Repetitive Stress Injuries (RSI)

Repetitive Stress Injuries (RSI)

Bone, Muscle, & Joint
Health & Wellness
Contributed byKrish Tangella MD, MBAJan 10, 2019

What are the other Names for this Condition? (Also known as/Synonyms)

  • CTD (Cumulative Trauma Disorder)
  • Occupational Overuse Syndrome
  • Repetitive Strain Injuries

What is Repetitive Stress Injuries? (Definition/Background Information)

  • Repetitive Stress Injuries (RSI) is a common term for a wide range of injuries that describes the pain felt within muscles, nerves, and tendons, caused by repetitive movement and overuse
  • Such repetitive movements and overuse of certain body parts are usually caused by occupations (such as construction-related, machine operations) and sports activities (such as basketball, gymnastics, bowling, etc.)
  • The forearm, elbow, wrist, hands, neck, and shoulder are the most common parts of the body affected by these injuries
  • Rest, physical therapy, or over-the-counter medications, usually form the initial recommendations to treat Repetitive Stress Injuries. However, surgery is an option, if these aforementioned treatment methods are unsuccessful

The following are several types of Repetitive Stress Injuries. These include:

  • Bursitis: Bursitis is a condition that occurs when the bursa becomes irritated and inflamed, causing the bursa sac to expand
  • Carpal tunnel syndrome (CTS): The carpal tunnel is a small rigid passageway surrounded by bones and ligaments, at the base of the hand. This passageway protects a key central nerve within the hand and 9 tendons that allow the fingers to function. Carpal tunnel syndrome occurs when the tissues that surround the tendons within the wrist swell and put excessive pressure on the median nerve
  • Diffuse RSI: Diffuse RSI is a condition in which an individual may complain of pain. However, on a physical examination by the healthcare professional, nothing adverse or abnormal may be observed
  • Dupuytren's contracture: Dupuytren’s contracture predominantly affects the ring finger, followed by the little finger, middle finger, and index finger. It is a common deformity of the hand characterized by an abnormal thickening of the fibrous tissue layer beneath the skin of the palm and fingers
  • Tennis elbow: Tennis elbow is a painful condition involving the tendons that attach to the forearm muscles on the outside (lateral part) of the elbow. It mostly occurs, when these tendons of the elbow are overworked and become inflamed
  • Ganglion cyst: A ganglion cyst is characterized as a benign non-cancerous fluid-filled lump that commonly develops within the hand or wrist, along the surrounding tendons and joints. They may also develop in several locations, such as in the ankles and feet. However, this abnormality is mainly observed to develop on the back of the wrist
  • Raynaud’s disease: Raynaud’s disease is a condition in which the blood flow to a body extremity is interrupted. This disease usually affects the fingers
  • Rotator cuff syndrome: Inflammation of tendons and muscles within the shoulder
  • Tendinitis: Tendinitis is the inflammation of a tendon
  • Tenosynovitis: It is an inflammation of the sheath surrounding a tendon, in particular the inner lining of the tendon sheath
  • Thoracic outlet syndrome (TOS): TOS is an uncommon condition used to illustrate a collection of disorders that describe the compression of nerves or blood vessels in the passageway, between the clavicle (collar bone) and first rib (called the thoracic outlet)
  • Trigger finger: Trigger finger is a common deformity that occurs, when the extensor tendon in one of the fingers or thumbs, become locked in a certain fixed position

Who gets Repetitive Stress Injuries? (Age and Sex Distribution)

  • Repetitive Stress Injuries are injuries that may occur in all individuals, regardless of age, race/ethnic group, or gender
  • However, the risk of such an injury is usually in individuals over the age of 30 years, and the risk increases with age

What are the Risk Factors for Repetitive Stress Injuries? (Predisposing Factors)

Common risk factors associated with Repetitive Stress Injuries include:

  • Individuals over the age of 30 years; the risk increasing with age
  • Highly stressful and repetitive activities that are related to sports and certain occupations

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Repetitive Stress Injuries? (Etiology)

Some common causes of Repetitive Stress Injuries include:

  • Participation in certain sports activities that typically involve a set of repetitive movements (basketball, golf, aquatics, etc.)
  • Individuals with certain occupations that require a set of repetitive physical movement/motion for prolonged periods, such as observed with carpentry and painting
  • Cold temperatures may cause a Repetitive Stress Injury to develop

What are the Signs and Symptoms of Repetitive Stress Injuries?

