Repetitive strain injury (RSI)
RSI is not a diagnosis but a collective name for pain that comes on from monotonous work with the hands: at a keyboard, behind a counter, with a tool, with…
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Medicines commonly prescribed for Repetitive strain injury (RSI)
For informational purposes only. Always consult a doctor before using any medicine.
Dosage form: TABLET, 600 mgActive substance: ibuprofenManufacturer: Viatris Pharmaceuticals S.L.U.Prescription requiredDosage form: CAPSULE, 200 mgActive substance: ibuprofenManufacturer: Hc Clover Productos Y Servicios S.L.Prescription requiredDosage form: ORAL SOLUTION/SUSPENSION, 100 mg / 5 mlActive substance: ibuprofenManufacturer: Laboratorio Aldo Union S.L.Prescription required
RSI is not a diagnosis but a collective name for pain that comes on from monotonous work with the hands: at a keyboard, behind a counter, with a tool, with scissors, with a child on your arm. On its own it explains nothing and points nowhere, because what sits underneath it varies enormously — from a tendon that has changed to a nerve under pressure — and each of those needs something different. So what follows covers two things: how to work out what is actually going on in your case, and what to change about your work before it reaches numbness and weakness, which no longer settle on their own.
What the label is hiding
Most often RSI turns out to be one of four things.
- Tendinopathy — a reorganisation of the tendon tissue itself under a load it has not had time to adapt to. It hurts at a definite spot, and more on movement than at rest. This is where the lateral and medial epicondylitis of the elbow belong, known as tennis elbow and golfer's elbow, along with rotator cuff tendinopathy of the shoulder.
- Tenosynovitis — irritation of the sheath the tendon slides through. The most recognisable version is De Quervain's disease: pain at the base of the thumb and along the edge of the wrist, flaring sharply when you move the thumb away or lift something heavy with that hand.
- Nerve entrapment syndromes — compression of a nerve where it passes through a tight space. In the carpal tunnel it is the median nerve: the thumb, index and middle finger go numb, more so at night, and people wake to shake the hand out. In the tunnel at the elbow it is the ulnar nerve: the little and ring fingers go numb, worse with the elbow bent, on the phone or in sleep.
- Neck and shoulder pain from a position held too long. Here the culprit is not movement but its absence: a muscle holds the head and the shoulder blade in one place for hours.
The difference between them matters enormously. Tendinopathy is treated with measured loading, not rest. In carpal tunnel syndrome the decisive things are a night splint and an assessment of the nerve. In pain from static posture neither of those helps: what works there is changing position. Which leads to a simple conclusion — the label RSI is worth swapping for a specific name as early as possible.
How it usually unfolds
Nearly always the same way, in three steps, and that is a convenient way of telling where you are.
At first the pain or heaviness only comes during the work and goes within half an hour of stopping. At this stage changing how the day is organised is enough, and everything returns to normal.
Then the pain starts to outlive the work: you are already home and the arm aches all evening. Morning stiffness appears, fine movements become clumsy, and you find yourself shifting your grip on things more often.
Later the pain is there without any effort, wakes you at night, stops you sleeping on that side, and strength drops noticeably. From this stage recovery takes months rather than weeks, and rarely happens unaided.
There is no point enduring as far as the third step. The difference between "I changed my desk height in March" and "I changed it in September" is the difference between a fortnight and half a year.
Signs that mean seeing a doctor
Some complaints are past the point where an ergonomic mat and a few breaks will help, because what is at stake is a nerve — or something that has nothing to do with overuse at all:
- numbness or pins and needles that persist and do not settle when you shift the arm;
- weakness: you drop things, cannot hold a mug, cannot turn a key or open a jar;
- the muscle at the base of the thumb looks visibly flatter than on the other hand;
- pain that wakes you at night or stops you falling asleep;
- a joint that is hot, red and badly swollen, with a fever;
- pain running from the neck down the arm in a narrow band, as far as the fingers;
- the same thing starting on the other hand, with morning stiffness lasting more than half an hour;
- fingers going white and cold, or a change in the colour of the skin or nails;
- an onset that was sudden, after a single movement or a knock, rather than gradual.
Numbness and weakness are the most important items on that list. A nerve that stays compressed for months recovers poorly and sometimes incompletely, and lost time costs more here than anything else. It is also worth remembering that carpal tunnel syndrome does not only come from work: it often appears in pregnancy, with an underactive thyroid, in diabetes and in rheumatoid arthritis, and then it is the cause that is treated first.
