Repetitive strain injury

"Gamer's thumb" redirects here. It is not to be confused with Gamekeeper's thumb.
Repetitive strain
Classification and external resources
Specialty Sports medicine, orthopedics
ICD-10 M70, X50, Z57.7
ICD-9-CM E927.1, E927.3E927.9, 727.2
DiseasesDB 11373
eMedicine pmr/94
MeSH D012090

A repetitive strain injury (RSI) is an "injury to the musculoskeletal and nervous systems that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained or awkward positions."[1] RSIs are also known as cumulative trauma disorders, repetitive stress injuries, repetitive motion injuries or disorders, musculoskeletal disorders, and occupational or sports overuse syndromes.


Repetitive strain injury (RSI) and associative trauma orders are umbrella terms used to refer to several discrete conditions that can be associated with repetitive tasks, forceful exertions, vibrations, mechanical compression, or sustained/awkward positions.[1][2] Examples of conditions that may sometimes be attributed to such causes include edema, tendinosis (or less often tendinitis), carpal tunnel syndrome, cubital tunnel syndrome, De Quervain syndrome, thoracic outlet syndrome, intersection syndrome, golfer's elbow (medial epicondylitis), tennis elbow (lateral epicondylitis), trigger finger (so-called stenosing tenosynovitis), radial tunnel syndrome, and focal dystonia.[1][2][3]

Since the 1970s there has been a worldwide increase in RSIs of the arms, hands, neck, and shoulder attributed to the widespread use of typewriters/computers in the workplace that require long periods of repetitive motions in a fixed posture.[4]

Specific sources of discomfort have been popularly referred to by terms such as Blackberry thumb, iPod finger, mouse arm disease, PlayStation thumb,[5] Rubik's wrist or "cuber's thumb",[6] stylus finger,[7] raver's wrist,[8] and Emacs pinky, among others.


Some examples of symptoms experienced by patients with RSI are aching, pulsing pain, tingling and extremity weakness, initially presenting with intermittent discomfort and then, with a higher degree of frequency.[9]

Causes and risk factors

Workers in certain fields are at risk of repetitive strains. Most occupational injuries are musculoskeletal disorders, and many of these are caused by cumulative trauma rather than a single event.[10] Miners and poultry workers, for example, must make repeated motions which can cause tendon, muscular, and skeletal injuries.[11][12]


RSIs are assessed using a number of objective clinical measures. These include effort-based tests such as grip and pinch strength, diagnostic tests such as Finkelstein's test for Dequervain's tendinitis, Phalen's Contortion, Tinel's Percussion for carpal tunnel syndrome, and nerve conduction velocity tests that show nerve compression in the wrist. Various imaging techniques can also be used to show nerve compression such as x-ray for the wrist, and MRI for the thoracic outlet and cervico-brachial areas.


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

The most-often prescribed treatments for early-stage RSIs include analgesics, myofeedback, biofeedback, physical therapy, relaxation, and ultrasound therapy.[3] Low-grade RSIs can sometimes resolve themselves if treatments begin shortly after the onset of symptoms. However, some RSIs may require more aggressive intervention including surgery and can persist for years.

General exercise has been shown to decrease the risk of developing RSI.[13] Doctors sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve sitting posture, reduce excessive kyphosis, and potentially thoracic outlet syndrome.[14] Modifications of posture and arm use (human factors and ergonomics) are often recommended.[3][15]


Although seemingly a modern phenomenon, RSIs have long been documented in the medical literature. In 1700, the Italian physician Bernardino Ramazzini first described RSI in more than 20 categories of industrial workers in Italy, including musicians and clerks.[16] Carpal tunnel syndrome was first identified by the British surgeon James Paget in 1854.[17]

Lee Jackson's 2006 work "A Dictionary of Victorian London", quotes a paragraph from the April 1875 issue of The Graphic describing "telegraphic paralysis".

