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Repetitive Strain Injury (RSI)

  1. What is RSI?
  2. Symptoms
  3. Causes
  4. Types
  5. Diagnosis
  6. Treatment
  7. Prevention
  8. FAQs

What is repetitive strain injury?

Repetitive strain injury, also known as RSI and repetitive motion disorder, is a term for damage to tissues caused by repeated physical actions. These actions are often work-related, such as typing or performing manual labor. The tissues affected are often in the upper body.

There are a number of conditions that can be classed as repetitive strain injuries, including:[1][2][3]

  • Carpal tunnel syndrome, which affects the median nerve in the wrist
  • Tendonitis in the wrist and hand
  • Tendinosis
  • Tenosynovitis, which affects the membrane surrounding a tendon
  • Bursitis in the wrist, knee, elbow or shoulder
  • Tennis elbow, also known as lateral epicondylitis
  • Cubital tunnel syndrome, which affects the ulnar nerve in the elbow
  • Ulnar tunnel syndrome, also known as Guyon canal syndrome, which affects the wrist
  • Trigger finger or trigger thumb, also known as stenosing tenosynovitis

People with these conditions experience symptoms ranging from a gentle ache to sharp pain in the affected area or limb that limits their ability to work and perform everyday actions.

Repetitive strain injuries usually affect people of working age. Because of the range of conditions and injuries involved, it is difficult to know exactly how many are affected by the condition. However, the Centers for Disease Control and Prevention estimates that carpal tunnel syndrome affects around 1.9 million people in the United States.[4]

With appropriate treatment, repetitive strain injuries will recover over a period of several months, depending on their severity. Some injuries, particularly those which cannot be alleviated by changes at work, may persist.[2]

Worried you may have a repetitive strain injury? Start your free symptom assessment in the Ada app.

Symptoms of repetitive strain injury

Symptoms of repetitive strain injury in the affected limb can include:[2][5][6][7][8]

  • Tingling
  • Tightness
  • Weakness
  • Swelling
  • Throbbing
  • Loss of sensation
  • Tenderness
  • Burning sensation
  • Numbness
  • Cramping
  • Ache
  • Sharp pain
  • Shooting pain
  • Difficulty moving certain fingers, especially the thumb or index finger
  • Clumsiness

Body parts commonly affected by repetitive strain injuries include:

  • Hands
  • Wrists
  • Arm
  • Neck
  • Shoulder
  • Back

Causes of repetitive strain injury

The common factor in all types of repetitive strain injuries is repetitive movements causing injury to body parts. The tissues in these body parts, usually limbs in the upper body, gradually become worn and damaged with overuse. Repeated stresses and strains cause small tears and signs of degeneration which, over time, create symptoms in the person with the condition.

Repetitive strain injuries can be caused by:[6]

  • Small, frequent movements
  • Vigorous movements containing a lot of force
  • A lack of movement, such as holding a limb in an unnatural position

Examples of activities that can cause repetitive strain injuries are:[5][6]

  • Using a jackhammer or other vibrating power tool
  • Bending the neck to hold a phone handset
  • Holding tools with small/narrow handles, such as sewing needles or knives
  • Holding tools that are too large
  • Stretching and twisting, such as when painting or cleaning
  • Lifting heavy loads, such as boxes or building materials
  • Gripping a steering wheel
  • Performing the same action repeatedly, such as scanning items at a checkout
  • Holding limbs without support, such as typing with no wrist support
  • Sitting in a cramped position for extended periods of time

Some of these activities can also cause pain in other parts of the body, such as the back.

Read more about pain the lower back »

Types of repetitive strain injury

Repetitive strain injuries are divided into two categories: Type 1 and Type 2 RSI.

Type 1 RSI is where the symptoms can be categorized as a specific condition, such as carpal tunnel syndrome or tennis elbow.

Type 2 RSI, or diffuse RSI, is where the symptoms are not easily recognized as a specific condition. Symptoms may be vague or shifting, with few or no visible or measurable signs, such as swelling or nerve damage.[2][9]

Some of the Type 1 RSI conditions are listed below.

Carpal tunnel syndrome

The carpal tunnel is a narrow passageway in the wrist made up of ligament and bone. The median nerve, which runs from the forearm into the hand, passes through the carpal tunnel. Carpal tunnel syndrome is caused when the median nerve becomes compressed or squeezed. If the carpal tunnel or the surrounding tendons swell, it can compress the median nerve. Numbness and pain in the hand can result.[10][11][12]

Repetitive strain injury is one possible cause of carpal tunnel syndrome. Repeated hand and wrist movements can irritate the wrist tendons.

