Ouch on a limb

Repetitive Strain Injury affects many people from keyboard users to gamekeepers. And until the condition is recognised by employers, it is likely to claim more victims

IT HAS long cast a shadow over writers, typists, and other office workers. Even Shakespeare was said to have suffered from a form of Repetitive Strain Injury (RSI). But the image of this potentially crippling condition as a white-collar syndrome is inaccurate.

Many professions have their own name for RSI. Sausage-Maker's Wrist, Kangaroo Paw and Breast Augmenter's Arm all describe the characteristic aches and pains of the upper limbs, particularly the wrist, hand and arm, but also in the shoulder and neck. Any job or activity involving repetitive action can contribute: sufferers range from factory workers to gamekeepers to office workers. RSI - or more accurately, upper-limb disorder - is now a significant occupational health issue.

At least half a million British people are thought to suffer from work-related upper-limb disorders, which costs industry an estimated #3 billion a year. According to recent figures from the European Agency for Health and Safety at Work, the primary cause of absenteeism is now musculo-skeletal disorders - an umbrella term for upper-limb disorders and back pain. Without treatment, they can lead to serious disability, but the problem could be reduced with a few simple changes to the working environment - such as the enforcement of regular breaks, small additions to machinery or the ability to vary tasks.

Upper-limb disorders tend to be brought on by any repetitive actions carried out over a long period of time, often when combined with stress. Overuse of the wrist, elbow and shoulder joints - particularly the carpal tunnel area of the wrist - can cause friction between the network of nerves, tendons and ligaments which pass through those areas, resulting in muscle damage or tendon inflammation. Scientists also believe some upper-limb disorders may be linked to hormones, as they are common in menopausal women.

Yet many people suffer the symptoms of upper-limb disorders in silence because employers do not understand the condition sufficiently. In the worst cases, they may simply make an employee redundant if a complaint is made.

Another problem is that the term covers some 22 known strains and can be very difficult to diagnose. Some, such as Carpal Tunnel Syndrome and Vibration-Induced White Finger Syndrome have distinct symptoms; but other forms are simply characterised by pain and discomfort in the upper limbs. Often, these have no visible signs, which creates a major problem for employees trying to claim compensation. Inaccurate diagnosis can often make the disorder worse, if the wrong treatment is given or the problem simply worsens.

From the peaceful workstation of his home in Edinburgh, ergonomist Rod Graves has designed a series of flowcharts and checklists to help GPs match up patients' symptoms with the most appropriate upper-limb disorder. "It is important that you get an accurate diagnosis that you can manage well," notes Graves, who also advises employers on solutions to improve the working conditions of their staff. "If it is exacerbated by the work you have a chance to change the work environment. So hopefully you'll have a better approach to identifying problems and risks."

Treatment can be a long process, however. The most important advice is to take a break from the work or activity causing the disorder, then attempt to relieve the blockage. That often involves physiotherapy, sometimes in conjunction with anti-inflammatories or analgesics. Patients can also be referred to an orthopaedic surgeon, rheumatologist or neurologist. Once the condition has improved, regular exercise helps to maintain blood flow in the damaged area.

An upper-limb disorder is a chronic problem which must be carefully managed to avoid a relapse. Returning to the same repetitive job which caused it will only bring on the symptoms again. The workstation must be adapted to place as little strain on the body as possible - but this may be a simple matter of rearranging equipment slightly, raising or lowering a chair. Adding small variations to the old working routine can help, such as swapping the computer mouse between the left and right hands, and taking regular breaks - even just for a few minutes to relax limbs and eyes - is essential. Office workers can install software on their computer which reminds them to take a break.

But until employers take an active stance in trying to prevent upper-limb disorder, more people are doomed to develop the condition. At a helpline run by the RSI Association the small staff handles some 3000 calls a year, and the numbers are rising. Director Andrew Chadwick says that overwork is the main problem. "People don't really get regular breaks, not the ones who come to us. What we're saying is: if you acknowledge that a car breaks down because you're overworking it, you must accept that can apply to human beings as well. So if you want to keep up production and meet those deadlines, you're going to have to back off a bit."

RSI Helpline: 0800 018 5012 Professor Rod Graves: 0131 451 5095

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