Repetitive strain injury: Difference between revisions

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-{{Infobox disease
-| Name           = Repetitive Strain Injury
-| Image          =
-| Caption        =
-| DiseasesDB     = 11373
-| ICD10          =
-| ICD9           =
-| ICDO           =
-| OMIM           =
-| MedlinePlus    =
-| eMedicineSubj  = pmr
-| eMedicineTopic = 97
-| MeshID         = D012090
-}}
-'''Repetitive strain injury''' ('''RSI''') (also known as '''repetitive stress injury''', '''repetitive motion injuries''', '''repetitive motion disorder''' ('''RMD'''), '''cumulative trauma disorder''' ('''CT'''), '''occupational overuse syndrome''', '''overuse syndrome''', '''regional musculoskeletal disorder''') is an injury of the [[musculoskeletal]] and [[nervous system]]s that may be caused by repetitive tasks, forceful exertions, vibrations, mechanical compression (pressing against hard surfaces), or sustained or awkward positions.<ref>http://www.state.nj.us/health/eoh/peoshweb/ctdib.htm</ref>
-Types of RSIs that affect computer users may include '''non-specific arm pain'''<ref>{{Cite web|last=Teixeira |first=Tania |url=http://news.bbc.co.uk/1/hi/technology/7761262.stm |title=Technology &#124; The mouse is biting some PC users |publisher=BBC News |date=2008-12-09 |accessdate=2009-08-17}}</ref> or '''work related upper limb disorder''' ('''WRULD'''). Conditions such as RSI tend to be associated with both physical and [[psychosocial]] stressors.<ref>Macfarlane, Hunt, Silman. Role of mechanical and psychosocial factors in the onset of forearm pain: prospective population based study. BMJ. 2000</ref>
-__TOC__
-==Causes==
-RSI is caused due to lifestyle without ergonomic care {{Citation needed|date=September 2010}}, E.g. While working in front of computers, driving, travelling etc. Simple reasons like 'Using a blunt knife for everyday chopping of vegetables', could cause RSI.
-Other typical habits that lead to RSI:
-* Reading books while looking down
-* Carrying heavy school/laptop bags
-* Use of phone/mobile leaning onto one side
-* Watching TV in incorrect position e.g. Too much to the left/right. Sleeping while watching TV.
-* Sleeping with head forward, while travelling
-* Drawing/Writing to the point of unhealthiness
-* use of the hands, wrists, back, neck etc. awkwardly or excessively
-* Others
-==Illness==
-===Symptoms===
-The following complaints are typical in patients who might receive a diagnosis of RSI:<ref name="ReferenceA">{{Cite journal|author=Ring D, Kadzielski J, Malhotra L, Lee SG, Jupiter JB |title=Psychological factors associated with idiopathic arm pain |journal=J Bone Joint Surg Am |volume=87 |issue=2 |pages=374–80 |year=2005 |month=February |pmid=15687162 |doi=10.2106/JBJS.D.01907 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=15687162}}</ref>
-* Short bursts of excruciating pain in the arm, back, shoulders, wrists,  hands, or thumbs (typically diffuse – i.e. spread over many areas).
-* The pain is worse with activity.
-* Weakness, lack of endurance.
-In contrast to [[carpal tunnel syndrome]], the symptoms tend to be diffuse and non-anatomical, crossing the distribution of nerves, tendons, etc.  They tend not to be characteristic of any discrete pathological conditions.
-===Frequency===
-A 2008 study showed that 68% of UK workers suffered from some sort of RSI, with the most common problem areas being the back, shoulders, wrists, and hands.<ref>{{Cite web|url=http://www.dailymail.co.uk/health/article-1024097/Two-thirds-office-staff-suffer-Repetitive-Strain-Injury.html |title=Two thirds of office staff suffer from repetitive strain injury &#124; Mail Online |publisher=Dailymail.co.uk |date=2008-06-04 |accessdate=2009-08-17}}</ref>
-===Physical examination and diagnostic testing===
-The physical examination discloses only tenderness and diminished performance on effort-based tests such as grip and pinch strength—no other objective abnormalities are present.  Diagnostic tests ([[radiological]], [[electrophysiological]], etc.) are normal. In short, RSI is best understood as an apparently healthy arm that hurts. Whether there is currently undetectable damage remains to be established.