Read more about Carpal Tunnel Syndrome »

Tendinopathy

Tendinopathy describes when tendons, which connect muscles to bone or other body parts, become injured. There are two types of tendinopathy:[13]

  • Tendonitis, which is when the tendon becomes inflamed. This can be caused by a sudden injury or by overuse
  • Tendinosis, which is when the tendon does not become inflamed. Tendinosis is typically due to a buildup of small injuries that fail to heal. This is usually caused by overuse

Tendonitis or tendinosis can be considered a repetitive strain injury when overuse is the cause.

There are tendons all over the body and all are capable of developing tendinopathy. Areas of the body that are commonly associated with tendinopathy include:

  • Heel
  • Wrist
  • Elbow
  • Thumb

Read more about Tendonitis »

Tenosynovitis

Tendons are surrounded by a protective sheath called the synovium. This sheath may become inflamed, resulting in a condition called tenosynovitis.[14]

Tenosynovitis can be caused by injury, infection and/or overuse. When tenosynovitis is caused by overuse and strain, it can be considered an RSI. Any tendon sheath may be affected, but tenosynovitis commonly affects tendons in the:

  • Ankles
  • Feet
  • Wrists
  • Hands

Trigger finger and trigger thumb

Stenosing tenosynovitis, commonly called trigger finger or trigger thumb, occurs when the sheath surrounding tendons in the fingers become damaged. There are bits of fibrous tissue that function as pulleys along the tendon sheaths that help fingers to bend. Stenosing tenosynovitis occurs if the pulley at the base of the finger (known as the A1 pulley) becomes inflamed or thicker than normal.[15][16]

Symptoms of stenosing tenosynovitis include:

  • Pain when moving the finger
  • A popping or catching feeling when moving the finger
  • A lump at the base of the finger
  • Affected finger becoming locked in a bent position

Stenosing tenosynovitis can be caused by various conditions, such as gout and rheumatoid arthritis, but can also be caused by repeated gripping actions. Where the condition is caused by overuse, it can be considered a repetitive strain injury.

De Quervain’s tenosynovitis

One of the most common forms of tenosynovitis is De Quervain’s tenosynovitis, sometimes known as gamer’s thumb. This is when the tendons around the base of the thumb and/or the synovium become swollen. De Quervain’s causes pain on the thumb side of the wrist, which gets worse with any gripping or grasping motion. The swelling may be visible.[17]

A diagnostic process known as Finkelstein’s test can help diagnose this type of tenosynovitis. This involves placing the affected thumb into the palm of the same hand and making a fist around it. Once the hand is in this position then the wrist should be bent towards the little finger, as if the person is pouring a jug of water. If this increases the pain, then it is likely the person has De Quervain’s tenosynovitis.

Bursitis

Bursitis is a form of repetitive strain injury that can affect the knee, elbow, wrist or shoulder. When bursitis affects the shoulder, it can also be referred to as a rotator cuff injury.[18] When the condition affects the area in front of the kneecap, it is sometimes known as housemaid’s knee.[19]

A bursa is a small sac filled with fluid that cushions bone and muscles, tendons or skin. Bursitis occurs when a bursa becomes inflamed. The affected area can become swollen and painful.[20][21]

Prolonged and repeated movement and pressure on the joint can cause bursitis. These movements can include:

  • Kneeling
  • Using picks and shovels
  • Raising arms
  • Leaning on elbows

Tennis elbow and golfer’s elbow

Tennis elbow, also known as lateral epicondylitis, is a form of tendinosis that affects the tendons attached to the outside of the elbow. Overuse or trauma can result in degeneration of the tendon’s attachment, which causes pain.

Activities that can lead to overuse include:[22][23]

  • Repetitive gripping, such as cutting meat, painting or using a screwdriver
  • Playing racket sports, such as tennis

In most people, it affects the dominant arm.

If the pain is felt on the inside of the elbow, it is known as medial epicondylitis or Golfer’s elbow.[13]

Cubital tunnel syndrome

Cubital tunnel syndrome is a form of repetitive strain injury where the ulnar nerve, which travels from the neck to the hand, becomes compressed or irritated at the elbow. Numbness and tingling in the hand and fingers, particularly in the ring and little fingers, can result.[7][24]

Repeatedly stretching or bending the elbow, or keeping the elbow bent for long periods of time, can cause the ulnar nerve to become compressed. People who regularly sleep on their elbow, for example, are more likely to be affected by cubital tunnel syndrome.

