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Repetitive Stress Syndrome - Repetitive Stress Injury

Overview, Causes, & Risk Factors

Repetitive stress injury (RSI) is caused by repeated or excessive movement of the shoulders and arms.

In order for the shoulder, arms, and hands to move, the muscles of the upper body must contract. Repetitive stress injury occurs when certain movements are made repeatedly, causing:

  • a diminished blood flow and oxygen supply to the muscles
  • tightening of the structures of the upper body, which makes them more susceptible to injury
  • rubbing of tendons against ligaments or bones, which causes inflammation of the tendons
  • pinched nerves, if tissues are inflamed or if repetitive movements rub the nerve
  • What are the causes and risks of the injury?

    Causes of repetitive stress injury include:

  • repetitive and excessive use of the muscles of the upper limbs. This includes activities such as typing, sewing, heavy lifting, playing tennis, sawing wood, and using a cash register
  • poor posture when carrying out the same activities
  • poorly designed work conditions and work stations
  • pregnancy
  • If RSI is not successfully treated, nerve and tissue damage may cause a decrease in feeling and range of motion. There may be chronic pain or soreness in affected area. Disability or loss of employment may also occur.

    RSI conditions include:

  • carpal tunnel syndrome, which causes pain and other symptoms in the hand and wrist
  • tendinitis, which is an inflammation of the tendons in any part of the body
  • bursitis, which is an inflammation of the sac that cushions a joint
  • ganglions, which are cysts that may occur on a tendon

  • Symptoms & Signs

    What are the signs and symptoms of the injury?

    Symptoms of repetitive stress injury may occur anywhere in the shoulders or arms. Usually they first occur during the repetitive movement. These first symptoms may include tired muscles, aches, and pain.

    Later, if repetitive movement continues, the symptoms worsen and may include:

  • muscles aches
  • muscle fatigue, during activity and at rest
  • tingling sensation in the affected area
  • pain radiating up the arm
  • difficulty sleeping
  • numbness in the affected area, especially the fingers
  • disability because of chronic pain or weakness
  • frustration and depression due to pain

  • Diagnosis & Tests

    How is the injury recognized?

    The diagnosis of repetitive stress injury begins with a complete medical history and physical examination. The healthcare provider may order tests, such as:

  • x-rays and other imaging scans, such as an MRI
  • a nerve conduction velocity test (NCV) to check for nerve damage
  • blood tests, including a complete blood count (CBC), to rule out infection
  • a biopsy of any fluid or growths to rule out infection, tumor, or cancer

  • Prevention & Expectations

    What can be done to prevent the injury?

    Avoiding overexertion of the arms and shoulders can prevent many cases of RSI. Warming up and stretching the muscles before activity may decrease the risk. Using proper body mechanics may also lessen the risk of injury.

    Ergonomics is the practice and study of arranging work equipment to allow for more comfort and less strain on the body. There are many ergonomic products, such as wrist pads, height adjusters on keyboard holders, and wrist support braces. These products are intended to decrease the stress on muscles, tendons, tissues, and nerves of the arms.

    Taking regular breaks during repetitive activities, and doing strengthening exercises may help. Learning proper methods of sitting, positioning the feet, lifting, and bending may also decrease the risk of RSI. Many causes cannot be prevented.

    Treatment & Monitoring

    What are the treatments for the injury?

    Minor pain or injury may require RICE therapy:

  • rest or reduced activity
  • ice or cold packs applied to the affected area
  • compression of the area, such as with ace bandages or wrist splints
  • elevation
  • Nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen and naproxen, may be used to reduce inflammation and discomfort. In some cases, a corticosteroid may be injected into the affected area.

    Physical therapy or strength training exercises may help increase the strength of the tendons and muscles. Ultrasound may be used to warm the muscles and improve blood flow. If conservative treatment is not successful, surgery may be necessary.

    What are the side effects of the treatments?

    NSAIDs can cause stomach upset and allergic reactions. Surgery poses a risk of bleeding, infection, and allergic reactions to anesthesia.

    What happens after treatment for the injury?

    In mild cases of repetitive stress injury, no further treatment is needed for minor pain and inflammation. For more serious disease or injury, treatment may continue. Physical therapy and daily strengthening exercises may be recommended.

    Any new or worsening symptoms should be reported to the healthcare provider.


    Author:Eileen McLaughlin, RN, BSN
    Date Written:
    Editor:Duff, Ellen, BA
    Edit Date:10/09/00
    Reviewer:Gail Hendrickson, RN, BS
    Date Reviewed:08/09/01


    Harrison's Principles of Internal Medicine, 1998, Fauci et al.

    Complete Guide to Symptoms, Illness, and Surgery, Griffith, 2000