-==Definition==
-The term "repetitive strain injury" is most commonly used to refer to patients in whom there is no discrete, objective, pathophysiology that corresponds with the pain complaints.  It may also be used as an umbrella term incorporating other discrete diagnoses that have (intuitively but often without proof) been associated with activity-related arm pain such as [[carpal tunnel syndrome]], [[cubital tunnel syndrome]], [[thoracic outlet syndrome]], [[DeQuervain's syndrome]], [[stenosing tenosynovitis]]/[[Trigger finger|trigger finger/thumb]], [[intersection syndrome]], [[Golfer's elbow]] (medial epicondylosis), [[Tennis elbow]] (lateral epicondylosis), and [[focal dystonia]].
-Finally RSI is also used as an alternative or an umbrella term for other non-specific illnesses or general terms defined in part by unverifiable pathology such as [[reflex sympathetic dystrophy syndrome]] (RSDS), [[Blackberry thumb]], disputed [[thoracic outlet syndrome]], [[radial tunnel syndrome]], "[[gamer's thumb]]" (a slight swelling of the thumb caused by excessive use of a [[gamepad]]), "Rubik's wrist" or "cuber's thumb" (tendinitis, carpal tunnel syndrome, or other ailments associated with repetitive use of a [[Rubik's Cube]] for [[speedcubing]]), "[[stylus finger]]" (swelling of the hand caused by repetitive use of [[mobile device]]s and mobile device testing.), "Raver's wrist", caused by repeated rotation of the hands for many hours (for example while holding [[glow stick]]s during a [[rave]]).
-Although [[tendinitis]] and [[tenosynovitis]] are discrete pathophysiological processes, one must be careful because they are also  terms that doctors often use to refer to non-specific or medically unexplained pain, which they theorize may be caused by the aforementioned processes.
-==Treatment==
-On their own, most RSIs will resolve spontaneously provided the area is first given enough rest when the RSI first begins. However, without such care, some RSIs have been known to persist for years, or have needed to be cured with operations.
-The most often prescribed treatments for repetitive strain injuries are rest, exercise, braces and massage. A variety of medical products also are available to augment these therapies. Since the computer workstation is frequently blamed for RSIs, particularly of the hand and wrist, ergonomic adjustments of the workstation are often recommended.
-===Ergonomics===
-Modifications of posture and arm use ([[ergonomics]]) are often recommended.<ref>Berkeley Lab. [http://www.lbl.gov/ehs/pub811/hazards/ergonomics.html ''Integrated Safety Management: Ergonomics'']. Website. Retrieved 9 July 2008.</ref>
-[[Image:Computer Workstation Variables.jpg|thumb|240px|Ergonomics: the science of designing the job, equipment, and workplace]]
-===Adaptive software===
-{{Main|List of Repetitive Strain Injury software}}
-There are several kinds of software designed to help in Repetitive Strain Injury. Among them, there are [[speech recognition]] software, and break timers.
-Break timers software reminds the user to pause frequently and perform exercises while working behind a computer.
-There is also automated mouse-clicking software that has been developed, which can automate repetitive tasks in games and applications.
-===Adaptive hardware===
-[[Adaptive technology]] ranging from special keyboards, mouse replacements to pen tablet interfaces might help improve comfort.
-====Mouse====
-Switching to a much more ergonomic mouse, such as a roller mouse, vertical mouse or joystick, or switching from using a mouse to a stylus pen with graphic tablet may provide relief, but in chronic RSI they may only result in moving the problem to another area. Using a graphic tablet for general pointing, clicking, and dragging (i.e. not drawing) may take some time to get used to as well. Switching to a [[Touchpad|trackpad]], which requires no gripping or tensing of the muscles in the arms may help as well. Inertial mice(which do not require a surface to operate) might offer an alternative where the user's arm is in a less stressful thumbs up position rather than rotated to thumb inward when holding a normal mouse. Also, since they do not need a surface to operate ("air mice" function by small, forceless, wrist rotations), the wrist and arm can be supported by the desktop.
-====Keyboards and keyboard-alternatives====
-Exotic keyboards by manufacturers such as [[Datahand]], OrbiTouch, [[Maltron keyboard|Maltron]] and [[Kinesis (keyboard)|Kinesis]] are available. Also one can use [[digital pen]]s and [[voice recognition]].