Ulnar tunnel syndrome

Ulnar tunnel syndrome, also known as Guyon’s canal syndrome, is a form of repetitive strain injury where the ulnar nerve becomes compressed at the wrist. The ulnar tunnel, or Guyon’s canal, is a canal in the wrist which the ulnar nerve passes through. If the ulnar nerve is compressed at the wrist, numbness and tingling in the ring and little fingers can result.[25][26]

Ulnar tunnel syndrome is less common than cubital tunnel syndrome. It is most often caused by a benign cyst, but can also be caused by repetitive movement or pressure to the hand. Activities that can cause such pressure include:

  • Gripping a bicycle handlebar
  • Using a jackhammer or other vibrating power tool
  • Typing

Diagnosing repetitive strain injury

There is no specific test to diagnose repetitive strain injury as the condition takes many forms. A complicating factor is that some conditions, such as carpal tunnel syndrome, can have several causes.

Repetitive strain injuries are diagnosed by taking a medical history and performing a physical examination. Symptoms may be the result of other conditions, and diagnostic tests may be ordered, such as:[2][7][11]

Other tests can investigate damaged tissues, and include:[2][27][28]

  • Nerve conduction studies (NCS). This test checks the function of nerves by applying small electrical currents and recording how well the nerve conducts electricity. The test causes a mild tingling and is not painful.
  • Electromyography, also known as Needle EMG. This test checks the function of muscles by inserting small needles into them to measure electrical signals. There may be a small amount of pain or discomfort during this test.
  • Scans. Medical imaging can reveal whether a person’s condition requires surgical treatment.

If you think you or a loved one may have a repetitive strain injury, you can download the Ada app to begin your free symptom assessment.

Treatment for repetitive strain injury

Treatment for repetitive strain injuries generally follow the same guidelines, whatever the cause or location of the injury. There is some debate about which treatments are effective, but none are actively harmful.[3]

Rest

Stopping the activity that has caused the repetitive strain injury gives the body tissue time to heal itself. If this is not possible, for example where the activity is part of a job, discussions should be held with the employer about changing work patterns or modifying equipment.

Medication

Painkillers can be helpful in the short term for repetitive strain injuries.

Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, can help manage pain. NSAIDs are available over the counter or can be prescribed by a medical professional, but carry risks when used in the long term. NSAIDs may be helpful for bursitis, which is caused by inflammation of a bursa.[18]

There is some evidence that other painkillers, such as paracetamol, can also be helpful in managing pain.[2]

Steroids

Corticosteroid injections into the site of the repetitive strain injury can provide short-term pain relief. Injections are administered by a medical professional and can provide relief for up to 48 hours.[29][30]

Steroid injections have few side effects, but may briefly worsen the pain. They work by directly reducing inflammation at the site of the injury. Steroids should not be taken for long periods of time as they can damage tissues and lead to other complications, such as cushing’s syndrome.[31]

Corticosteroid injections may be helpful for carpal tunnel syndrome, bursitis and tennis elbow.[11][20][32]

Brace

Wearing a brace or splint can prevent further pressure on the affected body part and allow it time to heal. A brace may be helpful for repetitive strain injuries such as:[7][11][25]

  • Cubital tunnel syndrome
  • Carpal tunnel syndrome
  • Ulnar tunnel syndrome

Surgery

Surgery is an option for repetitive strain injuries which do not respond to non-surgical treatment or cause particular pain and disruption.

Surgery may be helpful for severe cases of carpal tunnel syndrome, tennis elbow and cubital tunnel syndrome.

Surgery for tennis elbow removes the damaged part of the tendon.[32] For cubital tunnel surgery, the roof of the tunnel may be opened or widened, or the nerve may be moved to a new position at the front of the elbow.[33]

Carpal tunnel release surgery

Carpal tunnel release surgery is one of the most common procedures performed in the United States, with between 300,000 and 500,000 surgeries performed each year.[4][12]

Surgery for carpal tunnel syndrome is performed as a day procedure under local anaesthesia. The ligament that forms the top of the carpal tunnel is cut, creating more space for the nerve and releasing pressure. Symptoms should disappear over time, though severe cases may not be completely cured.[11][12]

Read more about the treatment of carpal tunnel syndrome

Physical therapy

Therapy to strengthen and improve mobility in body tissues may be helpful for repetitive strain injuries such as tennis elbow and bursitis. A physiotherapist can identify the best exercises for a particular injury and demonstrate how to perform each exercise so as to minimize the risk of further damage.[18][32]

Physiotherapy will also be recommended after any surgery.

