Elsevier

The Lancet

Volume 369, Issue 9575, 26 May–1 June 2007, Pages 1815-1822
The Lancet

Seminar
Repetitive strain injury

https://doi.org/10.1016/S0140-6736(07)60820-4Get rights and content

Summary

Repetitive strain injury remains a controversial topic. The term repetitive strain injury includes specific disorders such as carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, lateral epicondylitis, and tendonitis of the wrist or hand. The diagnosis is usually made on the basis of history and clinical examination. Large high-quality studies using newer imaging techniques, such as MRI and ultrasonography are few. Consequently, the role of such imaging in diagnosis of upper limb disorders remains unclear. In many cases, no specific diagnosis can be established and complaints are labelled as non-specific. Little is known about the effectiveness of treatment options for upper limb disorders. Strong evidence for any intervention is scarce and the effect, if any, is mainly short-term pain relief. Exercise is beneficial for non-specific upper limb disorders. Immobilising hand braces and open carpal tunnel surgery release are beneficial for carpal tunnel syndrome, and topical and oral non-steroidal anti-inflammatory drugs, and corticosteroid injections are helpful for lateral epicondylitis. Exercise is probably beneficial for neck pain, as are corticosteroid injections and exercise for shoulder pain. Although upper limb disorders occur frequently in the working population, most trials have not exclusively included a working population or assessed effects on work-related outcomes. Further high-quality trials should aim to include sufficient sample sizes, working populations, and work-related outcomes.

Section snippets

Epidemiology

Repetitive strain injury arises frequently in adults of working age, with many people reporting strains of the hands, wrists, arms, shoulders, or neck. Repetitive strain injury complaints are common in the general population and are a frequent reason for visiting the general practitioner.9 Several countries report a prevalence of 5–10% for non-specific complaints of strain that interferes with day-to-day activities,10, 11, 12, 13 but rates could be as high as 22–40% in specific working

Pathophysiology

Several hypotheses for the pathophysiology of repetitive strain injury exist, but none has been strongly supported by scientific evidence. Despite initial distal presentation, this disorder seems to be a diffuse neuromuscular illness.41 Mechanical (elastic deformation of connective tissue due to increased pressure within muscles) and physiological (electrochemical and metabolic imbalances) reactions might cause damage to muscle tissue and lead to complaints of strain. Continuous contraction of

Diagnosis

No gold-standard tests for repetitive strain injury exist. In most cases, diagnosis is made on the basis of history and physical examination, including assessment of range of motion of joints, hypermobility, muscle tenderness, pain, strength, and imbalance between right and left limbs.41 Some clinical tests are used for specific disorders. For example, Phalen's test, Tinel's test, and measurement of nerve conduction velocity are highly sensitive and specific for diagnosis of carpal tunnel

Non-specific work-related repetitive strain

Exercise therapy is a useful treatment for patients with non-specific work-related repetitive strain presenting to primary care physicians or physiotherapists. Exercise seems to provide symptom relief and improve activities of daily living.56, 57, 58, 59, 60, 61, 62, 63 Manual therapy, such as osteopathy or chiropractic could be useful in some patients.56, 64 If one kind of therapy does not reduce symptoms, multidisciplinary rehabilitation programmes are recommended, although no strong evidence

Conclusion

No consensus exists on use of the term repetitive strain injury (or any other term), and little is known about the pathophysiology of this disorder. Evidence about risk factors is increasing but the relative effects of such risk factors are not well understood, and commonly used diagnostic tests for specific strain injuries have no empirical support. Yet, repetitive strain injuries occur frequently, especially in workers, and many people with specific or non-specific symptoms will seek advice

Search strategy and selection criteria

We searched Pubmed, Embase and the Cochrane Library from the dates that these databases begin up to December, 2005, for studies on pathophysiology, epidemiology, prognosis, diagnosis, and treatment of repetitive strain injury. Detailed search strategies for diagnostic and therapeutic studies are available from the corresponding author. Studies about pathophysiology, epidemiology and prognosis were identified by use of the MESH terms or free text words: “pathophysiology”, “epidemiology”,

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