-[[Image:DataHand Professional II Keyboard-Right.jpg|thumb|150px|right|DataHand Professional II Keyboard, right side]]
-===Medical products===
-{{refimprovesection|date=September 2010}}
-A number of medical treatments, including non-narcotic pain medications, braces, and therapy. Although some professionals consider these to be [[palliative]], others consider them to be effective.<ref name="Amadio" /><ref name="ReferenceC">Living Beyond Your Pain: Using Acceptance & Commitment Therapy to Ease Chronic Pain by Joanne Dahl and Tobias Lundgren</ref>
-Pain medications, particularly [[non-steroidal anti-inflammatory drug]]s (NSAIDs), are most often used to eliminate pain. The major problem with such drug use with RSIs is that the pain can be masked, and therefore the patient returns to the activities which strained the tissues in the first place before the tissues have had time to heal. So a balance must be struck where pain is reduced, yet not so much that the tissues will be reinjured with continued over-use.
-Medical devices are available which help the strained tissues to heal faster. Several types of devices are available, and are classified as either passive or active devices. Passive devices generally immobilize the limb allowing the body to heal itself, while active devices enhance the body's healing capacity{{Citation needed|date=September 2010}}.
-Braces, particularly wrist braces, are by far the most often used products for RSIs{{Citation needed|date=September 2010}}. They stabilize the hand and allow healing to occur without further stressing the joint. Braces are available in two basic varieties; soft (i.e., nylon fabric) and hard shell.
-===Exercise===
-Exercise decreases the risk of developing RSI.<ref>{{Cite journal|title=Work-Related Repetitive Strain Injury and Leisure-Time Physical Activity|last=Ratzlaff|first=C. R.|coauthors=J. H. Gillies, M. W. Koehoorn|journal=Arthritis & Rheumatism (Arthritis Care & Research) |volume=57 |issue=3 |year=2007 |month=April |pages=495–500 |pmid=17394178|doi=10.1002/art.22610}}</ref>
-*  Doctors{{Citation needed|date=March 2010}} sometimes recommend that RSI sufferers engage in specific strengthening exercises, for example to improve posture.
-*  In light of the fact that a lifestyle that involves sitting at a computer for extended periods of time increases the probability that an individual will develop excessive [[kyphosis]], theoretically the same exercises that are prescribed for [[thoracic outlet syndrome]] or kyphotic postural correction would benefit an RSI sufferer.<ref>Carolyn Kisner & Lyn Allen Colby, Therapeutic Exercise: Foundations and Techniques, at 473 (5th Ed. 2007).</ref>
-*  Some sources{{who}} recommend motoric exercises and ergo-aerobics to decrease chances of strain injury. Ergo-aerobics target touch typists and people who often use computer keyboard.
-===Resuming normal activities despite the pain===
-Psychologists Tobias Lundgren and Joanne Dahl have asserted that, for the most difficult chronic RSI cases, the pain itself becomes less of a problem than the disruption to the patient's life caused by
-*   avoidance of pain-causing activities
-*   the amount of time spent on treatment
-They claim greater success from teaching patients psychological strategies for accepting the pain as an ongoing fact of life, enabling them to cautiously resume many day-to-day activities and focus on aspects of life other than RSI.<ref name="ReferenceC"/>
-==Psychosocial factors==
-===Population studies===
-Studies have related RSI and other upper extremity complaints with psychological and social factors. A large amount of psychological distress showed doubled risk of the reported pain, while job demands, poor support from colleagues, and work dissatisfaction also showed an increase in pain, even after short term exposure.<ref name=Nahit_2001>{{Cite journal|author=Nahit ES, Pritchard CM, Cherry NM, Silman AJ, Macfarlane GJ |title=The influence of work related psychosocial factors and psychological distress on regional musculoskeletal pain: a study of newly employed workers |journal=J. Rheumatol. |volume=28 |issue=6 |pages=1378–84 |year=2001 |month=June |pmid=11409134 |url=http://www.jrheum.org/cgi/pmidlookup?view=long&pmid=11409134}}</ref>
