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. 2001 Feb;47:311–316.

Chronic occupational repetitive strain injury.

B A O'Neil 1, M E Forsythe 1, W D Stanish 1
PMCID: PMC2016244  PMID: 11228032

Abstract

OBJECTIVE: To review common repetitive strain injuries (RSIs) that occur in the workplace, emphasizing diagnosis, treatment, and etiology of these conditions. QUALITY OF EVIDENCE: A MEDLINE search from January 1966 to June 1999 focused on articles published since 1990 because RSIs are relatively new diagnoses. MeSH headings that were explored using the thesaurus included "cumulative trauma disorder," "overuse injury," and "repetitive strain injury." The search was limited to English articles only, and preference was given to randomized controlled trials. MAIN MESSAGE: Repetitive strain injuries result from repeated stress to the body's soft tissue structures including muscles, tendons, and nerves. They often occur in patients who perform repetitive movements either in their jobs or in extracurricular activities. Common RSIs include tendon-related disorders, such as rotator cuff tendonitis, and peripheral nerve entrapment disorders, such as carpal tunnel syndrome. A careful history and physical examination often lead to the diagnosis, but newer imaging techniques, such as magnetic resonance imaging and ultrasound, can help in refractory cases. Conservative management with medication, physiotherapy, or bracing is the mainstay of treatment. Surgery is reserved for cases that do not respond to treatment. CONCLUSION: Repetitive strain injury is common; primary care physicians must establish a diagnosis and, more importantly, its relationship to occupation. Treatment can be offered by family physicians who refer to specialists for cases refractory to conservative management.

