1. Repetitive Strain Injury (RSI) Professor T.C. Aw MBBS, PhD, FRCP, FRCPC, FFOM, FFPHM Head, Division of Occupational Health University of Kent

2. RSI Settlement Compensation totalling £10,000 is to be paid to 30 poultry production workers at Beatrice International Foods of Lincoln who suffer from repetitive strain injury caused by handling birds. Out of court settlements from £2,000 to £8,500 were agreed

3. IntMedJ 2004;34(7):416-419 ‘Repetitive strain injuries: has the Australian epidemic burnt out?” Awerbuch (2004)

4. CommHlthStud 1988;12(3):348- 358 ‘The arguments about RSI: an examination’ Brammer G, Martin B (1988)

5. Extent of problem (UK) Musculo-skeletal problems: 0.5 million workers affected in the UK Increase of >50,000 affected since 2001/02 2 nd most common cause of sickness absence in many industries in the UK HSE: Self-reported work-related illness survey

6. Extent of problem (UK) For upper limb (and neck) 5 million working days lost average of 3 weeks lost time per person HSE: Self-reported work-related illness survey

7. Terminology Repetitive Strain Injury (RSI) Cumulative trauma disorder (CTD) Occupational overuse syndrome (OOS) Work-related repetitive movement injury (WRMI) Work-related upper limb disorder (WRULD)

8. Definition Pain and/or discomfort in the limbs due to Repetitive movements (dynamic stress), or Constrained postures (static stress)

9. Classification Specific entities: Carpal tunnel syndrome De Quervain’s syndrome Tendonitis/Tenosynovitis Peritendinitis crepitans Epicondylitis Tennis elbow Non-specific diffuse arm pain

10. Exposure Repetitive movements - within normal range e.g. flexion & extension; pronation & supination; abduction & adduction - extremes of range Constrained postures +/- FORCE

17. Courtesy of Dr. Syed Ahmed

18. Effect Symptoms Discomfort Pain Numbness Tingling Signs Localised swelling Warmth & redness Loss of function Crepitus

19. Contributory factors Non-occupational factors Individual susceptibility Ergonomics Psychological overlay Trauma – previous or recent Compensation?

21. Laboratory investigations Tendon acoustic monitoring CAT scan Nuclear magnetic resonance Thermography Electromyography Nerve conduction studies

22. Treatment Analgesics – NSAIDs, Ibuprofen Rest/Exercise Local injection Surgery Physiotherapy Ultrasound Infra-red

23. Prevention Frequent rest breaks Posture Workstation design [T’ai Chi, yoga, Alexander technique, communicating with the subconscious?]

26. Ref: RSI Association

30. Threshold limit value (TLV) Hand activity level (HAL) [0-10] e.g. 2 : Consistent, conspicuous long pauses; or very slow motions 6 : Steady motion/exertion; infrequent pause 10 : Rapid, steady motion/ difficulty keeping up or continuous exertion Peak hand force NIOSH, 2006

33. Conclusions Getting the right person &/or tools for the job Information, instruction & training

35. t.c.aw@kent.ac.uk