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[[Image:DataHand Professional II Keyboard-Right.jpg|thumb|150px|right|DataHand Professional II Keyboard, right side]]
[[Image:DataHand Professional II Keyboard-Right.jpg|thumb|150px|right|DataHand Professional II Keyboard, right side]]


Zombies hate orting.
===Medical Products===
A number of medical treatments, including non-narcotic pain medications, braces, and therapy. Although some professionals consider these to be [[palliative]], their widespread use and effectiveness is undeniable.<ref name="Amadio" /><ref>Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain by Joanne Dahl and Tobias Lundgren</ref> (See ''Are Some RSI Cases Psychosomatic?'' below)

Pain medications, particularly non-steroidal anti inflammatory drugs [[(NSAIDs)]], are most often used to eliminate pain. The major problem with such drug use with RSI's is that the pain can be masked, and therefore the patient returns to the activities which strained the tissues in the first place before the tissues have had time to heal. So a balance must be struck where pain is reduced, yet not so much that the tissues will be reinjured with continued over-use.

Medical devices are available which help the strained tissues to heal faster. Several types of devices are available, and are classified as either passive or active devices. Passive devices generally immobilize the limb allowing the body to heal itself, while active devices enhance the body's healing capacity. The [[Carpal Therapist]] is an active device designed to provide deep tissue massage and myofascial manipulation. It is an automated (electromechanical) therapeutic massager for injured soft tissues. The [[Flextend]] product is a passive device designed to provide some resistance to wrist movement. This encourages strengthening of the injured soft tissues.


Braces, particularly wrist braces, are by far the most often used products for RSIs. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.
Braces, particularly wrist braces, are by far the most often used products for RSIs. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.

Revision as of 19:00, 8 September 2010

Repetitive strain injury

Repetitive strain injury (RSI) (also known as repetitive stress injury, repetitive motion injuries, repetitive motion disorder (RMD), cumulative trauma disorder (CT), occupational overuse syndrome, overuse syndrome, regional musculoskeletal disorder) is an injury of the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions.[1]

Types of RSIs that affect computer users may include non-specific arm pain[2] or work related upper limb disorder (WRULD). Conditions such as RSI tend to be associated with both physical and psychosocial stressors.[3]

Causes

RSI is caused due to lifestyle without ergonomic care [citation needed], Eg. While working in front of computers, driving, travelling etc. Simple reasons like 'Using a blunt knife for everyday chopping of vegetables', could cause RSI. Other typical habits that lead to RSI:

  • Reading books while looking down
  • Carrying heavy school/laptop bags
  • Use of phone/mobile leaning onto one side
  • Watching TV in incorrect position e.g. Too much to the left/right. Sleeping while watching TV.
  • Sleeping with head forward, while travelling
  • Drawing/Writing to the point of unhealthiness
  • use of the hands, wrists, back, neck etc awkwardly or excessively
  • Others

Illness

Symptoms

The following complaints are typical in patients who might receive a diagnosis of RSI:[4]

  • Short Bursts of Excruciating Pain in the arm, back, shoulders, wrists, hands, or thumbs (typically diffuse – i.e. spread over many areas).
  • The pain is worse with activity.
  • Weakness, lack of endurance.

In contrast to carpal tunnel syndrome, the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc. They tend not to be characteristic of any discrete pathological conditions.

Frequency

A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.[5]

Physical examination and diagnostic testing

The physical examination discloses only tenderness and diminished performance on effort-based tests such as grip and pinch strength—no other objective abnormalities are present. Diagnostic tests (radiological, electrophysiological, etc.) are normal. In short, RSI is best understood as an apparently healthy arm that hurts. Whether there is currently undetectable damage remains to be established.

Definition

The term "repetitive strain injury" is most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints. It may also be used as an umbrella term incorporating other discrete diagnoses that have (intuitively but often without proof) been associated with activity-related arm pain such as carpal tunnel syndrome, cubital tunnel syndrome, thoracic outlet syndrome, DeQuervain's syndrome, stenosing tenosynovitis/trigger finger/thumb, intersection syndrome, Golfer's elbow (medial epicondylosis), Tennis elbow (lateral epicondylosis), and focal dystonia.

Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as reflex sympathetic dystrophy syndrome (RSDS), Blackberry thumb, disputed thoracic outlet syndrome, radial tunnel syndrome, "gamer's thumb" (a slight swelling of the thumb caused by excessive use of a gamepad), "Rubik's wrist" or "cuber's thumb" (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a Rubik's Cube for speedcubing), "stylus finger" (swelling of the hand caused by repetitive use of mobile devices and mobile device testing.), "Raver's wrist", caused by repeated rotation of the hands for many hours (for example while holding glow sticks during a rave).

Although tendinitis and tenosynovitis are discrete pathophysiological processes, one must be careful because they are also terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused by the aforementioned processes.

Treatment

On their own, most RSIs will resolve spontaneously provided the area is first given enough rest when the RSI first begins. However, without such care, some RSIs have been known to persist for years, or have needed to be cured with operations.

The most often prescribed treatments for repetitive strain injuries are rest, exercise, braces and massage. A variety of medical products also are available to augment these therapies. Since the computer workstation is frequently blamed for RSIs, particularly of the hand and wrist, ergonomic adjustments of the workstation are often recommended.

Ergonomics

Modifications of posture and arm use (ergonomics) are often recommended.[6]

Ergonomics: the science of designing the job, equipment, and workplace

Adaptive software

Main article: List of Repetitive Strain Injury software

There are several kinds of software designed to help in Repetitive Strain Injury. Among them, there are speech recognition software, and break timers. Break timers software reminds the user to pause frequently and perform exercises while working behind a computer. There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.

Adaptive hardware

Adaptive technology ranging from special keyboards, mouse replacements to pen tablet interfaces might help improve comfort.

Mouse

Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or joystick, or switching from using a mouse to using a stylus pen with graphic tablet may provide relief, but in chronic RSI they may only result in moving the problem to a different area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a trackpad, which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice(which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.

Keyboards and keyboard-alternatives

Exotic keyboards by manufacturers such as Datahand, OrbiTouch, Maltron and Kinesis are available. Also one can use digital pens and voice recognition.

DataHand Professional II Keyboard, right side

Zombies hate orting.

Braces, particularly wrist braces, are by far the most often used products for RSIs. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.

Exercise

Exercise decreases the risk of developing RSI.[7]

  • Doctors[citation needed] sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve posture.
  • In light of the fact that a lifestyle that involves sitting at a computer for extended periods of time increases the probability that an individual will develop excessive kyphosis, theoretically the same exercises that are prescribed for thoracic outlet syndrome or kyphotic postural correction would benefit an RSI sufferer.[8]

Resume Normal Activities Despite the Pain?

Some researchers believe that, for the most difficult chronic RSI cases, the pain itself becomes less of a problem than the disruption to the patient's life caused by

  • avoidance of pain-causing activities
  • massive investment of time into increasingly futile attempts at treatment

They claim greater success from teaching patients psychological strategies for accepting the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day activities and focus on aspects of life other than RSI.[9]

Others disagree, emphasizing the importance of rest in achieving recovery. For instance, it has been claimed that recovery can take up to 8 months without performing activities that might exacerbate the symptoms, and that the affected joint should never be put under severe or constant stress.[citation needed]

Psychosocial factors

Population studies

Studies have related RSI and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the reported pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in pain, even after short term exposure.[10]

For example, the association of Carpal tunnel syndrome with arm use is commonly assumed but not well-established.[11] Typing has long been thought to be the cause of carpal tunnel syndrome,[12] but recent evidence suggests that, if anything, typing may be protective.[13] Another study claimed that the primary risk factors for Carpal tunnel syndrome were "being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake."[14]

Psychological exacerbation of symptoms

There are three common mechanisms, by which a normally functioning human mind increases pain and pain-related disability.

  • Psychological distress (depression and anxiety) make pain seem worse.[15] Chronic pain, regardless of its source, leads to a cycle of increasing depression and reduced physical activity. Reduced physical activity reduces pain in the short term but increases it in the long term.[16]
  • Misinterpretation or over-interpretation of pain signals. Psychologists refer to this as pain catastrophizing (the tendency to think the worst when one feels pain),[4] and it is worsened by reliance on patient support groups and internet sites for diagnosis.[17] Gate Control Theory, part of the most accepted medical theory of pain, states that, when we are worried about a particular body part, the brain can actually signal to the spinal cord (via outgoing neurons) that it should be more apt to interpret nerve impulses from that body part as pain and pass them on to the brain.[18]. In patients with chronic arm pain, the brain may even learn to automatically trigger pain whenever the limb is moved, as a defense mechanism to prevent further movement[19]
  • A sense that something is seriously wrong that does not lessen with normal test results and reassurance from health professionals.[20] Psychologists call this heightened illness concern or health anxiety. (This is commonly seen in psychosomatic illnesses.[21].) The typical RSI patient presents with a strong intuition that their pain indicates existing and ongoing tissue damage.[20] One explanation is that they have a strong "pain alarm"—pain tends to be accepted as a sign of danger and they have difficulty modulating this intuitive uneasiness with pain.[4].