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Selected References

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  1. Anderson M. W., Kaplan P. A., Dussault R. G., Degnan G. G. Magnetic resonance imaging of the wrist. Curr Probl Diagn Radiol. 1998 Nov-Dec;27(6):187–229. doi: 10.1016/s0363-0188(98)90002-0. [DOI] [PubMed] [Google Scholar]
  2. Asami A., Morisawa K., Tsuruta T. Functional outcome of anterior transposition of the vascularized ulnar nerve for cubital tunnel syndrome. J Hand Surg Br. 1998 Oct;23(5):613–616. doi: 10.1016/s0266-7681(98)80014-4. [DOI] [PubMed] [Google Scholar]
  3. Ashbury F. D. Occupational repetitive strain injuries and gender in Ontario, 1986 to 1991. J Occup Environ Med. 1995 Apr;37(4):479–485. doi: 10.1097/00043764-199504000-00021. [DOI] [PubMed] [Google Scholar]
  4. Bachmann G. F., Melzer C., Heinrichs C. M., Möhring B., Rominger M. B. Diagnosis of rotator cuff lesions: comparison of US and MRI on 38 joint specimens. Eur Radiol. 1997;7(2):192–197. doi: 10.1007/s003300050133. [DOI] [PubMed] [Google Scholar]
  5. Burnham R., Gregg R., Healy P., Steadward R. The effectiveness of topical diclofenac for lateral epicondylitis. Clin J Sport Med. 1998 Apr;8(2):78–81. doi: 10.1097/00042752-199804000-00002. [DOI] [PubMed] [Google Scholar]
  6. Byl N. N., Melnick M. The neural consequences of repetition: clinical implications of a learning hypothesis. J Hand Ther. 1997 Apr-Jun;10(2):160–174. doi: 10.1016/s0894-1130(97)80070-1. [DOI] [PubMed] [Google Scholar]
  7. Byl N., Wilson F., Merzenich M., Melnick M., Scott P., Oakes A., McKenzie A. Sensory dysfunction associated with repetitive strain injuries of tendinitis and focal hand dystonia: a comparative study. J Orthop Sports Phys Ther. 1996 Apr;23(4):234–244. doi: 10.2519/jospt.1996.23.4.234. [DOI] [PubMed] [Google Scholar]
  8. Chang M. H., Chiang H. T., Lee S. S., Ger L. P., Lo Y. K. Oral drug of choice in carpal tunnel syndrome. Neurology. 1998 Aug;51(2):390–393. doi: 10.1212/wnl.51.2.390. [DOI] [PubMed] [Google Scholar]
  9. Cherniack M. G., Moalli D., Viscolli C. A comparison of traditional electrodiagnostic studies, electroneurometry, and vibrometry in the diagnosis of carpal tunnel syndrome. J Hand Surg Am. 1996 Jan;21(1):122–131. doi: 10.1016/S0363-5023(96)80165-1. [DOI] [PubMed] [Google Scholar]
  10. Cleland L. G. "RSI": a model of social iatrogenesis. Med J Aust. 1987 Sep 7;147(5):236, 238-9. doi: 10.5694/j.1326-5377.1987.tb133417.x. [DOI] [PubMed] [Google Scholar]
  11. Cole D. C., Hudak P. L. Prognosis of nonspecific work-related musculoskeletal disorders of the neck and upper extremity. Am J Ind Med. 1996 Jun;29(6):657–668. doi: 10.1002/(SICI)1097-0274(199606)29:6<657::AID-AJIM10>3.0.CO;2-Z. [DOI] [PubMed] [Google Scholar]
  12. DePalma M. T., Weisse C. S. Psychological influences on pain perception and non-pharmacologic approaches to the treatment of pain. J Hand Ther. 1997 Apr-Jun;10(2):183–191. doi: 10.1016/s0894-1130(97)80072-5. [DOI] [PubMed] [Google Scholar]
  13. DeStefano F., Nordstrom D. L., Vierkant R. A. Long-term symptom outcomes of carpal tunnel syndrome and its treatment. J Hand Surg Am. 1997 Mar;22(2):200–210. doi: 10.1016/S0363-5023(97)80152-9. [DOI] [PubMed] [Google Scholar]
  14. Downs D. G. Nonspecific work-related upper extremity disorders. Am Fam Physician. 1997 Mar;55(4):1296–1302. [PubMed] [Google Scholar]
  15. Feuerstein M., Burrell L. M., Miller V. I., Lincoln A., Huang G. D., Berger R. Clinical management of carpal tunnel syndrome: a 12-year review of outcomes. Am J Ind Med. 1999 Mar;35(3):232–245. doi: 10.1002/(sici)1097-0274(199903)35:3<232::aid-ajim3>3.0.co;2-g. [DOI] [PubMed] [Google Scholar]
  16. Furth H. J., Holm M. B., James A. Reinjury prevention follow-through for clients with cumulative trauma disorders. Am J Occup Ther. 1994 Oct;48(10):890–898. doi: 10.5014/ajot.48.10.890. [DOI] [PubMed] [Google Scholar]
