Work Related RSI No diagnosis Discussion

Many patients have the the impression that their problems represent an injury sustained by performing repetitive activities at work. Work related repetitive strain injury is also referred to as cumulative trauma disorder, fibrositis, as well as a number of similar descriptive names. The syndrome is commonly used to refer to symptoms due to excessive use of the upper extremity. It is a poorly defined condition which lacks a precise definition and is not based on any objective findings or assessment. Many patients reporting repetitive strain injury do not have any diagnosable condition involving the upper extremity, and there is not a preponderance of scientific evidence that tenosynovitis, tennis elbow, carpal tunnel syndrome, or in fact any other diagnosable condition has resulted from repetitive activity in an otherwise healthy individual trained to perform such work. There is current debate as to whether or not a repetitive strain syndrome exists at all. A recent hand surgery publication reports "...the patients who are labelled with a repetitive strain injury or cumulative trauma disorder do not have a uniformity of clinical presentation, with the exception of pain and, that they do not like their jobs...." Many disorders ascribed to repetitive activities are simply common in the general population, with incidence determined by age, sex, and body constitution rather than activity or occupation. Patients who have painful medical disorders of the upper extremity may be more aware of their symptoms while engaged in a work-related posture or activity, but this is not credible evidence of causation. Mislabeling a patient's complaints and mistakenly relating these complaints to a work injury work is harmful, particularly when complaints are ill defined. The prognosis for undefined pain syndromes such as fibrositis is worsened when the cause is related to work, as summarized in this comparison modified from Littlejohn (1989):


Non-Work related

Work related


Usually straightforward

Often delayed







Perceived cause


Stress Injury

Peer influence



Effect of compensation



The diagnosis of repetitive strain syndrome is associated with an increased risk for failure to return to work following surgery. Brief conservative management is often ineffective. Even with complete rest, patients may require months or years to recover enough to return to their prior occupation, and may be unable to return at all. Factors relating to the global work environment often play a more important role than ergonomic details, and change of employment may be the most reasonable effective intervention.

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