Repetitive strain injury (RSI) is a collective term that covers a range of hand, wrist, forearm, neck shoulder, back, and knee and ankle disorders. The upper limb RSI’s are those that are most commonly encountered.Symptoms include:Sensation of tingling, aching or burning,Swelling and / or numbnessPins and needlesIncessant, nagging pain.There are no characteristic clinical signs in RSI. Due to the ambiguous nature of complaints RSI is included in the chronic fatigue syndrome category of diseases.There are two main groups of disorders are localized and diffuse RSI.Localized RSI:Includes:TenosynovitisCarpal tunnel syndromeEpicondylitis (tennis elbow, golfers elbow)These conditions are characterized by clearly defined symptoms and clinical signs. There is little professional disagreement over the existence of such conditions.Tennis elbow (Picture) is a painful inflammation of the tendon at the outer border of the elbow caused by the over use of the forearm muscles.Diffuse RSI:It includes:Poorly localized or diffuse patterns of painTenderness and loss of function in the upper limbThis group with muscles, nerves,tendons and soft tissues being affected, is controversial one, with opinions varying over origin (aetiology).Causes:The diagnosis of RSI may be made by GP’s, occupational health physicians, orthopaedic surgeons, or rheumatologists. The diagnosis rests largely on reported symptoms and nature of the patients work.Localized RSIs are more specific than diffuse RSI’s and may be more positively identified: for example, conditions such as carpal tunnel syndrome due to median nerve compression at the wrist, tennis and golfers elbow and tenosynovitis have more diagnostic criteria.Diffuse RSI’s on the other hand, are more problematic. The diagnosing clinician can only rely on symptoms, the type of work and its repetitive nature.There are three main causes:Fixed working positionRepititve motionsPsychological stress.The standard vies is that RSI’s are msuculotendinous injuries of the upper limb, shoulder girdle or neck caused by an overload of particular muscle groups, from repeated use, or by the maintenance of constrained postures, which results in pain, fatigue, and a decline in work performance. An alternative hypothesis is that RSI’s are not organic in nature and are not work- related.Some experts believe that the condition is due to conversion hysteria, whereby psychological conflict is converted into imaginary pain. Others consider the problem to be form of compensation neurosis, that is the patients having symptoms but retain a desire for secondary gain such as compensation payments or time off work.Treatment:Treatment of localized RSI’s is usually with well documented stratagies such asSteroid injection therapyRestSplintingOccupational health ergonomicsPhysiotherapeutic methods: in the more diffuse RSIs, treatment is much more difficult and controversial. Many sufferers resort to alternative medicine therapies such as:AcupunctureManipulation from osteopaths and chiropractorsAlexander technique for postureWork place solutions include:A humane working environmentErgonomically designed workstationsJob rotationIncidence:Most information on incidence comes from Australia, where there was a virtual epidemic of cases between 1980 and 1984. The Australian public service carrying out Audit between 1985 and 1987 , found that 2,706 persons years had been lost during the two year period. The prevalence ranged of cases wasOne percent in clerical administrative staff16 percent among data processor operators24 percent among data processorsRSI complainants were more likely to be female- perhaps because of the nature of their work.Understanding RSITrade unions are believed to have had considerable influence in protracting the problems, whereas health professionals such as orthopedic surgeons and rheumatologists have been less sympathetic towards the nature of the disorder.Consequently, the incidence of reporting has lessened markedly since those years. The Australian public service no longer issued statistics after 1987, and this led to a loss of public interest or awareness. A research project in USA in 1998 estimated that RSI disorders accounted for 56% of all occupational injuries.Prognosis:Conditions in the localized group of RSI disorders are amenable to treatment with steroid injections and physiotherapy. Diffuse disorders are far more difficult to treat mainly due to different attitudes of health professional. Often, the disorder will only resolve on change of occupation or satisfactory settlement of compensation. This latter may involve a costly process of litigation.Prevention:Good working practices and the provision of suitable office furniture, for example , may help in the prevention of RSIs. Employment medical services may provide advice, especially with ergonomic design, on providing the optimum work conditions for employees.