Article - Repetitive stress injury Information and Treatment
- Repetitive stress injury is the name given to a group of conditions that are caused when too much stress is placed on a joint. Repetitive stress injury happens when the same action is performed over and over.
- Performing the same action over and over can cause pain and swelling in the muscles, tendons and bursae (pronounced bur-say).
- Tendons are the strong flexible bands of tissue that attach muscles to bones.
- Bursae are small sacs filled with fluid that act as cushions between tendons and bones. Bursa is the name used to talk about just one sac.
- The pain and swelling of repetitive stress injury is called inflammation.
- The two most common types of repetitive stress injury are tendinitis and bursitis. Tendinitis is inflammation of a tendon. Bursitis is inflammation of a bursa.
The term repetitive stress injury, or repetitive strain, refers to a group of conditions caused by placing too much stress on a joint. Repetitive stress injury happens when the same action is performed repeatedly.
When stress is placed on a joint it pulls on the tissues around it. These tissues include muscles, tendons and bursae. Tendons are the strong flexible bands of tissue that attach muscles to bones.
Bursae are small fluid-filled sacs that act as cushions between tendons and bones.
When an action that is stressful to a joint is repeated frequently, such as when playing tennis or typing, the area does not have time to recover and it becomes irritated. This can cause the area to become painful and swollen.
The two most common types of repetitive stress injury are tendinitis and bursitis. Tendinitis is inflammation of a tendon or the fluid-filled sheath surrounding a tendon. Bursitis is inflammation of a bursa.
- The exact number of Canadians with repetitive stress injury is not known.
- It can occur in both men and women.
- It usually affects people over the age of 30. However, it can also affect younger people.
- It is more common in people who have jobs that require repetitive actions or that play sports.
Repetitive stress injury generally occurs in those over the age of 30 as a result of the normal wear and tear of aging. The incidence of repetitive stress injury is becoming more widespread as many jobs now require people to make repetitive actions such as typing or clicking a computer mouse. It can also occur more frequently in those who play sports.
What are the warning signs of repetitive stress injury?
- Pain in one specific area.
- The area may also be tender, swollen, red and hot.
- Specific types of repetitive stress injury affect different areas of the body:
- Bicipital (pronounced by-sip-i-tal) tendinitis is inflammation of the tendon that attaches the biceps (upper arm muscles) to the shoulder.
- Tennis elbow is inflammation of the muscles attached to the outside of the elbow.
- Golfer's elbow is inflammation of the muscles on the inside of the elbow.
- Trigger finger is inflammation of the tendons in your hand that you use to make a fist. The swelling may cause bumps to form on the tendon and the fingers to 'lock'.
- DeQuervain's tendosynovitis (pronounced du-ker-vanes ten-do-sin-o-vite-iss) is inflammation of the lining that surrounds the tendons in the thumb. This is one of the most common work injuries.
- Trochanteric (pronounced tro-can-ter-ic) bursitis is inflammation of a bursa on the outer hip.
- Housemaid's knee is inflammation of the bursa on the front of the kneecap.
If you have repetitive stress injury the affected area may be tender, swollen, red and hot. It may be painful for you to move the area and it may wake you up during the night. The pain is usually not widespread throughout the body.
What causes repetitive stress injury?
- Bicipital tendinitis is often caused by using the arm to make repeated scrubbing motions.
- Tennis elbow is caused by repeatedly bending the wrist backwards with force, such as when playing tennis or painting with a brush.
- Golfer's elbow is caused by repeatedly bending the wrist forward with force, such as when pulling ropes or golfing.
- DeQuervain's tendosynovitis is caused by repeated pinching or twisting of the wrist.
- Housemaid's knee is caused by kneeling or leaning forward for a long period of time, such as when scrubbing the floor.
- Some forms of tendinitis and bursitis may also be caused by diseases such as rheumatoid (pronounced room-a-toid) arthritis, gout, psoriatic (pronounced sore-ee-at-ick) arthritis, Reiter's (pronounced rlt-urz) syndrome, thyroid disease and diabetes.
- Repetitive stress injury is caused when too much stress is placed on a joint as a result of the same action being performed over and over.
- Specific kinds of repetitive stress injury are caused by certain actions:
- If your doctor thinks you have repetitive stress injury, he or she may perform a physical examination and certain tests.
- Treatment is done to reduce the pain and swelling and to keep the problem from getting worse.
- Learn as much as you can about this condition. Speaking with your doctor or other people who are specialists in arthritis care can provide you with the information you need.
If your doctor thinks you have repetitive stress injury, he or she will perform a physical examination of the area. There are no laboratory tests to confirm diagnosis of tendinitis or bursitis. Blood tests and x-rays may be done to ensure that other conditions associated with tendinitis (such as rheumatoid arthritis, gout, etc.) are not the cause.
The goal of treating repetitive stress injury is to relieve pain and swelling and to prevent the problem from becoming worse. Your active involvement in developing your prescribed treatment plan is essential.
- Non-steroidal anti-inflammatory drugs (NSAIDs - pronounced en-seds) are often used to treat the inflammation of repetitive stress injury. These are a type of medication that helps reduce pain and swelling and decrease stiffness. However, they do not prevent further damage.