-For example, the association of [[Carpal tunnel syndrome]] with arm use is commonly assumed but not well-established.<ref>{{Cite journal|author=Lozano-Calderón S, Anthony S, Ring D |title=The quality and strength of evidence for etiology: example of carpal tunnel syndrome |journal=J Hand Surg Am |volume=33 |issue=4 |pages=525–38 |year=2008 |month=April |pmid=18406957 |doi=10.1016/j.jhsa.2008.01.004 |url=http://linkinghub.elsevier.com/retrieve/pii/S0363-5023(08)00008-7}}</ref> Typing has long been thought to be the cause of carpal tunnel syndrome,<ref>{{Cite journal|author=Scangas G, Lozano-Calderón S, Ring D |title=Disparity between popular (Internet) and scientific illness concepts of carpal tunnel syndrome causation |journal=J Hand Surg Am |volume=33 |issue=7 |pages=1076–80 |year=2008 |month=September |pmid=18762100 |doi=10.1016/j.jhsa.2008.03.001 |url=http://linkinghub.elsevier.com/retrieve/pii/S0363-5023(08)00281-5}}</ref> but recent evidence suggests that, if anything, typing may be protective.<ref>{{Cite journal|author=Atroshi I, Gummesson C, Ornstein E, Johnsson R, Ranstam J |title=Carpal tunnel syndrome and keyboard use at work: a population-based study |journal=Arthritis Rheum. |volume=56 |issue=11 |pages=3620–5 |year=2007 |month=November |pmid=17968917 |doi=10.1002/art.22956 |url=http://www3.interscience.wiley.com/journal/116835897/abstract }}</ref> Another study claimed that the primary risk factors for Carpal tunnel syndrome were "being a woman of menopausal age, obesity or lack of fitness, diabetes or having a family history of diabetes, osteoarthritis of the carpometacarpal joint of the thumb, smoking, and lifetime alcohol intake."<ref>{{Cite journal|author=Falkiner S, Myers S |title=When exactly can carpal tunnel syndrome be considered work-related? |journal=ANZ J Surg |volume=72 |issue=3 |pages=204–9 |year=2002 |month=March |pmid=12071453 |url=http://www3.interscience.wiley.com/resolve/openurl?genre=article&sid=nlm:pubmed&issn=1445-1433&date=2002&volume=72&issue=3&spage=204 |doi=10.1046/j.1445-2197.2002.02347.x}}</ref>
-===Psychological exacerbation of symptoms===
-There are three common mechanisms, by which a normally functioning human mind increases pain and pain-related disability.
-* Psychological distress (depression and anxiety) make pain seem worse.<ref>{{Cite journal|author=Ring D, Kadzielski J, Fabian L, Zurakowski D, Malhotra LR, Jupiter JB |title=Self-reported upper extremity health status correlates with depression |journal=J Bone Joint Surg Am |volume=88 |issue=9 |pages=1983–8 |year=2006 |month=September |pmid=16951115 |doi=10.2106/JBJS.E.00932 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=16951115 |format=}} {{Dead link|date=June 2010}}</ref> Chronic pain, regardless of its source, leads to a cycle of increasing depression and reduced physical activity. Reduced physical activity reduces pain in the short term but increases it in the long term.<ref>Turk and Winter. The Pain Survival Guide: How to Reclaim Your Life</ref>
-* Misinterpretation or over-interpretation of pain signals. Psychologists refer to this as pain catastrophizing (the tendency to think the worst when one feels pain),<ref name="ReferenceA"/> and it is worsened by reliance on patient support groups and internet sites for diagnosis.<ref>{{Cite book|author=Taylor, Steven J.; Asmundson, Gordon J. G. |title=It's Not All in Your Head: How Worrying about Your Health Could be Making You Sick—and What You Can Do about It |publisher=The Guilford Press |location=New York |year=2005 |isbn=1-57230-993-8 }}</ref> [[Pain#Gate_Control|Gate Control Theory]], part of the most accepted medical theory of pain, states that, when we are worried about a particular body part, the brain can actually signal to the spinal cord (via outgoing neurons) that it should be more apt to interpret nerve impulses from that body part as pain and pass them on to the brain.<ref>Brannon and Feist. Health Psychology: An Introduction to Behavior and Health</ref> In patients with chronic arm pain, the brain may even learn to automatically trigger pain whenever the limb is moved, as a defense mechanism to prevent further movement<ref>page 193. The Brain That Changes Itself: Stories of Personal Triumph from the Frontiers of Brain Science.</ref>
-* A sense that something is seriously wrong that does not lessen with normal test results and reassurance from health professionals.<ref name="autogenerated1"/>  Psychologists call this heightened illness concern or health anxiety. (This is commonly seen in psychosomatic illnesses.<ref name="ReferenceB">{{Cite book|author=Shorter, Edward |title=From Paralysis to Fatigue: A History of Psychosomatic Illness in the Modern Era |publisher=Free Press ; Toronto : Maxwell Macmillan Canada ; New York : Maxwell Macmillan International |location=New York |year=1992 |isbn=0-02-928665-4 }}</ref>) The typical RSI patient presents with a strong intuition that their pain indicates existing and ongoing tissue damage.<ref name="autogenerated1">{{Cite journal|author=Vranceanu AM, Safren S, Zhao M, Cowan J, Ring D |title=Disability and psychologic distress in patients with nonspecific and specific arm pain |journal=Clin. Orthop. Relat. Res. |volume=466 |issue=11 |pages=2820–6 |year=2008 |month=November |pmid=18636306 |pmc=2565030 |doi=10.1007/s11999-008-0378-1}}
-</ref> One explanation is that they have a strong "pain alarm"—pain tends to be accepted as a sign of danger and they have difficulty modulating this intuitive uneasiness with pain.<ref name="ReferenceA"/>
-===Psychosomatic cases===