Ice

Cooling the affected area with ice is a common home remedy for repetitive strain injuries. Ice can numb the skin and provide short-term pain relief.[20] However, evidence to show whether using ice is helpful for long-term tissue repair is lacking.[34]

Preventing repetitive strain injury

Repetitive movements are the main cause of repetitive strain injuries, so taking steps to prevent the injury or stopping it getting worse is important.

Many repetitive strain injuries happen at work, and workplaces should be equipped to do an ergonomic assessment of the work environment. Ergonomics is the study of how people interact with objects and their surroundings in the safest way.

Preventative measures that may be recommended include:[5][35][36]

  • Using wrist rests or adjusting a computer keyboard for typing
  • Adjusting a chair and desk, so feet rest flat on the floor
  • Using an appropriate chair, if sitting for long periods of time
  • Taking breaks from repetitive tasks
  • Using padding or gloves to reduce the effects of vibration from power tools
  • Using a headset for prolonged telephone use
  • Maintaining good posture
  • Avoiding standing or sitting in one position for long periods of time
  • Using less force when carrying out tasks

The U.S.’s National Institute for Occupational Safety and Health has a step-by-step guide to evaluating and addressing workplaces for ergonomic best practices.

Repetitive strain injuries can also be caused by playing sport or taking part in hobbies. Preventative measures can include:[37]

  • Doing warm up exercises before playing sport
  • Changing equipment, such as a tennis racket with a properly fitted grip and flexible strings
  • Improving or changing technique
  • Being aware of ergonomic factors in the home and with hobbies
  • Taking regular breaks from repetitive movements during activities such as knitting or woodworking

Repetitive strain injury FAQs

Q: Can I get compensation for repetitive strain injury?
A: Repetitive strain injuries are often caused by poor practices in the workplace. Whether your workplace is liable to pay compensation will depend on the laws of the country you are working in. In the U.S., the extent of the injury, how severely it affects your activities and whether the employer took steps to prevent the injury are taken into account.

Q: Is repetitive strain injury permanent?
A: Repetitive strain injury can be cured with appropriate treatment, which may range from rest to surgery. Some severe cases may not be entirely cured. Effective treatment should be complemented by changing the activity that caused the injury. See Treatment for repetitive strain injury above.

Q: Which types of repetitive strain injury affect the wrist?
A: Of the types of repetitive strain injury mentioned in this resource, the ones that can affect the wrist are:

Type 2 or diffuse RSI, where the injury cannot be classified into a specific syndrome, can also affect the wrist.

Q: Which types of repetitive strain injury affect the thumb?
A: Of the types of repetitive strain injury mentioned in this resource, the ones that can affect the thumb include:

  • Trigger thumb, also known as stenosing tenosynovitis
  • De Quervain’s tenosynovitis
  • Tendonitis or tendinosis

Type 2 or diffuse RSI, where the injury cannot be classified into a specific syndrome, can also affect the thumb.

Q: Which types of repetitive strain injury affect the shoulder?
A: Of the types of repetitive strain injury mentioned in this resource, the ones that can affect the shoulder are:

  • Bursitis, sometimes known as a rotator cuff injury when the shoulder is affected
  • Tendonitis or tendinosis
  • Tenosynovitis

Type 2 or diffuse RSI, where the injury cannot be classified into a specific syndrome, can also affect the shoulder.

Q: Which types of repetitive strain injury affect the elbow?
A: Of the types of repetitive strain injury mentioned in this resource, the ones that can affect the elbow are:

  • Tennis elbow, also known as lateral epicondylitis
  • Golfer’s elbow, also known as medial epicondylitis
  • Bursitis
  • Tendonitis or tendinosis
  • Tenosynovitis

Type 2 or diffuse RSI, where the injury cannot be classified into a specific syndrome, can also affect the elbow.

Q: Which types of repetitive strain injury affect the forearm?
A: Of the types of repetitive strain injury mentioned in this resource, the ones that can affect the forearm are:

  • Carpal tunnel syndrome
  • Cubital tunnel syndrome
  • Bursitis
  • Tendonitis or tendinosis
  • Tenosynovitis

Pain from De Quervain’s tenosynovitis can sometimes travel up the forearm, even if the injury only affects the base of the thumb. Type 2 or diffuse RSI, where the injury cannot be classified into a specific syndrome, can also affect the forearm.

Q: Can repetitive strain injury cause arthritis?
A: Arthritis is the name for a number of conditions in which a person’s joints, the connections between the bones in their body, become inflamed. Repetitive strain injury is a term describing damage to tissue, such as tendons and muscles, through overuse. While the tissue damage itself cannot cause arthritis, the reasons behind the RSI, e.g. certain work environments that place specific stresses upon the body, may make it more likely that a person develops arthritis.

Read more about Arthritis »


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