Protect Your Hands Against Repetitive Stress Injuries

By Mark Hendrickson, M.D., Head, Section of Hand Surgery

Hands are a complex array of nerves, muscles, tendons and bones—we have more than 25 bones in each hand! Hands are engineering marvels that enable us to move our fingers in ways machines cannot match. Yet those very components that enable us to play the piano or simply to get dressed also make our hands susceptible to numerous injuries, particularly repetitive strain injuries (RSI). Although not life threatening, these injuries, such as carpal tunnel syndrome, tendonitis and bursitis, can be painful and debilitating.

Q: What types of repetitive strain injuries are most common?

A: Tendonitis, an inflammation of the tendons, is the most common repetitive use injury we treat. Tendons connect muscle to bones, and they can be inflamed or injured along their course by repetitive movements. “Trigger finger” and “tennis elbow” are two common maladies that are actually tendonitis. Uncommonly, tendonitis is caused by a disease.

Q: What are the symptoms of repetitive use injury?

A: In addition to pain, other common symptoms can include swelling, tingling, numbness, stiffness, weakness and sensitivity to cold or heat.

Q: How soon should I seek treatment if I suspect a repetitive strain injury?

A: Don’t wait until the pain and functional loss is severe. In other words, if pain and loss of function are limiting your activities, seek medical help immediately. Even if you are experiencing mild discomfort and dysfunction, you may want to look at modifying your activities or work techniques to reduce further injury.

Q: Should a patient with a hand injury see a plastic hand surgeon or an orthopaedic hand surgeon?

A: Hand surgeons can be trained primarily as general, plastic or orthopaedic surgeons. The history of hand surgery relates to WWII, when soldiers, sailors and airmen were treated by general, orthopaedic and plastic surgeons. A group of these surgeons became interested in hand surgery and formed an organization that grew into the American Society for Surgery of the Hand. This tradition continues today at Cleveland Clinic, where we have orthopaedic and plastic surgeons who specialize in treating every type of hand injury.

Q: I spend a lot of time at my computer. Am I at high risk?

A: Repetitive strain injuries can be caused by a variety of work conditions, including computer use. For example, prolonged exposure to cold and vibration can be aggravating to the hands. So a construction worker who uses power tools every day or someone who works outside in the winter may be more prone to injury.

Carpal tunnel syndrome is a common RSI in many people, regardless of the type of work they perform. Although it has been suggested that people who use computers may be more prone to developing this condition, studies have shown otherwise.

Other factors may also predispose a person to developing carpal tunnel syndrome. For example, people with small wrists—particularly females—may be more prone to RSI. The smallness of their wrists limits the space for swelling, which is common in RSI. These same individuals also may be more sensitive when swelling does occur.

Q: How is a repetitive stress injury treated?

A: We may treat the injury with rest, icing, splinting and elevation. Often an anti-inflammatory or, less frequently, a steroid injection may be used. A splint or wrap may help protect and rest the injured area.

If the injury is work-related, an occupational therapy program will help speed a patient’s recovery. Cleveland Clinic’s “work-hardening” program also helps the injured worker return to work by focusing closely and specifically at work requirements and designing a program to better prepare the worker for his or her job. The program might include hand exercises, stretching and light weightlifting, as well as changing work activities to lessen the stress on the affected area.

Q: Can RSI be prevented?

A: You can minimize your risk of incurring an RSI by understanding the basic principles of good positioning (e.g., seating, standing, bending). You also should have appropriate physical conditioning for the type of work you’re doing. In addition, federal laws and guidelines exist to require employers to try to prevent RSI. No matter what job a person is doing, it should be fairly well designed ergonomically to minimize problems.