Repetitive strain injury (RSI), also called work-related upper limb disorder (WRULD), is a general term used to describe the pain caused to muscles, nerves and tendons by repetitive movement and overuse. The condition mostly affects parts of the upper body, such as the forearm, elbow, wrist, hands, neck and shoulders.  RSI is usually associated with doing a particular activity repeatedly or for a long period of time. It often occurs in people who work with computers or carry out repetitive manual work.  In the UK one worker in 50 has reported an RSI condition.

Types of RSI

There are two types of RSI:

Type 1 RSI: RSI is classed as type 1 when a doctor can diagnose a recognised medical condition, such as carpal tunnel syndrome. Symptoms usually include swelling and inflammation of the muscles or tendons.

Type 2 RSI: RSI is classed as type 2 when a doctor cannot diagnose a medical condition from the symptoms. This is usually because there are no obvious symptoms, just a feeling of pain. Type 2 RSI is also referred to as non-specific pain syndrome.

RSI conditions

There are several medical conditions and injuries that can be classed as type 1 RSI, including the following.

• Bursitis: inflammation and swelling of the fluid-filled sac near a joint at the knee, elbow or shoulder.
• Carpal tunnel syndrome: pressure on the median nerve passing through the wrist.
• Dupuytren's contracture: a thickening of deep tissue in the palm of the hand and into the fingers.
• Epicondylitis: inflammation of an area where bone and tendon join. An example of epicondylitis is tennis elbow.
• Rotator cuff syndrome: inflammation of muscles and tendons in the shoulder.
• Tendonitis: inflammation of a tendon.
• Tenosynovitis: inflammation of the inner lining of the tendon sheath that houses tendons. Tenosynovitis most commonly occurs in the hand, wrist or forearms.
• Ganglion cyst: a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers.
• Raynaud’s phenomenon: a condition where the blood supply to extremities, such as the fingers, is interrupted.
• Thoracic outlet syndrome: compression of the nerves or blood vessels that run between the base of the neck and the armpit.
• Writer’s cramp: part of a family of disorders known as dystonia that cause muscle spasms in the affected part of the body. Writer’s cramp occurs from overuse of the hands and arms.

Symptoms of repetitive strain injury (RSI), or work-related upper limb disorders (WRULD), can vary but may include:

• pains or tenderness in your muscles or joints
• stiffness
• throbbing
• tingling or numbness
• weakness
• cramp

At first, symptoms might only occur when you are carrying out a particular repetitive action, for example when you are at work. When you have finished work and are resting, your symptoms may improve. This is the first stage of symptoms and may last for several weeks.

If left untreated, the symptoms of RSI are likely to get worse and cause longer periods of pain. You may also get swelling in the affected area, which can last for several months.

Without treatment the symptoms of RSI can become constant. At this stage the condition may be irreversible.

It is important to get treatment as soon as you experience symptoms of RSI. This increases the chances of recovery and reduces the risk of long-term problems.

Types of RSI

RSI is classed as type 1 when a doctor can diagnose a recognised medical condition, such as carpal tunnel syndrome, from your symptoms. It is usually characterised by swelling and inflammation of the muscles or tendons.

RSI is classed as type 2 when a doctor cannot diagnose a medical condition from your symptoms. This is usually because there are no obvious symptoms, apart from a feeling of pain. Type 2 RSI is also referred to as non-specific pain syndrome.

Repetitive strain injury (RSI), or work-related upper limb disorder (WRULD), is related to the overuse of muscles and tendons in the upper body, especially the hands, wrists, arms, shoulders, back or neck.

Factors that can put you at risk of RSI include:

• repetitive activities
• doing an activity for a long time without rest
• doing an activity that involves force, such as lifting heavy objects
• poor posture or activities that require you to work in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting RSI and can make the symptoms worse. Stress can also be a contributing factor.

RSI is most commonly caused by a repeated action carried out on a daily basis. A variety of jobs can lead to RSI, such as working at an assembly line, at a supermarket checkout, or typing and data entry at a computer.

If you use a computer at work you may experience a typical RSI condition called writer's cramp. This is when the repetitive action of typing on the computer causes painful symptoms in your hands, such as a throbbing pain.

It is important that your working environment, for example your desk space, is laid out so that you can work comfortably. Your employer is under a legal duty to try to prevent work-related RSI and ensure that anyone who already has the condition does not get any worse.

There are no tests to confirm a diagnosis of repetitive strain inury (RSI), or work-related upper limb disorder (WRULD), as the pain and symptoms are often caused by a variety of factors.

