“My doctor says I have cervico brachial neurological syndrome (CBNS), but I can’t find any information about it. Could I have RSI?”
There seem to be a million names for RSI! Cervicobrachial neurological syndrome is one of the newer ones, as is cervicobrachialgia.
RSI – for repetitive strain injury – was used to describe the epidemic that occurred in Australia in the 1980s. It still used for the condition in the UK and parts of Europe. Australia decided to go with “occupational overuse syndrome” in the late 1990s and New Zealand went along with us.
In the Netherlands, they’ve decided to use “complaints of the arms, neck and shoulders (CANS)” and in the US they call it “cumulative trauma disorder”, a term that includes back problems as well as RSI.
Before the 1980s, RSI was called “tendinitis” or “tenosynovitis”. Both of these imply that the problem is mainly inflammatory, a view that is now contested. But people are still being diagnosed with these conditions. In sports medicine, “tendinosis” or “tendonopathy” are used instead, implying that the condition is degenerative. The umbrella term in sports injuries is “overuse injury”.
All of these different terms create problems for doctors, medical researchers, patients and support groups like us. How do patients find the right help and what do support organisations like us call ourselves? It’s a hard call!
How do I know if I have RSI/OOS?
The first signs of an overuse injury may be soreness, tingling or discomfort in the neck, arms, wrists, fingers or shoulders. These symptoms may come on when you do something or appear afterwards. They may disappear when you stop the activity that brought them on. It may take only a few hours for the symptoms to go away, or it may take as long as a couple of days. If it isn’t treated successfully, RSI can turn into a chronic pain problem.
The symptoms of an overuse injury include:
- burning, aching or shooting pain in the neck, shoulders, upper back, forearms, wrists, hand or fingers
- tremors, clumsiness and numbness
- fatigue or lack of strength
- weakness in the hands or forearms to the extent that it is difficult to perform even simple tasks such as lifting a bag of shopping
- difficulty with normal activities like opening doors, chopping vegetables, turning on a tap
- chronically cold hands, particularly the fingertips.
What causes RSI/OOS?
Overusing your body is the main cause of repetitive strain injury. Contributing factors include:
- doing something with your arms repeatedly for too long
- working with equipment that doesn’t fit your body
- working too fast
- not having breaks
- holding your muscles in the same position for a long time
- lack of training in the safest way to carry out a task
- long work hours
- lack of variety in the type of work you do
- working in cold conditions.
The underlying cause common to all RSI-type conditions is damage to muscles and tendons (and the nerves that run through them) through repeated micro-trauma. Whenever muscles are used, tiny tears can occur in muscle tissue. The local area becomes inflamed for a short time as the body attempts to repair the damage.
Without enough rest for the damaged area to be repaired fully, more activity causes further damage and more inflammation, thickening, scar tissue and pain. Nerves are also damaged by RSI. Tingling feelings are caused by the compression of nerves. Nerves run through muscles, and if muscle health is poor, so is nerve health. Damaged nerves can heal but the process is extremely slow.
I’ve recently been diagnosed with/ think I might have RSI/OOS. What should I do?
There are lots of things you should do! First of all, try to find a good doctor, one who is both knowledgeable and sympathetic – and that may not be the GP you normally use. Try to get some time away from work, as rest can cure the injury in the early stages. At the same time, get as much exercise you can – walking, running, cycling, anything that gets your blood flowing.
Have a really good look at your work and try to decide what needs fixing. Do you have the right desk, keyboard and monitor setup? Are you working too hard? Are you stressed at work? Do you get regular breaks?
Take this injury seriously – many people end up permanently injured.
What is the best treatment for RSI?
Very careful graded strengthening exercise seems to be the therapy with the best evidence base. Make sure you go to a physiotherapist or exercise physiologist who really knows their stuff and doesn’t push you too hard! Your local gym probably won’t have the expertise to help.
Other therapies that our members tell us are really helpful include deep tissue massage, careful stretching exercises, osteopathy, acupuncture for pain, meditation, and stress management. Anything that helps you to physically relax will be helpful.
Interviewees in Moving on with RSI (RSI Association, 2003) indicated that they had to go in search of treatment options that worked for them and that often meant a period of trial and error.
How long does RSI/OOS last?
RSI usually lasts only a few days or weeks if treated properly in the early stages, but it can affect a person for many years if not treated or diagnosed properly in the beginning (Pascarelli & Quilter, 1994).
How Common is RSI/OOS?
The incidence of RSI is actually increasing. More than 60% of worker’s compensation cases in the USA are for RSI and similar conditions (Quilter, 1998). Although there are no comparable Australia-wide statistics available, eight out of ten computer users in the Australian Public Service reported symptoms of overuse injury (Comcare, 1997).
What kinds of activity cause RSI/OOS?
RSI spans many industries and occupations, including journalists, butchers, hairdressers, musicians, carpenters and cleaners. The highest incidence of RSI occurs in meatworkers. RSI can be also caused by leisure activities such as golf, knitting, computer games and playing a musical instrument (Arndt, 1986). In the past, most highly repetitive and/or forceful physical work was done by poorly-paid manual workers. However, now that computers are widely used by white collar workers and managers, RSI is common across all levels of the workforce. Comcare’s 1997 report states that 80% of sales people, 81% of clerks, 86% of professionals and 78% of managers reported mild or severe OOS.
I have heard RSI was invented in Australia in the 1980’s. Is this true?
The name ‘RSI’ may have been coined in Australia in the 1980s, but the conditions associated with it have been known for hundreds of years. It was first described in the 1700s by Italian physician Bernadino Ramazzini as a work-related condition. In 1870 there was an epidemic among British and French telegraphers, in 1911 among Morse key operators, and in 1964 among Japanese keypunchers. The Australian National Occupational Health & Safety Commission’s Interim Report of the RSI Ad Hoc Committee concluded that RSI was not new and not typically Australian (Brennan, 1985).
I have heard RSI is a mental health issue. Is this true?
Arguments for the psychological basis of RSI rest on the idea that people with RSI suffer from anxiety and depression before the symptoms first appear. A 1997 Comcare report into the incidence of Occupational Overuse Syndrome among government employees found that psychological distress was more likely to be a symptom of OOS rather than a cause. As more research is conducted, more evidence of the physical causes of RSI is being published. One researcher managed to create RSI in monkeys by making them work repetitively for their food! (Holmes, 1999).
Are women more likely to get RSI/OOS?
Yes, women are more likely than men to get RSI. However, the difference is small. It is notable that the occupation with the highest incidence of RSI ‑ meatworkers ‑ is dominated by men. The fact that women workers tend to do more work at home using the same muscle groups as at work could explain women’s higher rate. There is also an increasing body of evidence showing that even when women have the same jobs as men, they do different tasks.