Repetitive Strain Injury (RSI)
What is Good Treatment?
Repetitive strain injury (RSI) is a common condition that encompasses many different injuries. The spectrum ranges from carpal tunnel syndrome to tendonitis.
The common denominator is that they are cause by excessive repetitive activity or overuse. There is no specific protocol for treating RSI, due to the fact that RSI can be so many things. However, getting the correct treatment is essential for recovery of the affected area. And the earlier you seek treatment, the faster the recovery.
It can be difficult to find a doctor who is experienced in diagnosing and treating RSI. Most people will start with their primary care physician. Some primary care physicians will have the skills to treat your condition, but most will refer you out to specialists. Some of the specialists you might see include orthopedic surgeons, rheumatologists, neurologists, hand specialists, and physiatrists. The correct doctor often depends on the seriousness of your injury.
Diagnosis of RSI is not simple. Sometimes it is difficult to arrive at a definite diagnosis because you may have a multitude of symptoms that can change from time to time. Your doctor may use a variety of diagnostic procedures in addition to a physical examination to evaluate your symptoms.These may include:
- Nerve conduction studies and EMG tests. These tests involve attaching electrodes to your hand and passing an electrical current through your arm. The time required for the nerve to respond is measured. Slow or delayed times can be indicative of pinched or injured nerves.
- Diagnostic imaging. X-rays and MRI scans are used to check for skeletal problems, most commonly at the wrist, elbow, back shoulders and neck. If you have the symptoms of thoracic outlet syndrome, your doctor might also want to check for extra ribs or other abnormalities.
Your doctor will use the findings from these exams and his clinical findings to refer you to another doctor or a therapist to begin the rehabilitation process. Sometimes you may see more than one specialist. The most common are:
The physical therapist should check your spine and neck and look for pinched or stretched nerves.A good assessment will include the following:
- Posture - To determine areas of the body that may be compromised due to poor posture
- Spinal range of motion - Determines how much motion there is in the neck and back to determine limitations in range.
- Joint mobility - Determines how the each individual neck and back vertebrae moves.
- Strength – Specific assessment of scapular muscles and functional assessment of arm, leg and abdominal strength.
- Neural tension - Assessment of nerve tissue integrity and mobility as it courses out from the neck and down the arm.
- Soft tissue - Assessment of restrictions of movement in the arm and hand
The occupational therapist should complete a thorough evaluation of the following:
- Strength – To determine areas of upper extremity that are weak.
- Flexibility – Determine tightness or range limitations in shoulder, elbow, forearm, hand and wrist.
- Soft tissue - Determine presence of scar tissue, swelling, and tendon and nerve integrity.
- Pain – Determine areas of discomfort and things that increase pain levels.
- Time management/Lifestyle assessment - Determination of effective stress management strategies for home and work.
- Worksite evaluation – Review of your job to determine problems in workstation design or work that can interfere with your recovery.
A certified hand therapist can also treat over-use injuries. Hand therapists can either be physical or occupational therapists and may provide a combination of the previously listed services.
Therapists have a variety of skill levels and expertise. Make sure you choose a therapist who has experience and expertise in treating over-use injuries. Your therapists should collaborate to develop a comprehensive treatment plan that addresses all of the identified problem areas. Typical treatment plans include the following:
- Range of motion and mobility exercises
- Strengthening exercises
- Postural exercises with emphasis on scapular and abdominal or “core” strengthening
- Nerve gliding activities
- Soft tissue mobilization
- Splinting PRN
- Pain management
- Work techniques
- Work pacing and time management
- Use of adaptive equipment including specially designed keyboards, pointing devices, furniture and alternative technologies such as speech recognition
There is frequent cross over between hand, occupational, and physical therapists. For example, the hand therapist might use modalities to reduce swelling. Soft tissue mobilization and stretching might be performed to increase the flexibility of the soft tissue. Treatment is very individual and this outline is general. It should give you as idea of what to expect if you need treatment.
Remember, don’t wait too long to seek treatment. RSI can become so serious that it is not curable. Your symptoms may never go completely away if you wait too long to get help.