Diagnosis of repetitive strain injury (RSI)

Oct 08, 2018

There are no specific tests for confirmation of repetitive strain injury (RSI). Clinical features of pain and stiffness on particular movements and the progressive nature of the condition is often diagnostic of RSI.

Diagnosis is more of a challenge because pain in the muscles and joints may be caused by other diseases and injuries as well. Notable among this is accidental injury that manifests as sudden onset pain at the affected area rather than a diffuse and a longer lasting painful condition.

Process of diagnosing RSI

Steps towards diagnosis of RSI include taking a detailed history of the patient, examining the affected area and so forth. (1-4)

Detailed history of the patient

The patient provides a detailed history of:

the onset of pain
duration (this is an assumption since the symptoms are gradual in onset and patient often cannot pin point the exact time of onset)
nature of pain
swelling or inflammation
nature of work
history of repetitive activity
forceful activity
awkward or static posture or vibration exposure at work or at leisure related activities

Within the history patient provides clues as to what activity aggravates and what relieves pain. They may disclose the position and duration of rest to the affected muscle that provides relief from the pain and symptoms.

Examination of the affected area

On examination of the affected area, muscle or joint swelling, redness and tenderness is often noted. There may be weakness in the affected muscles.

For example, if the hands are affected the grip may be weakened. On movement there may be limited range of motion of the affected joint and sounds like popping or clicking.

Imaging studies

Imaging studies like X ray, MRI and CT scans are not undertaken unless surgery is contemplated or there is a suspicion of an old fracture.

On X ray stress fractures, thinning and drying up (atrophy) of the cartilage and bone avulsions (breakages) as well as calcium deposits on tendons are noted.

MRI scans help detect damage to muscles, tendons and ligaments as well as soft tissues. They also help detect pinching or compression of the nerves in certain types of repetitive stress injuries.

Electromyography (EMG) and nerve conduction studies are often prescribed to check on nerve functions in these cases.

Bone scans are sometimes required to reveal stress fractures.

Alternative diagnoses with the same symptoms

Conditions that may be confused with RSI include several musculoskeletal disorders. For example, causes of neck pain may also present with features like RSI. These include:

Spondylosis
Acromioclavicular degeneration
Suprascapular nerve compression
Supraspinatus tendonitis

In the arms and legs the following conditions may mimic RSI symptoms:

elbow degeneration
osteoarthritis
anterior cruciate laxity
pronator teres syndrome
tibialis anterior tendinopathy
tibialis posterior tendinopathy
achilles tendon injuries and tendonitis
ankle degeneration
shin splints
tarsal tunnel syndrome etc.

Laboratory studies include markers of other disorders like rheumatoid arthritis etc. to rule out conditions that mimic RSI.

RSI medical conditions

Several medical conditions may be seen as RSI. These include:

Bursitis - This is an inflammation and swelling of the fluid filled sac around knee, elbow or shoulder joints. This can occur at the knee, elbow, and shoulder and is called “beat knee”, “beat elbow” or “beat shoulder”.
Carpal tunnel syndrome - This is caused due to inflammation at the wrist leading to pinching or twisting of the median nerve passing through the wrist
Dupuytren's contracture - This is caused by thickening of deep tissue within the palms of the hand and fingers.
Epicondylitis - This commonly affects the joint between the bone and a tendon at the elbow joint. It is called tennis elbow or golfer’s elbow.
Rotator cuff syndrome - This is when there is inflammation of muscles and tendons in the shoulder
Endonitis and tenosynovitis - This involves inflammation of a tendon or the lining over it.
Ganglion cyst - This is a sac of fluid that forms around a joint or tendon, fingers or wrist.