  17. Glowacki K. A., Breen C. J., Sachar K., Weiss A. P. Electrodiagnostic testing and carpal tunnel release outcome. J Hand Surg Am. 1996 Jan;21(1):117–121. doi: 10.1016/S0266-7681(96)80025-8. [DOI] [PubMed] [Google Scholar]
  18. Glowacki K. A., Weiss A. P. Anterior intramuscular transposition of the ulnar nerve for cubital tunnel syndrome. J Shoulder Elbow Surg. 1997 Mar-Apr;6(2):89–96. doi: 10.1016/s1058-2746(97)90028-8. [DOI] [PubMed] [Google Scholar]
  19. Goupille P., Sibilia J. Local corticosteroid injections in the treatment of rotator cuff tendinitis (except for frozen shoulder and calcific tendinitis). Groupe Rhumatologique Français de l'Epaule (G.R.E.P.). Clin Exp Rheumatol. 1996 Sep-Oct;14(5):561–566. [PubMed] [Google Scholar]
  20. Hadler N. M. Cumulative trauma disorders. An iatrogenic concept. J Occup Med. 1990 Jan;32(1):38–41. [PubMed] [Google Scholar]
  21. Helliwell P. S., Mumford D. B., Smeathers J. E., Wright V. Work related upper limb disorder: the relationship between pain, cumulative load, disability, and psychological factors. Ann Rheum Dis. 1992 Dec;51(12):1325–1329. doi: 10.1136/ard.51.12.1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Hess D. Employee perceived stress. Relationship to the development of repetitive strain injury symptoms. AAOHN J. 1997 Mar;45(3):115–123. [PubMed] [Google Scholar]
  23. Heuck A., Bonél H., Stäbler A., Schmitt R. Imaging in sports medicine: hand and wrist. Eur J Radiol. 1997 Dec;26(1):2–15. doi: 10.1016/s0720-048x(97)01174-1. [DOI] [PubMed] [Google Scholar]
  24. Hong C. Z., Long H. A., Kanakamedala R. V., Chang Y. M., Yates L. Splinting and local steroid injection for the treatment of ulnar neuropathy at the elbow: clinical and electrophysiological evaluation. Arch Phys Med Rehabil. 1996 Jun;77(6):573–577. doi: 10.1016/s0003-9993(96)90297-x. [DOI] [PubMed] [Google Scholar]
  25. Itzkowitch D., Ginsberg F., Leon M., Bernard V., Appelboom T. Peri-articular injection of tenoxicam for painful shoulders: a double-blind, placebo controlled trial. Clin Rheumatol. 1996 Nov;15(6):604–609. doi: 10.1007/BF02238552. [DOI] [PubMed] [Google Scholar]
  26. Jones A. O. Magnetic resonance imaging of the supraspinatus tendon: the significance of signal intensity alterations at the 'critical zone'. Australas Radiol. 1998 May;42(2):106–113. doi: 10.1111/j.1440-1673.1998.tb00584.x. [DOI] [PubMed] [Google Scholar]
  27. Kaempffe F. A., Farbach J. A modified surgical procedure for cubital tunnel syndrome: partial medial epicondylectomy. J Hand Surg Am. 1998 May;23(3):492–499. doi: 10.1016/S0363-5023(05)80467-8. [DOI] [PubMed] [Google Scholar]
  28. Katz J. N., Fossel K. K., Simmons B. P., Swartz R. A., Fossel A. H., Koris M. J. Symptoms, functional status, and neuromuscular impairment following carpal tunnel release. J Hand Surg Am. 1995 Jul;20(4):549–555. doi: 10.1016/S0363-5023(05)80265-5. [DOI] [PubMed] [Google Scholar]
  29. Katz J. N., Larson M. G., Sabra A., Krarup C., Stirrat C. R., Sethi R., Eaton H. M., Fossel A. H., Liang M. H. The carpal tunnel syndrome: diagnostic utility of the history and physical examination findings. Ann Intern Med. 1990 Mar 1;112(5):321–327. doi: 10.7326/0003-4819-112-5-321. [DOI] [PubMed] [Google Scholar]
  30. Krischek O., Hopf C., Nafe B., Rompe J. D. Shock-wave therapy for tennis and golfer's elbow--1 year follow-up. Arch Orthop Trauma Surg. 1999;119(1-2):62–66. doi: 10.1007/s004020050356. [DOI] [PubMed] [Google Scholar]
  31. Kuklo T. R., Taylor K. F., Murphy K. P., Islinger R. B., Heekin R. D., Baker C. L., Jr Arthroscopic release for lateral epicondylitis: a cadaveric model. Arthroscopy. 1999 Apr;15(3):259–264. doi: 10.1016/s0749-8063(99)70031-9. [DOI] [PubMed] [Google Scholar]
  32. Lawler A. L., James A. B., Tomlin G. Educational techniques used in occupational therapy treatment of cumulative trauma disorders of the elbow, wrist, and hand. Am J Occup Ther. 1997 Feb;51(2):113–118. doi: 10.5014/ajot.51.2.113. [DOI] [PubMed] [Google Scholar]
