The last few months have seen an exponential increase in the number of patients referred to my clinic with RSI (repetitive strain injury). This certainly relates to the fact that we are now working long periods from home, usually typing or using a mouse with a computer while adopting poor posture and ergonomics.

However, RSI may also be associated with certain jobs such as working at a supermarket checkout, at an assembly line  or with sports such as tennis and squash.

RSI is associated with jobs that require working for long periods and using a computer mouse, coupled with poor posture and ergonomics. Photo: Shutterstock.com

RSI is not a new disease. It was first described more than 300 years ago. Today it comes under different guises: BlackBerry thumb, iPod finger and PlayStation thumb, for obvious reasons.

RSI may affect the muscles, joints, tendons or nerves mostly of the upper limb and is caused by excessive or repetitive movements or from overuse and vibration. Psychological stress and monotony can worsen the symptoms.

It may affect the shoulder and neck, but more commonly affects the elbow, wrist and fingers, and may manifest itself as pain associated with swelling, numbness, cramping, weakness or stiffness in these areas. The symptoms may begin gradually to then become more constant and intense.

More commonly, it affects the elbow, wrist and fingers and may manifest itself as pain associated with swelling, numbness, cramping, weakness or stiffness in these areas

RSI may be diagnosed as carpal tunnel syndrome (at the wrist or compression of the ulnar nerve at the elbow), cubital tunnel syndrome, tenosynovitis of the flexor (trigger finger or golfers elbow) or extensor tendons (tennis elbow or De Quarvain’s syndrome in the wrist) or as simple joint pains, swelling and stiffness.

A detailed history and examination normally confirm the diagnosis, but sometimes diagnostic investigations such as ultrasound or nerve-conduction studies may be required.

Prevention is better than cure: by adopting a proper posture, seated square on a hard-backed chair, feet flat on the floor, proper work-bench ergonomics, screen at eye level and at arms’ length, forearms and wrists well aligned and supported on jelly rests and, more importantly, by taking regular breaks to allow stretching.

If a person is affected by the condition, the treatment varies according to the symptoms. In the initial stages, this may involve resting the area and avoiding the causal activity, and applying ice and compression, such as using a bandage or splints. Exercise and stretching of the affected part may also help. In addition, anti-inflammatory medication and steroid injections may be needed. In the acute stages, one would expect the symptoms to settle fully within a fortnight provided all necessary ergonomic changes are made.

However, when the symptoms have set in and the condition becomes chronic,  surgery may be required. This may involve the release of the median nerve in carpal tunnel syndrome or release of inflamed tendons in trigger finger or in tennis elbow or in tenosynovitis.

Alistair Pace is a consultant orthopaedic surgeon and works at St Thomas Hospital in Qormi, St James Hospital in Sliema and Da Vinci Hospital in Birkirkara.