Understanding A Repetitive Strain Injury

by Frank Barnett

Repetitive Strain Injury, or RPI, is a group of conditions occurring due to repeated movements made in the course of using a computer keyboard or musical instrument or other such actions. Even though the source of inflammation connected with cumulative trauma hasn't been made clear, numerous things, such as mechanical fatigue in the ligaments, tendons and other soft tissues may be involved.

Differential diagnosis depends on the site of inflammation and includes the diagnosis of Achilles tendon injuries and tendonitis, Acromioclavicular degeneration, Ankle degeneration, Anterior cruciate laxity, Carpel tunnel syndrome, Elbow degeneration, Gamekeeper's thumb, Knee degeneration, Neck pain, Shin splints, Suprascapular nerve compression and tendinopathy. Carpal Tunnel Syndrome is a common well known injury. Triangular Fibrocartilage Complex Injury (TFCC) is an injury of the small, cartilage-like structure in the wrist joint. Symptoms include pain on the ulnar side of the wrist, clicking sound and reduced grip strength. Osteonecrosis of the lunate bone of the wrist in patients with systemic sclerosis also causes wrist pain. Osteonecrosis represents an important cause of wrist pain especially in scleroderma patients. A positive scaphoid compression test will confirm the presence of a fractured scaphoid in patients without a visible fracture on initial X-ray studies.

A definitive test for scaphoid instability is the scaphoid shift test, which uses pressure against the scaphoid tubercle. The compression of the median never at the wrist is the cause of Carpal Tunnel Syndrome (CTS), or median neuropathy, this can lead to pain in the hand. Some cases of carpal tunnel syndrome are caused by repetitive activities, while occur without any known cause. There remains a correlation between a painful dorsal wrist ganglion and wrist joint abnormality, but the exact cause of the dorsal wrist ganglia is still a medical mystery. Scaphoid fractures and dynamic scapholunate instability are both injuries that can happen to the scapholunate ligament. The scapholunate ligament stabilizes the palmar rotation force of the scaphoid against the dorsal rotation force of the lunate and maintains the proximal pole of the scaphoid adjacent to the lunate.

De Quervain's tenosynovitis is an inflammation of the tendons in the wrist. The affected tendons are on the side of the wrist near the thumb. When they swell, it can make movement of the wrist and thumb difficult. Diagnostic imaging and bone X-rays can lead to the diagnosis of this syndrome. Once the condition is diagnosed, appropriate treatment can begin.

Though the true prevalence and natural history of intercarpal ligament injuries are not known, Scapholunate injuries have been reported to occur in association with distal radial fractures. Distal lunate joint instability due to dysfunction of the distal radio-ulnar joint is commonly encountered in patients with rheumatoid disease or following fracture to the distal radius. Hamate fractures constitute 2% of all carpal fractures related to sports activities involving racquets, bats, and clubs. The hamate bone is a triangular bone composed of both a body and a hook.

Repetitive Strain Injuries are especially common among information workers, who work at a computer for long hours. Often, RSIs can be avoided by following a few simple ergonomic rules.

Published November 24th, 2008

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