad practice. |
| Employ some of the available technology such as voice recognition
software to reduce the amount of work your hands have to do. |
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| Self-treatment
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Several short breaks are better than a few
long ones. Just let your arms relax in your lap or at your side for a
few minutes. Every half-hour find an excuse to get up from your desk to
loosen your neck and shoulder muscles. |
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Gentle exercise such as swimming, walking
and stretching and massage are good to maintain muscular condition which
probably helps avoid tiredness. |
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Massage is relaxing and may help to
stretch muscles but also risks aggravating the injury. |
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Stretching prior to every activity,
whether it is work or play, is always recommended. |
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Put ice or heat packs on affected areas.
One reduces swelling, the other stimulates blood flow. |
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Hot baths and saunas also stimulate blood
flow which can aid recovery. |
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You can apply a tubular bandage which may
help, possibly by limiting the amount you can use your muscles. |
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Yoga, meditation and other body-awareness
exercises such as the Alexander Technique can be beneficial for the
back, neck and shoulders. |
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| Sources of help |
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| Websites |
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Repetitive Strain Injuries
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