Psychosomatic cases

Some doctors and medical researchers believe that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to RSI. The most famous advocate of this point of view, Dr. John E. Sarno, Professor of Rehabilitation Medicine at the New York University Medical School considers that RSI, back pain, and other pain syndromes, although they sometimes have a physical cause, are more often a manifestation of tension myositis syndrome, a psychogenic disorder in which stress causes the autonomic nervous system to reduce blood flow to muscles, causing pain and weakness.[22]

RSI shares many characteristics with known psychosomatic disorders:

  • Freud and other psychiatrists believe that diffuse, difficult to describe symptoms likely indicated a psychosomatic root cause for an illness, especially if they moved around the body.[21] (Only some RSI cases fit this description.)
  • Psychosomatic illnesses typically display symptoms whose origins are unverifiable but which seem consistent with the time period's understanding of physical (non-psychosomatic) disease processes. When an objective test invented which is able to prove the psychosomatic origins of a specific illness, that illness typically disappears and is replaced by new, undiagnosable sets of symptoms.[21]
  • Patients and their advocates usually reject the suggestion that their disease may be non-physical in origin. Doctors frequently avoid giving psychosomatic diagnosis, for fear of angering patients or prompting them to switch doctors.[21]. "Psychosomatic" is often misunderstood to mean "faking it" or "imaginary". [21] Other psychosomatic diseases have been known to cause severe pain, paralysis, seizures[21], observable physical damage, even death.[23].

A common theme among different subtypes of RSI is a stigmatization and demonization of hand use. Illness concepts that stigmatize hand use have the potential to create more illness as well-documented in the experience with the Australian RSI epidemic. [24] RSI was first diagnosed in Australia in the 1980s. (Only later was it diagnosed in the US and Britain.) In the early Australian experience, RSI cases increased rapidly over several years, leading to widespread media coverage and worker protests. After a widely publicized court case in which a judge ruled an alleged RSI victim had no bodily injury and could not receive damages, complaints dropped off rapidly. Many observers felt that the media coverage and social mobilization against the epidemic had actually helped spread it by causing psychosomatic symptoms in worried workers.[25] This pattern has been seen in other psychosomatic illnesses.[21]

