KEYTOOLS LTD. PO Box 700. Southampton. SO17 1LQ Telephone: 023 8058 4314 Email: rsia@keytools.com. Web: www.keytools.com REPETITIVE STRAIN INJURY AWARENESS RSI A Epicondylitis RSI Conditions The term Repetitive Strain Injury is an umbrella term used to describe a number of specific
musculoskeletal conditions, including epicondylitis, as well as diffuse RSI, which is more difficult
to define but which recent research attributes to nerve damage. These conditions are often
occupational in origin. Lack of adequate diagnosis or access to appropriate treatment can
exacerbate the condition and sometimes leads to job loss and economic hardship. What is Epicondylitis? Epicondylitis is a common and well defined condition affecting the elbow. It is characterised by
pain at the epicondyle, the bony parts on the inside and outside of the elbow joint. It appears
under many names and is commonly known as Tennis Elbow in the lateral aspect (outside) and
Golfers Elbow in the medial aspect (inside). Epicondylitis is the result of some kind of muscle
lesion or inflammation of tendons at the point where they attach to the bone. It has nothing to do
with arthritis or any other disease. The Symptoms Epicondylitis usually starts with an ache in the forearm and the pain will feel worse with gripping or
twisting movements. Certain sports or work activities may also cause discomfort. When the syndrome
has existed for some time, there may be a constant, dull aching of the elbow or even sharp pain.
Occasionally, pain radiates to the middle and ring fingers. Aching may increase in the evening, with
elbow stiffness in the morning on awakening. There is no noticeable swelling, and no catching or lock-
ing of the elbow. The Causes Often Epicondylitis is caused by repeated strain on the muscles of the forearm that extend the
wrist and fingers. Twisting or extension of the arm during work activities, e.g. VDU use or routine
assembly line work, may strain these muscles and irritate their attachment at the elbow. Tennis
Elbow is not restricted to leisure activities and tears in the tendon can also result from carrying
a heavy load with the arm extended and palm towards the floor. Any sudden period of physical
activity could cause a degeneration of the tendon. In rare instances, a direct blow to the elbow
may cause this condition. It is often difficult to decide whether Epicondylitis is work-related and
it is important to differentiate from symptoms caused by local nerve entrapment or referred
shoulder and neck pain. The Doctors Examination In the UK, GPs receive little training in the diagnosis and treatment of musculoskeletal disorders.
Ideally your doctor will refer you to a specialist who has taken an interest in RSI-type conditions,
usually a rheumatologist or neurologist. Examination of the effected elbow will usually reveal
tenderness and discomfort when direct pressure is applied to this area, specifically the epicondyle.
No other special diagnostic criteria exist. Treatment The type of treatment will depend upon the severity and length of time the condition has been present.
Initial treatment of epicondylitis involves limiting the activities which place a strain on the muscles and
tendons of this region. Most commonly you will be advised to return to work after a period of rest. You
may be offered anti-inflammatories or a local cortisone injection to reduce pain, though these treat-
ments alone are usually unsatisfactory. Though each case has to be considered individually and non-occupational factors should also be inves-
tigated, generally some changes will be needed at work. Areas to consider include pacing, rest breaks,
reducing repetition and force, posture, and the use of ergonomically designed tools and equipment to
reduce the risk of further injury. In rare cases surgery may be recommended. An incision is made on the outside of the elbow, and the
surgeon will explore the tendon origin and take the appropriate steps to remove degenerative tissue.
However, recovery rates vary and, before undergoing an operation, other alternative forms of treatment
should be considered, including physiotherapy or deep tissue massage. For more detailed advice,
please refer to the RSI Association Information sheet RSI Its Nature and Treatment.