NSAIDs reduce pain when taken at a low dose, and relieve inflammation when taken at a higher dose. NSAIDs such as ASA (Aspirin, Anacin, etc.) and ibuprofen (Motrin IB, Advil, etc.) can be purchased without a prescription. Examples of NSAIDs that require a prescription include Naprosyn, Relafen, Indocid, Voltaren, Feldene, and Clinoril. The various NSAIDs and Aspirin?, if taken in full doses, usually have the same levels of anti-inflammatory effect. However, different individuals may experience greater relief from one medication than another. Taking more than one NSAID at a time increases the possibility of side effects, particularly stomach problems such as heartburn, ulcers and bleeding. People taking these medications should consider taking something to protect the stomach, such as misoprostol (Cytotec).
- Oral cortisone could also be prescribed if the swelling does not go away. Cortisone is a steroid that reduces inflammation.
Cortisone is a steroid that reduces inflammation and swelling and that can influence regulation of the immune system. It is a hormone naturally produced by the body. Corticosteroids are man-made drugs that closely resemble cortisone.
The most common form of corticosteroid is called prednisone, taken in pill form. Prednisone use needs to be carefully monitored because of its many side effects, and the drug must never be stopped abruptly. Some of the side effects from long-term use include cataracts, high blood pressure, sleep problems, muscle loss, bruising, thinning of the bones (osteoporosis), weight gain and increased risk of infections. The goal with this and most drugs is to find the lowest effective dose that will avoid as many of the side effects as possible.
- Your doctor might also inject cortisone into the affected joint. An occasional cortisone injection into an inflamed joint or tendon brings short-term relief.
- After the pain and swelling has been reduced, exercising can help you strengthen the joint.
- Too much exercise, or the wrong kind could also make the condition worse. Talk to your doctor before starting an exercise program.
After the irritation and swelling of the joint has been reduced, it is important to begin exercising the muscles slowly so they do not become irritated again and to prevent loss of movement in the joint. Consult your doctor before beginning an exercise program. He or she may recommend you to a therapist who can show you the proper exercises to do. Before doing any exercise, or any other strenuous or repetitive activity, be sure to 'warm up' your muscles first so they can better handle the stress.
- Applying cold helps to lessen the pain and swelling. For example, put an ice pack on the area that is sore.
- If you have a condition that causes you to have poor blood circulation, do not apply cold as it causes the blood vessels to shrink.
Cold application can provide temporary relief of the pain of repetitive stress injury. Cold helps numb the area by constricting the blood vessels and blocking nerve impulses in the joint - this reduces the inflammation. If you have poor blood circulation as a result of a condition like Raynaud's phenomenon (pronounced ray-noze feh-naw-meh-non), you should avoid cold treatments.
Protect your joints:
- Be kind to your body. After doing heavy work, or doing the same task over and over, stop. Slow down by doing an easy task, or by taking a rest.
- If you are doing a task for work or a hobby that may have caused your repetitive stress injury, change how you do that task. Find different tools that can make the task easier.
- Use your back, arms and legs in safe ways to avoid putting stress on joints. For example, carry a heavy load close to your body.
- Use helpful devices such as a cart to carry your grocery bags, or an enlarged handle that fits over a knife handle so you can hold it easily. A cart will help you to walk more safely. A grab bar, which attaches to a shower, will help you to get in and out of the tub more easily.
- Consider getting a splint to hold your joint in a comfortable position at night. A splint can help decrease pain, swelling and stiffness.
Protecting your joints means using them in ways that avoid excess stress. Benefits include less pain and greater ease in doing tasks. There are several techniques to protect your joints:
Pacing, by alternating heavy or repeated tasks with easier tasks or breaks, reduces the stress on painful joints and allows weakened muscles to rest.
Positioning joints wisely helps you use them in ways that avoid extra stress. Use larger, stronger joints to carry loads. For example, use a shoulder bag instead of a hand-held one. Also, avoid keeping the same position for a long period of time.
Many cases of repetitive stress injury are caused by using the wrong tools or equipment. Using the correct tools that keep you from having to assume awkward positions will help to prevent excess stress on your joints.
Using helpful devices, such as canes, luggage carts, grocery carts and reaching aids, can help make daily tasks easier. Small appliances such as microwaves, food processors and bread makers can be useful in the kitchen. Using grab bars and shower seats in the bathroom can help you to conserve energy and avoid falls.
Resting the sore area will reduce the irritation and speed up healing. For some types of tendinitis, splints are available that allow the joint to rest or minimize the amount of irritation to the joint. Your doctor will be able refer you to a therapist who can help find the best splint for you.
- Relaxing the muscles around an inflamed area reduces pain.
- There are many ways to relax. Try deep breathing exercises. Listen to music or relaxation tapes. Meditate or pray. Another way to relax is to imagine or visualize a pleasant activity such as lying on a beach, or sitting in front of a fireplace.
Developing good relaxation and coping skills can give you a greater feeling of control over your arthritis and a more positive outlook.
Additional Tips for Living Well
- The Arthritis Society offers a variety of programs and services that can be helpful.
- You can reach the Society at 1-800-321-1433 from anywhere in Canada.
- You can also reach us through our Web site at www.arthritis.ca
Along with the physical symptoms of arthritis, many people experience feelings of helplessness and depression. Learning daily living strategies to manage your arthritis gives you a greater feeling of control and a more positive outlook. To get the best results, people affected by arthritis need to form close ties with their doctors and therapists, and become full partners in their treatment. From our perspective, it's all part of 'living well with arthritis.' There are several resources you can use in finding out how best to manage your own arthritis.