The signs and symptoms of Repetitive Stress Injuries may vary, depending on which part of the body is affected, and the underlying cause of the injury.

  • Initially, the symptoms may only occur when an individual is performing the repetitive task, and slowly disappear with rest
  • However, the symptoms may also be persistent (and worsen during the repetitive activity), if left untreated

The most common signs and symptoms of Repetitive Stress/Strain Injuries include:

  • Pain and tenderness within the affected muscle or joint
  • A throbbing or tingling sensation within affected area, particularly in the hand or arm
  • Loss of sensation in the hand; loss of strength

Some individuals with persistent symptoms may have sleeping difficulties. At this stage, the condition is usually permanent. However, early treatment is more likely to prevent an irreversible damage from RSI.

How is Repetitive Stress Injuries Diagnosed?

  • Currently, there are no definitive methods available to diagnose Repetitive Stress Injuries, because the signs and symptoms may be caused by a wide range of factors
  • However, healthcare professionals will usually perform a physical examination and medical history evaluation, to see if the signs and symptoms can be linked to a specific repetitive activity
  • Radiological imaging studies may be used to visualize the condition as required

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the possible Complications of Repetitive Stress Injuries?

Complications associated with Repetitive Stress Injuries entirely depend on the type of injury the individual is diagnosed with. Some common complications may include:

  • Prolonged and chronic pain
  • Permanent disability
  • Occupation-related RSI may cause prolonged absence or even retirement from work
  • Sports-related RSI may cause professionals to keep out of athletic sports and other competitive events for prolonged periods

How is Repetitive Stress Injuries Treated?

Treatments associated with Repetitive Stress Injuries may include both nonsurgical and surgical methods.

The nonsurgical treatment methods include:

  • Any activity that aggravates affected area should be avoided. The physician may advise the individual to refrain from participating in any physical activities, till the pain stops or symptoms get better
  • Applying ice (or a damp heated towel) to the affected area can help reduce pain and swelling
  • Non-steroidal anti-inflammatory oral medications, such as indomethacin and naproxen, may be used to treat Repetitive Stress Injuries. These medications can help reduce the pain and swelling 
  • Some individuals made need physical therapy exercises. The goals of these exercises are to strengthen the affected muscles, improve flexibility, and decrease stiffness. It may take several months for an individual to complete the physical therapy program and regain full strength and functionality

Surgery is an option, if nonsurgical treatment methods for treating Repetitive Stress Injuries prove to be unsuccessful.

How can Repetitive Stress Injuries be Prevented?

To prevent Repetitive Stress Injuries, individuals should be careful and consciously aware, while performing any physical activities, such as sports, or even some normal daily activities that could lead to repetitive overuse of their limbs.

A few ways to further help prevent Repetitive Stress Injuries include:

  • Maintaining a good posture and the proper use of one’s elbow and arms
  • Avoid leaning on the elbow, while sitting or standing
  • Take regular breaks, if your work involves repetitive tasks

What is the Prognosis of Repetitive Stress Injuries? (Outcome/Resolutions)

  • The long-term prognosis of individuals with a Repetitive Stress Injury is usually good, in a majority of the cases. With proper treatment, most individuals regain the full strength and range of motion in their affected extremity
  • In a high percentage of cases, the individuals are able to return to their regular physical or daily activities
  • In cases of defined nerve compression, the surgical release of the nerve can usually resolve symptoms, with a low rate of recurrence of the condition
  • Severe injuries may require prolonged physical therapy, in order to achieve optimal results

Additional and Relevant Useful Information for Repetitive Stress Injuries:

  • According to the US Bureau of Labor Statistics, Repetitive Stress Injuries of all types accounts for 60% of all reported occupational disorders
  • By some estimates (in the US), approximately 27 million individuals have visited a medical professional for a RSI of the hand, and around 40 million have experienced symptoms, but did not seek professional treatment
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Krish Tangella MD, MBA

Pathology, Medical Editorial Board, DoveMed Team


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