Repetitive Stress InjuriesPrevention & Management

Dr. Debadutta MishraRehabilitation Consultant

Jindal Steel & Power Ltd.

• Repetitive stress injuries (RSI) or Cumulative Trauma Disorder (CTD) is a catch-all terms used to refer to many painful conditions, such as trigger finger, nerve spasms, and carpal tunnel syndrome. They can cause stiffness, swelling, tingling, weakness, numbness and, in some cases, irreversible nerve damage, resulting in a disabling condition or a limitation in working capacity.

Definition

• overuse• muscle tension• nerve tension• psychosocial factors• mind-body interaction• muscle weakness• awkward or static

postures

•force•poor tool and equipment design•poor ergonomics•fatigue•repetition•temperature•vibration•work without break

Causes and Risk Factors

Workers in many jobs are at risk for repetitive strain injuries (RSI). An RSI is an injury or disorder that occurs over time as a result of repetitive, forceful or awkward body movements. This results in –

• Early fatigue•Loss of concentration•Lowering of efficiency and endurance •Medical complication•Increased medical bills and medical leaves•Loss of work hours everyday during rehabilitation phase

And ultimately loss of Productivity

Effects on Human Occupation

• When force is applied repeatedly to the same muscle group, joint, or tendon over a prolonged period, cumulative forces may cause soft tissue tears and trauma. The resulting injury may lead to ligament and tendon disorders, degenerative joint disease, bursitis, or nerve damage. In addition to repetition and high force, risk factors associated with RSI and CTDs include awkward joint posture and prolonged constrained posture.

Causes and Risk Factors

• Hand-and-wrist RSI begins when the tendons or nerves that pass through a delicate channel in the wrist (the "tunnel" formed by eight small carpal, or wrist bones protecting the medial nerve) are irritated. Typing with the wrist at an angle - a common practice - places extra stress on those tendons or nerves, which can cause permanent injury. Other problems known generically as RSI include tenosynovitis and myofascitis, or inflammation of the tendons, connective tissues and muscles, and de Quervain's disease, a tendinitis of the thumb, which may develop from the overuse of the space bar or computer mouse.

Causes and Risk Factors

• Typical early symptoms include numbness, or tingling or burning sensations, in the fingers, hands or forearms which can become crippling. Victims of full-blown RSI cannot wash their hair or even hold a sheet of paper without agonizing pain. Some of the very severely afflicted never recover.

Symptoms of RSI

• Pains in the wrists and hands as well as numbness in the fingers are the symptoms of Carpal Tunnel Syndrome. They are also the symptoms for a number of other repetitive stress injuries. The numbness in Carpal Tunnel Syndrome is localized to the thumb and first two fingers.

• Carpal Tunnel Syndrome often weakens your thumb and therefore your grip.

• Pain and numbness are also more prevalent during the night.

Carpal Tunnel Syndrome

• Tendonitis, also spelled Tendinitis, is an inflammation or irritation of a tendon. Chronic strain, overuse or misuse of a tendon leading to a repetitive stress injury, or a serious acute injury can lead to a weakness, tear or swelling of the tendon tissue resulting in pain and stiffness near the tendon.

Tendonitis

• Bursitis is the irritation or inflammation of a bursa, which is a fluid filled sac located around joints and that reduce friction and ease movement as tendons or muscles pass over bones or skin. Pain in the area of the bursa is the main symptom. Tenderness, swelling and warmth around the area are other symptoms.

• Bursitis can also cause reduction in or loss of motion at the affected joint.

• Bursitis usually occurs in the shoulder, knee, elbow, hip, heel and thumb.

Bursitis

• Tennis elbow occurs when there is a problem with the tendons that attach to the outside of the elbow. These tendons are the attachment of the muscles that function to cock the wrist back. Patients with tennis elbow experience pain on the outside of the elbow that is worsened by grasping objects and cocking back the wrist. Also called epicondylitis…

• The most common symptoms of tennis elbow are:– Pain over the outside of the elbow– Pain when lifting objects– Pain radiating down the forearm

Tennis Elbow

• A common complaint that causes pain and locking of the fingers. The tendons are like ropes that attach to the ends of your fingers. When your muscle contracts, the flexor tendons pull the fingers into a fist. The tendons run part of their course through a sheath called the flexor tendon sheath. When a patient has the trigger finger condition, this mechanism of movement is inhibited.