-Some doctors and medical researchers believe that stress is the main cause, rather than a contributing factor, of a large fraction of pain symptoms usually attributed to RSI. The most famous advocate of this point of view, Dr. [[John E. Sarno]], Professor of Rehabilitation Medicine at the [[New York University Medical School]] considers that RSI, back pain, and other pain syndromes, although they sometimes have a physical cause, are more often a manifestation of [[tension myositis syndrome]], a psychogenic disorder in which stress causes the autonomic nervous system to reduce blood flow to muscles, causing pain and weakness.<ref name=Sarno_2006>{{Cite book| last = Sarno | first = John E | title = The Divided Mind: The Epidemic of Mindbody Disorders | publisher = Regan Books | year = 2006 | isbn = 978-0060851781}}</ref>
-RSI shares many characteristics with known psychosomatic disorders:
-*   Freud and other psychiatrists believe that diffuse, difficult to describe symptoms likely indicated a psychosomatic root cause for an illness, especially if they moved around the body.<ref name="ReferenceB"/> (Only some RSI cases fit this description.)
-*   Psychosomatic illnesses typically display symptoms whose origins are unverifiable but which seem consistent with the time period's understanding of physical (non-psychosomatic) disease processes. When an objective test invented which is able to prove the psychosomatic origins of a specific illness, that illness typically disappears and is replaced by new, undiagnosable sets of symptoms.<ref name="ReferenceB"/>
-*   Patients and their advocates usually reject the suggestion that their disease may be non-physical in origin. Doctors frequently avoid giving psychosomatic diagnosis, for fear of angering patients or prompting them to switch doctors.<ref name="ReferenceB"/> "Psychosomatic" is often misunderstood to mean "faking it" or "imaginary".<ref name="ReferenceB"/> Other psychosomatic diseases have been known to cause severe pain, paralysis, seizures,<ref name="ReferenceB"/> observable physical damage, even death.<ref>The science of voodoo: When mind attacks body. New Scientist. 2009</ref>
-A common theme among different subtypes of RSI is a stigmatization and demonization of hand use.  Illness concepts that stigmatize hand use have the potential to create more illness as well-documented in the experience with the Australian RSI epidemic.<ref name="Amadio">{{Cite journal|author=Amadio PC |title=Repetitive stress injury |journal=J Bone Joint Surg Am |volume=83-A |issue=1 |pages=136–7; author reply 138–41 |year=2001 |month=January |pmid=11205849 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=11205849}}</ref> RSI was first diagnosed in Australia in the 1980s. (Only later was it diagnosed in the US and Britain.) In the early Australian experience, RSI cases increased rapidly over several years, leading to widespread media coverage and worker protests. After a widely publicized court case in which a judge ruled an alleged RSI victim had no bodily injury and could not receive damages, complaints dropped off rapidly. Many observers felt that the media coverage and social mobilization against the epidemic had actually helped spread it by causing psychosomatic symptoms in worried workers.<ref>{{Cite book|author=Lucire, Yolande |title=Constructing RSI: Belief and Desire |publisher=University of New South Wales Press |location=Sydney |year=2003 |isbn=0-86840-778-X }}</ref> This pattern has been seen in other psychosomatic illnesses.<ref name="ReferenceB"/>
-==See also==
-* [[List of Repetitive Strain Injury software]]
-* [[Carpal tunnel syndrome]]
-==Footnotes==
-{{Reflist}}
-==References==
-;References that support or promote use of the physical illness concept of RSI
-* ''Repetitive Strain Injury: A Computer User's Guide''; Emil Pascarelli and Deborah Quilter (ISBN 0-471-59533-0)
-* ''It's Not Carpal Tunnel Syndrome! RSI Theory and Therapy for Computer Professionals''; Suparna Damany, Jack Bellis (ISBN 0-9655109-9-9)
-* ''Conquering Carpal Tunnel Syndrome & Other Repetitive Strain Injuries, A Self-Care Program''; Sharon J. Butler (ISBN 1-57224-039-3)
-* ''The Trigger Point Therapy Workbook: Your Self-Treatment Guide for Pain Relief, Second Edition''; Clair Davies, Amber Davies (ISBN 1-57224-375-9)
-* ''Electromyographic Applications in Pain, Physical Medicine and Rehabilitation: Repetitive Strain Injury Computer User Injury With Biofeedback: Assessment and Training Protocol''; Erik Peper, Vietta S Wilson et al.  The Biofeedback Foundation of Europe, 1997
-* {{Cite journal|author=van Tulder M, Malmivaara A, Koes B |title=Repetitive strain injury |journal=Lancet |volume=369 |issue=9575 |pages=1815–22 |year=2007 |pmid=17531890 |doi=10.1016/S0140-6736(07)60820-4}}
-;References that are cautious about the use of the physical illness concept of RSI
-* {{Cite journal|author=Szabo RM, King KJ |title=Repetitive stress injury: diagnosis or self-fulfilling prophecy? |journal=J Bone Joint Surg Am |volume=82 |issue=9 |pages=1314–22 |year=2000 |month=September |pmid=11005523 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=11005523}} Review.