The Swiss surgeon Fritz de Quervain first identified De Quervain’s tendinitis in Swiss factory workers in 1895.[18] The French neurologist Jules Tinel (1879–1952) developed his percussion test for compression of the median nerve in 1900.[19][20][21] The American surgeon George Phalen improved the understanding of the aetiology of carpal tunnel syndrome with his clinical experience of several hundred patients during the 1950s and 1960s.[22]

See also


  1. 1 2 3 Public Employees Occupational Safety and Health Program of the New Jersey Department of Health and Senior Services
  2. 1 2 van Tulder M, Malmivaara A, Koes B (May 2007). "Repetitive strain injury" (PDF). Lancet. 369 (9575): 1815–22. doi:10.1016/S0140-6736(07)60820-4. PMID 17531890.
  3. 1 2 3 Verhagen, Arianne P.; Bierma-Zeinstra, Sita M. A.; Burdorf, Alex; Stynes, Siobhán M.; de Vet, Henrica C. W.; Koes, Bart W. (2013). "Conservative interventions for treating work-related complaints of the arm, neck or shoulder in adults". The Cochrane Database of Systematic Reviews. 12: CD008742. doi:10.1002/14651858.CD008742.pub2. ISSN 1469-493X. PMID 24338903.
  4. "Welcome to the RSI Awareness Website". 17 November 2010. Retrieved 17 July 2014.
  5. Vaidya, Hrisheekesh Jayant (March 2004). "Playstation thumb". The Lancet. 363 (9414): 1080. doi:10.1016/S0140-6736(04)15865-0. PMID 15051306.
  6. Waugh D (September 1981). "Cuber's thumb". N. Engl. J. Med. 305 (13): 768. doi:10.1056/nejm198109243051322. PMID 7266622.
  7. "5 Modern Technology Strain Injuries | Carpal Tunnel Syndrome". 30 December 2012. Retrieved 17 July 2014.
  8. Raver’s Wrist
  9. "Repetitive Strain Injury: What is it and how is it caused?" (PDF). Selikoff Centers for Occupational Health. Retrieved 12 February 2016.
  10. Cumulative Trauma Disorders in the Workplace. U.S. CDC-NIOSH Publication 95-119. 1995.
  11. Mining Publication: Risk Profile of Cumulative Trauma Disorders of the Arm and Hand in the U.S. Mining Industry U.S. CDC-NIOSH web site.
  12. "CDC - Poultry Industry Workers - NIOSH Workplace Safety and Health Topic". Retrieved 2016-07-15.
  13. Ratzlaff, C. R.; J. H. Gillies; M. W. Koehoorn (April 2007). "Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity". Arthritis & Rheumatism. 57 (3): 495–500. doi:10.1002/art.22610. PMID 17394178.
  14. Carolyn Kisner & Lyn Allen Colby, Therapeutic Exercise: Foundations and Techniques, at 473 (5th Ed. 2007).
  15. Berkeley Lab. Integrated Safety Management: Ergonomics. Website. Retrieved 9 July 2008.
  16. Ramazzini, De Morbis Artificum Diatriba (Diseases of Workers), Modena, 1700.
  17. Pearce JM (April 2009). "James Paget's median nerve compression (Putnam's acroparaesthesia)". Pract Neurol 9 (2): 96–9.
  18. Ahuja NK, Chung KC, "Fritz de Quervain, MD (1868–1940): stenosing tendovaginitis at the radial styloid process", J Hand Surg., vol.29 #6 pp. 1164–70.
  19. Tinel, J., “Nerve wounds” London: Baillère, Tindall and Cox, 1917
  20. Tinel, J., ‘’Le signe du fourmillement dans les lésions des nerfs périphériques’’, “Presse médicale”, 47, 388–389,1915
  21. Tinel, J. ‘’The "tingling sign" in peripheral nerve lesions’’ (Translated by EB Kaplan). In: M. Spinner M (Ed.), “Injuries to the Major Branches of Peripheral Nerves of the Forearm”, 2nd ed. pp 8–13, Philadelphia: WD Saunders Co, 1978.
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