  33. Martin C. E., Schweitzer M. E. MR imaging of epicondylitis. Skeletal Radiol. 1998 Mar;27(3):133–138. doi: 10.1007/s002560050352. [DOI] [PubMed] [Google Scholar]
  34. Melhorn J. M. Cumulative trauma disorders and repetitive strain injuries. The future. Clin Orthop Relat Res. 1998 Jun;(351):107–126. [PubMed] [Google Scholar]
  35. Novak C. B., Lee G. W., Mackinnon S. E., Lay L. Provocative testing for cubital tunnel syndrome. J Hand Surg Am. 1994 Sep;19(5):817–820. doi: 10.1016/0363-5023(94)90193-7. [DOI] [PubMed] [Google Scholar]
  36. Novak C. B., Mackinnon S. E. Repetitive use and static postures: a source of nerve compression and pain. J Hand Ther. 1997 Apr-Jun;10(2):151–159. doi: 10.1016/s0894-1130(97)80069-5. [DOI] [PubMed] [Google Scholar]
  37. Oztas O., Turan B., Bora I., Karakaya M. K. Ultrasound therapy effect in carpal tunnel syndrome. Arch Phys Med Rehabil. 1998 Dec;79(12):1540–1544. doi: 10.1016/s0003-9993(98)90416-6. [DOI] [PubMed] [Google Scholar]
  38. Rankin M. E., Rankin E. A. Injection therapy for management of stenosing tenosynovitis (de Quervain's disease) of the wrist. J Natl Med Assoc. 1998 Aug;90(8):474–476. [PMC free article] [PubMed] [Google Scholar]
  39. Rempel D., Tittiranonda P., Burastero S., Hudes M., So Y. Effect of keyboard keyswitch design on hand pain. J Occup Environ Med. 1999 Feb;41(2):111–119. doi: 10.1097/00043764-199902000-00006. [DOI] [PubMed] [Google Scholar]
  40. Rozmaryn L. M., Dovelle S., Rothman E. R., Gorman K., Olvey K. M., Bartko J. J. Nerve and tendon gliding exercises and the conservative management of carpal tunnel syndrome. J Hand Ther. 1998 Jul-Sep;11(3):171–179. doi: 10.1016/s0894-1130(98)80035-5. [DOI] [PubMed] [Google Scholar]
  41. Schwartz R. G. Cumulative trauma disorders. Orthopedics. 1992 Sep;15(9):1051–1053. doi: 10.3928/0147-7447-19920901-09. [DOI] [PubMed] [Google Scholar]
  42. Sheon R. P. Repetitive strain injury. 1. An overview of the problem and the patients. The Goff Group. Postgrad Med. 1997 Oct;102(4):53-6, 62, 68. doi: 10.3810/pgm.1997.10.337. [DOI] [PubMed] [Google Scholar]
  43. Spence S. H., Sharpe L., Newton-John T., Champion D. Effect of EMG biofeedback compared to applied relaxation training with chronic, upper extremity cumulative trauma disorders. Pain. 1995 Nov;63(2):199–206. doi: 10.1016/0304-3959(95)00047-V. [DOI] [PubMed] [Google Scholar]
  44. Stahl S., Kaufman T. The efficacy of an injection of steroids for medial epicondylitis. A prospective study of sixty elbows. J Bone Joint Surg Am. 1997 Nov;79(11):1648–1652. doi: 10.2106/00004623-199711000-00006. [DOI] [PubMed] [Google Scholar]
  45. Steinbach L. S., Fritz R. C., Tirman P. F., Uffman M. Magnetic resonance imaging of the elbow. Eur J Radiol. 1997 Nov;25(3):223–241. doi: 10.1016/s0720-048x(97)00073-9. [DOI] [PubMed] [Google Scholar]
  46. Vender M. I., Kasdan M. L., Truppa K. L. Upper extremity disorders: a literature review to determine work-relatedness. J Hand Surg Am. 1995 Jul;20(4):534–541. doi: 10.1016/S0363-5023(05)80263-1. [DOI] [PubMed] [Google Scholar]
  47. Wigley R. D. Repetitive strain syndrome--fact not fiction. N Z Med J. 1990 Feb 28;103(884):75–76. [PubMed] [Google Scholar]
  48. Yassi A. Repetitive strain injuries. Lancet. 1997 Mar 29;349(9056):943–947. doi: 10.1016/S0140-6736(96)07221-2. [DOI] [PubMed] [Google Scholar]
  49. Yuasa K., Kiyoshige Y. Limited surgical treatment of de Quervain's disease: decompression of only the extensor pollicis brevis subcompartment. J Hand Surg Am. 1998 Sep;23(5):840–843. doi: 10.1016/S0363-5023(98)80160-3. [DOI] [PubMed] [Google Scholar]
  50. Zingas C., Failla J. M., Van Holsbeeck M. Injection accuracy and clinical relief of de Quervain's tendinitis. J Hand Surg Am. 1998 Jan;23(1):89–96. doi: 10.1016/S0363-5023(98)80095-6. [DOI] [PubMed] [Google Scholar]
  51. el Hawary R., Stanish W. D., Curwin S. L. Rehabilitation of tendon injuries in sport. Sports Med. 1997 Nov;24(5):347–358. doi: 10.2165/00007256-199724050-00006. [DOI] [PubMed] [Google Scholar]

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