RSI is often diagnosed when symptoms develop following a repetitive task and fade when the task is stopped.

Your GP can examine the area where you have pain and will ask about your symptoms and medical history. If you have type 1 RSI symptoms, such as inflammation and swelling, they may be able to diagnose a specific condition.

There are several medical conditions and injuries that can be classed as type 1 RSI. These include the following.

• Bursitis: inflammation and swelling of the fluid-filled sac near a joint at the knee, elbow or shoulder.
• Carpal tunnel syndrome: pressure on the median nerve passing through the wrist.
• Dupuytren's contracture: a thickening of deep tissue in the palm of the hand and into the fingers.
• Epicondylitis: inflammation of an area where bone and tendon join. An example of epicondylitis is tennis elbow.
• Rotator cuff syndrome: inflammation of muscles and tendons in the shoulder.
• Tendonitis: inflammation of a tendon.
• Tenosynovitis: inflammation of the inner lining of the tendon sheath that houses the tendons, most commonly in the hand, wrist or forearms.
• Ganglion cyst: a sac of fluid that forms around a joint or tendon, usually on the wrist or fingers.
• Raynaud’s phenomenon: a condition where the blood supply to extremities, such as the fingers, is interrupted.
• Thoracic outlet syndrome: compression of the nerves or blood vessels that run between the base of the neck and the armpit.
• Writer’s cramp: part of a family of disorders known as dystonia that cause muscle spasms in the affected part of the body. Writer’s cramp occurs from overuse of the hands and arms.

Many of the conditions described above, such as carpal tunnel syndrome and dupuytren’s syndrome, can develop as part of normal aging.

If you have type 2 RSI symptoms (non-specific pain but no inflammation or swelling), you may be referred for further tests to rule out other conditions, for example, you may be given an X-ray to test for osteoarthritis.

If no other condition is found after having tests you may be diagnosed with type 2 RSI, which is also known as non-specific pain syndrome.

If you are diagnosed with repetitive strain inury (RSI), or a work-related upper limb disorder (WRULD), it is likely that your GP will initially advise you to stop doing the task or activity that is causing your symptoms.

In some cases this might not be possible, for example if it is an activity you carry out for work. You may need to tell your employer about your RSI so that arrangements can be made at work to improve your symptoms.

There are many treatment options for RSI. They all aim to relieve pain and enable your strength and mobility to return. Treatment options include:

• taking a course of anti-inflammatory painkillers, such as aspirin or ibuprofen
• using a heat or cold pack, elastic support or splint
• being referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles
• having steroid injections to reduce inflammation in an affected area (this is only recommended if an area has definite inflammation from a condition, such as carpal tunnel syndrome or tenosynovitis)

Your doctor may also prescribe a short course of sleeping tablets if your RSI is preventing you from sleeping.

Self help

Often, small changes to your lifestyle and working environment can help to relieve symptoms of RSI.

Think about the activity that is causing your RSI. What is it, when do you do it and how long you do it for? Could you spend less time doing the activity or take more regular breaks so you are doing it for shorter periods of time?

If your RSI is caused by typing, learning to touch type might help as you can look straight ahead at your screen rather than down or to the side.

Some people with symptoms of RSI find that including exercise in their daily routine, such as walking or swimming, helps to ease their symptoms.

Complementary therapies

Many long-term sufferers of RSI use complementary therapies and relaxation techniques, such as massage, yoga, acupuncture and reflexology, to help relieve symptoms of RSI.

However, it should be stressed that there is little or no evidence to suggest that any of these approaches is effective.

Many repetitive strain injuries (RSI), or work-related upper limb disorders (WRULD), are cumulative rather than sudden, which means they develop over a long period.

Preventing the development of RSI, or relieving your symptoms, involves understanding and reviewing the lifestyle factors that cause RSI, including work, hobbies, general stress and posture.

Aspects of your working environment are likely to have the most impact on your RSI. Employers have a legal duty to prevent work-related RSI and make sure that the symptoms of anyone who already has the condition do not get worse.

Most employers will carry out something called a risk-assessment or desk-assessment when you join a company. This is to check your work area is suitable and comfortable for you and that the risk of accident and injury is as low as possible. You can request an assessment if you have not had one.

You can review other aspects of your lifestyle yourself, such as your hobbies or general stress levels. The most important thing is to notice the factors that are causing or aggravating your RSI and make changes accordingly.

More information on RSI and WRULD prevention can be found on the RSI Awareness website.