See also

Footnotes

  1. ^ http://www.state.nj.us/health/eoh/peoshweb/ctdib.htm
  2. ^ Teixeira, Tania (2008-12-09). "Technology | The mouse is biting some PC users". BBC News. Retrieved 2009-08-17.
  3. ^ Macfarlane, Hunt, Silman. Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study. BMJ. 2000
  4. ^ a b c Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB (2005). "Psychological factors associated with idiopathic arm pain". J Bone Joint Surg Am. 87 (2): 374–80. doi:10.2106/JBJS.D.01907. PMID 15687162. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  5. ^ "Two thirds of office staff suffer from repetitive strain injury | Mail Online". Dailymail.co.uk. 2008-06-04. Retrieved 2009-08-17.
  6. ^ Berkeley Lab. Integrated Safety Management: Ergonomics. Website. Retrieved 9 July 2008.
  7. ^ Ratzlaff, C. R. (2007). "Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity". Arthritis & Rheumatism (Arthritis Care & Research). 57 (3): 495–500. doi:10.1002/art.22610. PMID 17394178. {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help); Unknown parameter |month= ignored (help); line feed character in |title= at position 42 (help)
  8. ^ Carolyn Kisner & Lyn Allen Colby, Therapeutic Exercise: Foundations and Techniques, at 473 (5th Ed. 2007).
  9. ^ Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain by Joanne Dahl and Tobias Lundgren
  10. ^ Nahit ES, Pritchard CM, Cherry NM, Silman AJ, Macfarlane GJ (2001). "The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers". J. Rheumatol. 28 (6): 1378–84. PMID 11409134. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  11. ^ Lozano-Calderón S, Anthony S, Ring D (2008). "The quality and strength of evidence for etiology: example of carpal tunnel syndrome". J Hand Surg Am. 33 (4): 525–38. doi:10.1016/j.jhsa.2008.01.004. PMID 18406957. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  12. ^ Scangas G, Lozano-Calderón S, Ring D (2008). "Disparity between popular (Internet) and scientific illness concepts of carpal tunnel syndrome causation". J Hand Surg Am. 33 (7): 1076–80. doi:10.1016/j.jhsa.2008.03.001. PMID 18762100. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  13. ^ Atroshi I, Gummesson C, Ornstein E, Johnsson R, Ranstam J (2007). "Carpal tunnel syndrome and keyboard use at work: a population-based study". Arthritis Rheum. 56 (11): 3620–5. doi:10.1002/art.22956. PMID 17968917. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  14. ^ Falkiner S, Myers S (2002). "When exactly can carpal tunnel syndrome be considered work-related?". ANZ J Surg. 72 (3): 204–9. doi:10.1046/j.1445-2197.2002.02347.x. PMID 12071453. {{cite journal}}: Unknown parameter |month= ignored (help)
  15. ^ Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB (2006). "Self-reported upper extremity health status correlates with depression" ([dead link‍]). J Bone Joint Surg Am. 88 (9): 1983–8. doi:10.2106/JBJS.E.00932. PMID 16951115. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  16. ^ Turk and Winter. The Pain Survival Guide: How to Reclaim Your Life
  17. ^ Taylor, Steven J.; Asmundson, Gordon J. G. (2005). It's Not All in Your Head: How Worrying about Your Health Could be Making You Sick—and What You Can Do about It. New York: The Guilford Press. ISBN 1-57230-993-8.{{cite book}}: CS1 maint: multiple names: authors list (link)
  18. ^ Brannon and Feist. Health Psychology: An Introduction to Behavior and Health
  19. ^ page 193. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.
  20. ^ a b Vranceanu AM, Safren S, Zhao M, Cowan J, Ring D (2008). "Disability and psychologic distress in patients with nonspecific and specific arm pain". Clin. Orthop. Relat. Res. 466 (11): 2820–6. doi:10.1007/s11999-008-0378-1. PMC 2565030. PMID 18636306. {{cite journal}}: Unknown parameter |month= ignored (help)CS1 maint: multiple names: authors list (link)
  21. ^ a b c d e f g Shorter, Edward (1992). From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era. New York: Free Press ; Toronto : Maxwell Macmillan Canada ; New York : Maxwell Macmillan International. ISBN 0-02-928665-4.
  22. ^ Sarno, John E (2006). The Divided Mind: The Epidemic of Mindbody Disorders. Regan Books. ISBN 978-0060851781.
  23. ^ The science of voodoo: When mind attacks body. New Scientist. 2009
  24. ^ Amadio PC (2001). "Repetitive stress injury". J Bone Joint Surg Am. 83-A (1): 136–7, author reply 138–41. PMID 11205849. {{cite journal}}: Unknown parameter |month= ignored (help)
  25. ^ Lucire, Yolande (2003). Constructing RSI: Belief and Desire. Sydney: University of New South Wales Press. ISBN 0-86840-778-X.

References

References that support or promote use of the physical illness concept of RSI
  • Repetitive Strain Injury: A Computer User's Guide; Emil Pascarelli and Deborah Quilter (ISBN 0-471-59533-0)
  • It's Not Carpal Tunnel Syndrome! RSI Theory and Therapy for Computer Professionals; Suparna Damany, Jack Bellis (ISBN 0-9655109-9-9)
  • Conquering Carpal Tunnel Syndrome & Other Repetitive Strain Injuries, A Self-Care Program; Sharon J. Butler (ISBN 1-57224-039-3)
  • The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition; Clair Davies, Amber Davies (ISBN 1-57224-375-9)
  • Electromyographic Applications in Pain, Physical Medicine and Rehabilitation: Repetitive Strain Injury Computer User Injury With Biofeedback: Assessment and Training Protocol; Erik Peper, Vietta S Wilson et al. The Biofeedback Foundation of Europe, 1997
  • van Tulder M, Malmivaara A, Koes B (2007). "Repetitive strain injury". Lancet. 369 (9575): 1815–22. doi:10.1016/S0140-6736(07)60820-4. PMID 17531890.{{cite journal}}: CS1 maint: multiple names: authors list (link)
References that are cautious about the use of the physical illness concept of RSI
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