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You may not realize it, but your hands are a complex array of bones (more
than 25 in each), nerves, muscles and tendons. The system is an engineering
marvel that allows humans to move the fingers in ways that no machine can match.
The very components that enable a person to play the piano or simply get
dressed also make the hands susceptible to numerous injuries, particularly
repetitive strain injuries (RSI). They include carpal tunnel syndrome,
tendonitis and bursitis. Left untreated, these conditions can worsen over time,
cause chronic pain, interfere with livelihoods, and diminish quality of life.
To get some guidance about protecting the hands as well as treatment options
for RSI, Health Extra talked with Mark Hendrickson, M.D., staff surgeon and
chief of the section of hand surgery in The Cleveland Clinic’s Department of
Plastic and Reconstructive Surgery.
Q. Do patients with hand injuries frequently see plastic surgeons, or are
they more likely to see an orthopaedic specialist?
A. It’s a common misconception that all hand surgeons are orthopedic
surgeons, or that only orthopedic surgeons perform hand surgery. (Orthopedics
involves prevention and correction of musculoskeletal disorders.) The truth is,
hand surgeons may have done their "basic" training in the general,
plastic or orthopedic surgery realms. The history of hand surgery essentially
begins with WWII, when plastic, general, and orthopaedic surgeons treated
soldiers, sailors and airmen. (Plastic surgery involves performing
reconstructive and cosmetic procedures.) A group of these surgeons who were
treating veterans 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 The Cleveland Clinic, where we have orthopaedic and plastic
surgeons who treat every type of hand injury.
When we see a patient with a repetitive strain injury, it’s usually because
other treatments aren’t providing relief. Very often we’re seeing people who
have significant problems of pain and function with their hands. They may have
already seen a company or family doctor, and by the time they see us, other
treatment options have already been tried and failed.
Q. What are some of the more common repetitive strain injuries you see?
A. I see about an equal number of people with injuries from accidents and
from repetitive use caused by the work they do. The difference between the two
is that an accident is an acute, sudden injury that occurs instantly, and the
patient knows to seek medical help right away. But a repetitive use injury
occurs gradually over a long period of time, and often the patients don’t
realize they should seek medical treatment.
Probably the most common repetitive use injury we see is tendonitis, which is
an inflammation of the tendons. Tendons connect muscle to bones, and movement
that is repeated over and over can injure them. "Trigger finger" and
"tennis elbow" are two common types of tendonitis. In rare cases, a
disease may cause tendonitis, but in most cases it’s caused by overuse.
Q. What causes a repetitive strain injury in the hand, and what are some of
the symptoms?
A. Certain repeated motions of the wrist, hand and fingers can aggravate
bones, joints, muscles, tendons or nerves, leading to pain and dysfunction. The
duration of the work and positioning of the hands while working also play key
roles in causing or preventing repetitive strain injuries. Ergonomics are key,
including the workstation itself, the design of equipment and work techniques.
In addition to pain, other common symptoms include tingling, numbness, stiffness
and sensitivity to cold or heat.
Q. With the widespread use of computers and keyboards, do you see a lot of
patients who suffer from RSI because they spend so much time at a computer?
A. We see a lot of patients who have repetitive injuries from a variety
of causes, including computer use. Carpal tunnel syndrome is a common repetitive
use injury that has received quite a bit of attention in recent years, primarily
because of speculation that people who use computers may be prone to develop
carpal tunnel syndrome. In reality, studies have shown that carpal tunnel
syndrome is not more prevalent among people who use computers every day. Many
people develop this condition regardless of the type of work they do.
In fact, repetitive strain injuries can be caused by a variety of work
conditions. For example, prolonged exposure to cold and vibration can be very
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.
The size of the patient’s wrists can also be a factor. Swelling generally
accompanies any repetitive strain injury, and people with small wrists—particularly
females—can be more prone to RSI because there’s only so much room for
swelling to occur, and thus they can be more sensitive when swelling does occur.
Q. How do you treat patients with repetitive stress injuries?
A. We may treat the injury with rest, icing, splinting and elevation.
Managing the symptoms with medications also is common. These include
nonsteroidal anti-inflammatory agents (e.g., Advil, Aleve) and on occasion,
corticosteroid injections. A splint or wrap may be used to protect and rest the
injured area.
For people who are recovering from a work-related injury, an occupational
therapy program will facilitate recovery. The objective of our
"work-hardening" program is to enable the injured person to return to
work. We look closely and at their work requirements and design a program that
prepares them for their specific job. Such a program might include hand
exercises, stretching and light weightlifting, as well as modifying work
techniques or postures to minimize stress on the affected area.
Q. What is your recommendation regarding seeking treatment for a possible
repetitive strain injury?
A. We don’t want someone to wait until the pain and functional loss is
severe. If pain and functional loss is limiting a work activity, a person should
seek medical help immediately. Even if the symptoms consist of mild discomfort
and dysfunction, the individual may benefit from modifying work techniques to
decrease the likelihood of further injury.
Q. Is there anything people can do to prevent RSI?
A. Number one, they should be aware that there are federal laws and
guidelines that require employers to try to prevent RSI. Regardless of the job,
the goal is to have an ergonomic setting; that is, one intended to maximize
productivity by minimizing fatigue and discomfort.
People should also understand the basic principles of workplace ergonomics
and be on the alert for activities or work techniques that place them at high
risk for RSI. You should also have reasonable physical conditioning for the type
of work you’re doing. If you experience pain, stiffness, swelling, weakness
and numbness that won’t go away, see a physician as soon as possible.
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