-* {{Cite journal|author=Ring D, Guss D, Malhotra L, Jupiter JB |title=Idiopathic arm pain |journal=J Bone Joint Surg Am |volume=86-A |issue=7 |pages=1387–91 |year=2004 |month=July |pmid=15252084 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=15252084}}
-* {{Cite journal|author=Quintner JL |title=The Australian RSI debate: stereotyping and medicine |journal=Disabil Rehabil |volume=17 |issue=5 |pages=256–62 |year=1995 |month=July |pmid=7626774 |doi=10.3109/09638289509166644 }}
-* {{Cite journal|author=Hall W, Morrow L |title='Repetition strain injury': an Australian epidemic of upper limb pain |journal=Soc Sci Med |volume=27 |issue=6 |pages=645–9 |year=1988 |pmid=3227370 |doi=10.1016/0277-9536(88)90013-5 }}
-* Lucire Y. Constructing RSI: Belief and Desire.  University of New South Wales Press. 2001
-* {{Cite journal|author=Brooks P |title=Repetitive strain injury |journal=BMJ |volume=307 |issue=6915 |pages=1298 |year=1993 |month=November |pmid=8257882 |pmc=1679411 |doi=10.1136/bmj.307.6915.1298 }}
-==External links==
-* {{dmoz|Health/Conditions_and_Diseases/Musculoskeletal_Disorders/Repetitive_Strain_Injuries/|Repetitive Strain Injuries}}
-* [http://osha.europa.eu/topics/msds Musculoskeletal disorders] from the European Agency for Safety and Health at Work ([[EU-OSHA]])
-* [http://www.workrave.org/ Workrave] application for prevention of RSI
-* {{Cite journal|author=Amadio PC |title=Repetitive stress injury |journal=J Bone Joint Surg Am |volume=83-A |issue=1 |pages=136–7; author reply 138–41 |year=2001 |month=January |pmid=11205849 |url=http://www.ejbjs.org/cgi/pmidlookup?view=long&pmid=11205849}}
-* [http://www.rsi.deas.harvard.edu/ Harvard RSI Action]
-* [http://www.eecs.umich.edu/~cscott/rsi.html Prevention and Management of Repetitive Strain Injury]
-* [[My work, my sorrow]], a documentary on RSI in France today
-{{Use dmy dates|date=September 2010}}
-{{DEFAULTSORT:Repetitive Strain Injury}}
-[[Category:Disability]]
-[[Category:Musculoskeletal disorders]]
-[[Category:Occupational diseases]]
-[[Category:Overuse injuries]]
-[[cs:Repetitive strain injury]]
-[[de:Repetitive Strain Injury Syndrom]]
-[[es:Enfermedad profesional#Enfermedades osteomusculares]]
-[[eo:Trouza braka malsano]]
-[[fr:Troubles musculosquelettiques]]
-[[ko:반복사용긴장성손상증후군]]
-[[hi:पुनरावृत्त तनाव क्षति]]
-[[it:Repetitive Strain Injury]]
-[[he:פציעת מאמץ חוזרני]]
-[[nl:Repetitive strain injury]]
-[[pl:RSI (choroby)]]
-[[pt:Lesão por esforço repetitivo]]
-[[simple:Repetitive Strain Injury]]
-[[sv:Musarm]]
-[[zh:重複使力傷害]]