Sorting out the workstation
This is the cheapest and most effective thing anybody can do unaided.
- Sit so that the forearms lie horizontal and the elbows are bent at roughly a right angle, close to the body. If the desk is too high, raise the chair and use a footrest; if it is too low, raise the desk.
- When typing, the hands should continue the line of the forearm rather than being cocked upwards. The edge of the desk should not dig into the wrist.
- Keep the mouse next to the keyboard rather than out to one side, and move it from the shoulder instead of with small wrist movements. If the edge of the wrist is what hurts, a differently shaped mouse or a trackball helps.
- The top edge of the screen should sit roughly at eye level, at about arm's length. Put a laptop on a stand and plug in a separate keyboard, because otherwise the neck and the hands cannot both be right at the same time.
- Do not wedge the phone under your shoulder. A headset removes half of all neck complaints.
- For manual work, choose the tool to fit your hand: a thick soft handle needs less force than a thin one. Keep your hands warm and reduce vibration where you can, since cold and vibration make everything worse.
And the main thing, which tends to get lost among the lists: there is no ideal posture. The best posture is the next one. Changing position every half hour or hour does more than a flawlessly adjusted desk you then sit at without moving for four hours.
Change the load, do not remove it
The advice to "rest the arm completely until it passes" is outdated and in many cases does harm. An immobilised tendon loses strength, the muscle weakens within weeks, and on returning to work the pain turns out to be worse than before. Complete immobility is justified after an acute injury and for a short time, not for overuse pain.
The approach that works looks different.
- Cut down the amount of that particular load rather than activity in general. The rule of thumb is simple: pain during an activity is acceptable if it is moderate and settles within twenty-four hours. If the next day is worse, you took on too much.
- Break the work up. A short pause every thirty to forty-five minutes, to stand, drop the arms and move the neck, works better than one long break.
- Alternate tasks so that the same movement is not repeated for hours on end.
- Build strength back gradually. A tendon responds precisely to load, but to load that increases slowly: start small and add a little week by week.
- Heat or cold, whichever suits you better; it makes no difference to the outcome and a real difference to how you feel.
Prepare to be patient. Tendons and nerves recover slowly, and here the count runs in weeks and months rather than days. That is not a sign that the treatment is wrong.
What to use for the pain
Painkillers are here so that you can move and sleep, not so that you can keep working through the pain. Silenced pain stops being a signal, and the person then does exactly what started the whole thing.
Paracetamol and non-steroidal anti-inflammatory drugs are taken as a short course. For tendons that lie near the surface, gels and creams containing an anti-inflammatory work as well as tablets and are better tolerated. Discuss the particular medicine and how long to take it with your doctor or pharmacist, especially if you take anything else or have had trouble with your stomach, kidneys or blood pressure.
The second home measure is a splint or brace, and here everything depends on what exactly you have. In carpal tunnel syndrome a night splint that keeps the wrist straight is one of the few home measures with proven benefit. In tendinopathy, by contrast, rigid immobilisation for long periods is not what you want: the tendon needs work.
What a doctor can offer
- Exercise therapy. This is the main treatment in tendinopathy: a tailored programme of exercises done at home over months achieves more than massage and passive treatments.
- A steroid injection relieves pain quickly but does not last, and repeated injections into the tendon itself make its condition worse. In tenosynovitis and carpal tunnel syndrome an injection fits better, because there it buys time.
- Tests are not for everyone: ultrasound helps with a tendon, and nerve conduction studies with an entrapment, when the picture is unclear or surgery is being considered.
- Surgery is rare and is the last step, with one exception: in carpal tunnel syndrome with constant numbness or wasting of the muscle it is done without delay, because waiting here means losing nerve.
A separate piece of work is the conversation with your employer. Changing tasks, equipment or hours for a few weeks usually solves the problem more cheaply than months of sick leave, and in many countries an employee has a right to such adjustments.
Online consultation
A remote appointment does the essential thing: it turns a vague "my arm hurts from work" into a clear name and a plan. The doctor will ask where exactly it hurts, what makes it worse, whether the fingers go numb and which ones, whether the pain wakes you at night, will go through how your working day is put together and say what to change first. It is also the place to work out whether you need a brace and which one, whether any test is worth doing, how to choose pain relief given your other medicines, and by what signs you will know that home measures have not worked and it is time for a specialist. The signs in the list above, and persistent numbness and weakness of the hand above all, need a face-to-face examination — those are better not left waiting.
This material is for information only and does not replace medical advice.
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