ConditionBones, joints & muscles
Repetitive Strain Injury (RSI)
Repetitive strain injury (RSI) is an umbrella term for pain and dysfunction in muscles, tendons and nerves caused by repeated movements, sustained awkward postures or overuse. It most often affects the hands, wrists, forearms, elbows, neck and shoulders of people who type, use a mouse, work on assembly lines, play instruments or do sports. Specific RSIs include carpal tunnel syndrome, tennis elbow, de Quervain's tenosynovitis and trigger finger. Early changes to tasks and workstations, rest breaks and physical therapy prevent most from becoming long-term.
Also called: RSI, cumulative trauma disorder, work-related upper limb disorder, overuse injury, occupational overuse syndrome
At a glance
- What it is
- Pain and dysfunction from repetitive motion, forceful or awkward postures, and sustained positions.
- Common sites
- Wrists, hands, forearms, elbows, neck and shoulders.
- Specific types
- Carpal tunnel syndrome, tennis and golfer's elbow, de Quervain's tenosynovitis, trigger finger, tendinitis, cubital tunnel syndrome.
- Symptoms
- Aching, burning or sharp pain, stiffness, tingling, numbness, weakness, worse with the activity.
- Treatment
- Modify tasks, ergonomic changes, breaks, splints, physical therapy, pain relief, injections and occasionally surgery.
When to get help
See a doctor within a day or two
- Sudden severe weakness, loss of grip or inability to move fingers
- Hot, red, swollen joint or tendon area with fever
- Numbness or weakness that is rapidly worsening
Book a routine appointment
- Pain, tingling or numbness in the hand, wrist or arm that lasts more than 2 weeks or keeps returning with work
- Night-time numbness in the thumb, index and middle fingers
- Dropping things, reduced grip strength or clumsiness
- Symptoms affecting your ability to work
Usually safe to manage at home
- Mild aching after a long day of typing or manual work that settles overnight, managed with breaks, stretches and workstation changes
How RSI develops
Repeated movements and static postures cause small amounts of strain to tendons, muscles and nerves. When recovery time between bouts of activity is too short, tissue damage accumulates, causing tendon degeneration (tendinopathy), inflammation of tendon sheaths (tenosynovitis), muscle fatigue and nerve compression.
Risk factors
Task factors
- high repetition with little variation
- forceful gripping or pinching
- awkward postures: bent wrists, raised elbows, neck flexed
- sustained static positions
- vibration from power tools
- working without breaks or under time pressure
Workstation factors
- keyboard or mouse at the wrong height
- screen too low, high or far away
- chair without support
- small or heavy tools
Personal factors
- sudden increase in workload or a new task
- poor fitness
- diabetes, hypothyroidism, rheumatoid arthritis and pregnancy (especially for carpal tunnel syndrome)
- stress and anxiety, which increase muscle tension and pain perception
Common types of RSI
| Condition | Location | Key symptoms |
|---|---|---|
| Carpal tunnel syndrome | Wrist, median nerve | Numbness and tingling in thumb, index and middle fingers, worse at night |
| Tennis elbow | Outer elbow | Pain on gripping and lifting with palm down |
| Golfer's elbow | Inner elbow | Pain on gripping and wrist bending |
| De Quervain's tenosynovitis | Thumb side of wrist | Pain on thumb and wrist movement, common in new parents |
| Trigger finger | Base of finger | Catching, locking and clicking |
| Cubital tunnel syndrome | Elbow, ulnar nerve | Numbness in ring and little fingers |
| Wrist tendinitis | Wrist | Aching and swelling with use |
| Rotator cuff tendinopathy | Shoulder | Pain with overhead work |
| Nonspecific RSI | Forearm, neck, shoulder | Diffuse aching without a single diagnosis |
Symptoms
- aching, burning, throbbing or sharp pain
- stiffness and tightness
- tingling or numbness
- weakness, reduced grip and clumsiness
- cramp
- symptoms that start during the activity, then persist after, then become constant if untreated
Diagnosis
A doctor or physical therapist takes a work and activity history and examines the affected area, using specific tests (such as Phalen's and Tinel's tests for carpal tunnel). Additional tests may include:
- nerve conduction studies for nerve compression
- ultrasound for tendon problems
- X-rays to exclude arthritis
- blood tests for diabetes, thyroid disease or inflammatory arthritis
Treatment
Modify the activity
- reduce repetition, force and duration where possible
- vary tasks and take microbreaks every 20 to 30 minutes
- avoid sustained bent-wrist positions
Ergonomic adjustments
- keyboard and mouse at elbow height, wrists straight
- screen at eye level, about an arm's length away
- chair with lumbar support, feet flat
- consider a vertical mouse, split keyboard, voice dictation and keyboard shortcuts
- use tools with larger grips and anti-vibration features
Medical treatment
- splints: wrist splints at night for carpal tunnel, thumb splints for de Quervain's
- physical therapy: stretching, strengthening and nerve gliding exercises
- pain relief: ice for acute pain, heat for stiffness, acetaminophen (paracetamol) or NSAIDs, following the label dose. Topical NSAID gels for tendon pain
- corticosteroid injections for carpal tunnel, de Quervain's and trigger finger
- surgery for persistent nerve compression or tendon problems not responding to other treatment
Return to work
Early, graded return to work with adjusted duties is usually better than prolonged time off. Employers in the US have duties under OSHA to address ergonomic hazards, and many offer workstation assessments.
Outlook
Most RSIs improve within weeks to months when caught early and the causes are addressed. Symptoms ignored for a long time can become chronic and harder to treat.
Frequently asked questions
What are the symptoms of repetitive strain injury?
Common symptoms are aching, burning or sharp pain, stiffness, tingling, numbness, weakness and cramp in the hands, wrists, forearms, elbows, neck or shoulders, usually worse during or after the repetitive activity.
What causes RSI?
RSI is caused by repeated movements, forceful gripping, awkward or static postures, vibration and too little rest between tasks. Typing, mouse use, assembly work, instrument playing and some sports are common triggers.
How do you treat repetitive strain injury?
Treatment includes modifying or reducing the activity, improving workstation ergonomics, taking regular breaks, wearing splints, physical therapy and pain relief. Steroid injections or surgery are used for specific conditions that do not improve.
How long does RSI take to heal?
Mild RSI often improves within a few weeks of changing activities. More established cases can take several months. Long-standing symptoms may need specialist treatment, so early action helps.
Can typing cause carpal tunnel syndrome?
Keyboard and mouse use can contribute to wrist and hand symptoms, though the link with carpal tunnel syndrome is weaker than for forceful, vibrating manual work. Good wrist posture and breaks reduce symptoms.
Sources
This guide was written from current patient and clinical guidance, including:
- Occupational Safety and Health Administration (OSHA): Ergonomics
- CDC/NIOSH: Work-related musculoskeletal disorders
- NHS: Repetitive strain injury (RSI)
- American Academy of Orthopaedic Surgeons (OrthoInfo): Carpal tunnel syndrome; Tennis elbow
- Health and Safety Executive (UK): Upper limb disorders