Trigger Finger

BlackBerry Thumb generated quite a media buzz over the last few years. Dr. Greaney explained that the human body can withstand a finite amount of use. Overuse injuries, such as RSI, occur because of insufficient recovery time between demands, such as frequent use of the thumb on a PDA or BlackBerry. “These types of injuries occur when mechanical fatigue in tendons and ligaments cause small tears in the connective tissue “This condition is worsened by the fact that the connective tissue has not repaired itself, yet continues to be placed under stress. The cumulative effect of stress on the region causes the mechanical or chemical activation of pain receptors, resulting in pain and dysfunction.”

Black Berry Thumb

First there was Blackberry thumb, the repetitive strain injury resulting from too much typing on mobile devices. Now bloggers and media outlets are buzzing over the latest new epidemic to start worrying about: text neck.The average human head weighs 4.5kg to 5.5kg, and the neck and shoulders are not made to support its weight for long stretches, say experts. Children are especially at risk because their heads are larger in relation to their body size than adults. "The condition, which can result in headaches and shoulder, arm, and wrist pain, most often afflicts tall, young women with slender necks," noted blogger The Frisky.

Black Berry Thumb/ Text Neck

• Vibration White Finger is a repetitive stress injury where the small blood vessels in the fingers periodically spasm. The spams cause constriction of the blood supply to the fingertips turning the fingers white. Soon after, the available oxygen in the blood is used up and the fingers turn blue. Once the spasms subside the fingers turn red as oxygenated blood returns to the finger tips.

Vibration White Finger

• Produces widespread pain, disturbed sleep, and exhaustion from head to toe.

• Regional muscle pain also occurs in the majority of people with fibromyalgia.

• Patients experience firm knots in their muscles, often causing restricted movement and radiating pain.

Key SymptomsPain all over

Fatigue

Brain fog

Trouble sleeping

Exercise difficulties

Irritable bowel

Headaches

Jaw pain

Multiple sensitivities

Fibromyalgia

• pain, tingling, sensory deficits or loss of function• loss of strength or loss of mobility in the arms, legs or trunk• loss of balance or other problems with walking and general mobility

skills• speech or memory difficulties following a stroke or other medical

problem• difficulty with dressing, bathing, cooking or other activities of daily

living• problem returning back to work after a work-related injury• recovery from an accident or sports related injury

Fibromyalgia… Contd..

• The risk of developing an RSI can be lowered by reducing the risk factors present on the job, such as repetition, high force, awkward posture, contact stress and static posture. Using Occupational therapy techniques & ergonomics can help reduce the risk of RSIs. Ergonomics is the science that studies people and the work they do. Ergonomics helps the work fit the worker, and helps increase safety, efficiency, and avoid problems such as back pain, sore wrists and hands or sore shoulders. Occupational Therapy looks at

• Design of the workstation• Design of tools used at work• How the work is organized• How the work is done• Functional Capacity Evaluations• Job Demands Analysis• Work Hardening • Impairment Ratings• Hand & Upper Extremity Rehabilitation

Prevention & Management

• Functional Capacity EvaluationsValid, Reliable, SafeWhole Body, Upper Extremity Specific, Job Specific, Focused Test ApproachOne or two day evaluations.Work Hardening—Highly structured program designed to maximize the client’s ability to return to work. Injury prevention education is integrated into this program.

• Job Analysis - We can provide on-site, in-depth, Job Analysis that can help you eliminate uncertainty . Our assessments can be used to match the worker to a job that he can perform safely when making return to work decisions, or to determine critical job demand limits for use with Pre-Work Screening of potential employees.

• Impairment Ratings are based on the AMA Guides for Evaluating Permanent Impairment, 5th Edition. An FCE can also be done for additional Information in making impairment decisions.

Contd..

• Occupational therapists can help patients with these disorders practice "joint protection." Patients can learn to use their hands in non-deforming positions.

• RSI may be avoidable through proper work habits - including posture, wrist position and regular work breaks - as well as ergonomically designed workstations and keyboards.

Contd..

Thank You…