Elsevier

The Lancet

Volume 349, Issue 9056, 29 March 1997, Pages 943-947
The Lancet

Series
Repetitive strain injuries

https://doi.org/10.1016/S0140-6736(96)07221-2Get rights and content

Summary

Repetitive strain injuries (RSI) present an increasingly common challenge to clinicians. They consist of a variety of musculoskeletal disorders, generally related to tendons, muscles, or joints, as well as some common peripheral-nerve-entrapment and vascular syndromes. These disorders generally affect the back, neck, and upper limbs, although lower limbs may also be involved. Although RSI may occur as a result of sports and recreational activities, occupational RSIs, affecting the patient's livelihood, are particularly important. These injuries result from repetitive and forceful motions, awkward postures, and other work-related conditions and ergonomic hazards. Occupationally induced RSIs are generally costly, creating a strong incentive for physicians to become familiar with the symptoms, signs, and risk factors so that they can be diagnosed early and appropriate interventions facilitated.

Section snippets

Clinical evaluation of RSI

RSI can occur to hands, wrists, elbows, shoulders, neck, back, hips, knees, and ankles. Back problems are the most common RSI; there have been many publications on the assessment and management of back pain, and on the evaluation and redesign of tasks to prevent back injuries. Since upper-limb RSIs are one of the fastest-growing group of occupational disorders,10 these are the focus of this paper (table). However, we should point out that repetitive activities commonly inflict injuries on

General RSI evaluation

The diagnosis of RSI is reached through a careful medical and occupational history, physical examination, and exclusion of non-occupational diseases. The history should include the location, duration, frequency, and intensity, and aggravating and ameliorating factors. Details of onset of symptoms in relation to work tasks or changes in work tasks are especially important, although many workers do not experience symptoms until after weeks, months, or even years of exposure. The occupational

Clinical course of RSIs

The clinical course of most RSIs can be divided into three stages. In the first stage, which may persist for weeks or months but is reversible, most patients experience aching and weakness during the work activity, but improve on days off work. There are no physical signs and no great interference with work. In the second stage, which may persist for months, symptoms begin more quickly and persist for longer. Physical signs may be present, sleep may be disturbed, and the patient may have

Elimination of hazardous conditions

The sudden rise in RSIs in Australia led some sceptics to question the relation between occupational factors and these disorders, arguing instead that they were conversion disorders, or a product of economic incentives and social iatrogenesis.22, 23, 24 Despite the acknowledged methodological weakness of the epidemiological literature and the imprecise terminology used, there is widespread consensus, based on a large body of scientific study, that specific occupational factors do increase the

Conclusion

Precise estimates of the prevalence of RSI in the general population are fraught with difficulties, especially imprecision in diagnostic coding systems.2, 29 Nonetheless, hundreds of occupational groups are at risk,1 in industries that include construction, forestry, mining, garment and product manufacturing, meat processing, health care, retail, clerical work, and performing arts. Sufficient information exists to confirm that RSI is an important clinical problem.12 Moreover, a large amount of

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