Thursday, August 28, 2008

Repetitive Strain Injury RSI, Carpal Tunnel Syndrome CTS

Repetitive Strain Injury (RSI) became first Work Related Upper Limb Disorder (WRULD) and now Carpal Tunnel Syndrome (CTS). CTS is good news for private doctors, it comes with tests, and an operation. This offers a chance to generate waiting lists, consultation fees, investigations, second opinions, surgery and anaesthetists fees.

Carpal Tunnel syndrome is just the latest and most lucrative name for RSI. Other names include De Quervains synovitis when it is so bad the tendon "crackles", but don't forget, golfer's elbow, tennis elbow, sometimes frozen shoulder, dystonia (Awkward movements), writers' cramp, and good old myalgia (Pain in the muscles). In truth these conditions all have the same underlying cause.

The results are stiff, painful, swollen muscles in the hands, arms, shoulders and neck. The swelling in the arms puts pressure on the nerves. The Carpal Tunnel is literally a tunnel through which the nerves and tendons to the hands go through, the swelling causes pressure, and pain. Surgeons are tempted to relieve the pain by operating on the Carpal Tunnel.
a) no one knows what happens in the long term when a youngster has this surgery. It reminds me of the enthusiasm with which cartilages were removed from knees in the 1970s an 1980s and the knee pain and osteoarthritis which inevitably followed in the 1990s and 2000s .
b) It does not treat the cause, just one symptom.

This is the One Minute Medicine approach to RSI

1) RSI is caused by repeating one action or activity or a limited range of activities. Any activity done often enough, can cause RSI. From counting tickets, running on running machines (yes any limb, any activity - it used to be called "shin splints"), writing, data entry, to good old typing.

2) Hard working types get RSI. People going for the Word Speed Record, or Ticket Counting Tally. It is not a condition for idlers or the faintheartedly. Their enthusiasm means they ignore the first warning signs of pain and stiffness and wait until it becomes seriously painful.

3) RSI causes pain and stiffness in all of the muscles of the arms, shoulders and neck. The person is usually tense and rigid, and highly focused on work, and they do not notice the pain that this causes. This may be the only exercise they get. Wrists, hands and shoulders are stiff, often on both side and he or she can never pinch their shoulder blades together at the back.
The First step
Stop or reduce the activity - that is complete rest until pain goes and then start from scratch gradually increasing the activity with frequent breaks. This may be every ten minutes to at the beginning

Then Treatment is three fold

1) Find ways to avoid typing such as -

a) Voice recognition software, but it can be difficlt to train a computer and you have to speak to it slowly
b) Dictate the reports and get them back from India four hours later, ready for editing - for example,

2) Do the it differently -

a) work station assessments to make sure the person's posture is correct,
b) wrist rests and other aids, to make sure the person keeps their joints in a neutral position. For example, Track Balls instead of mice, big pens that are easier to grip and so on.
c) change your typing position - most of learn to type in a hit or miss sort of a way. A proper old fashioned typing coure can help someone unlearn bad habits and learn to type better and more effectively

The neutral position is the most efficient way to work a muscle and joint. Extending or stretchig to work at a distance from the body means that the muscles do not work efficiently. This causes pain quicker than if the joint or limb is held in a comfortable neutral position.

3) Loosen up !

a) Physiotherapists are best at managing RSI. They intuitively understand that all parts, wrists, arms, shoulders and neck need treating. Physio is essential if you want to solve the problem and prevent it coming back
b) learn to fidget rather than sit still - stretch and shake yourself out every few minutes, change positions, shrug your shoulders, keep moving!
c) do different physical activities - like dance, yoga, pilates, Alexander technique, different sports, gardening and other outdoor pursuits, rather than just the gym. Do a different type of exercise every day.
d) learn to relax and enjoy the day, rather than keep trying to chase your tail faster and faster - the harder you chase your tail, the faster it moves. Do things differently!
e) Quick exercise = Roll your shoulders forwards, Roll your shoulder backwards and shake your arms out! 10 of each every twenty minutes as required.

None of this suggests surgery. I wrote this post because this morning, I saw a young girl heading for surgery for her "Carpal Tunnel Syndrome". I was left wondering why after millions of years of evolution, and some of the finest biological design work imagineable, does a person suddenly need their wrists cut open in order to lead a normal life?

Copyright (c) Dr. Liz Miller

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