Some of the most common issues seen in orthopedics involve repetitive stress injuries, also known as repetitive strain injuries. As their names suggest, these problems arise when the muscles, tendons, and nerves are repeatedly exposed to the same stress. Most commonly, these injuries involve the fingers, wrists, elbows, and knees. The repetitive motion causing the injury can be as small as typing on a keyboard or as big as a tennis serve. Any movement done too often can result in this type of injury, which can often be treated at home with rest. However, you may need the help of an orthopedist to identify the motion causing the problem or to ensure that no further intervention is necessary. Also, a physician can help you get accommodations at work to prevent further injury. These accommodations are required by federal law.
The Basics You Should Know About Repetitive Stress Injuries
All people can develop repetitive strain injuries, but some individuals are more prone to them than others based on their occupation and hobbies. Some of the people most at risk include musicians, athletes, computer users, and manual laborers, as these individuals frequently make the same movements as they work or practice. Unfortunately, repetitive strain injuries are very common. While the injuries themselves are not seriously dangerous, they can precipitate more serious conditions like trigger finger, Osgood-Schlatter disease, carpal tunnel syndrome, and tendinitis. Preventing these more serious conditions is the reason that repetitive stress injuries should be taken seriously and treated.
Without adequate treatment, generally meaning rest, the injuries can build up over time and cause some very painful conditions that frequently require surgical intervention. For example, stress fractures can occur, as can herniated discs. Another common problem resulting from untreated repetitive stress injury is Dupuytren’s contracture. When people can recognize the symptoms of repetitive stress injuries and give their bodies proper rest, these problems can be avoided altogether. What, then, are the symptoms of this type of injury? The most common are pain, swelling, weakness, and even tingling or numbness. Some people will experience the injury as stiffness. Any of these symptoms should prompt you to consider the cause and the role of rest.
How Physicians Approach the Diagnosis of Repetitive Stress Injuries
When you bring up a concern that sounds like a potential repetitive stress injury, your provider will first get a thorough history, including a review of risk factors for developing one. You should expect several questions about your work and your pastimes, including the tools you use and your posture. The goal is to figure out exactly what movement is causing the issue. Next, the provider will do a physical exam to get a more complete sense of how the injury is affecting you and judge whether or not more severe problems like occult fractures need to be ruled out with imaging. The physical exam is an important baseline for judging recovery down the line and will include strength testing and range of motion, as well as some specialty tests depending on the location of the pain. From there, your provider will develop a strategy for treating the injury, which could involve additional evaluation.
Beyond a history and physical, any additional evaluation would involve imaging. The imaging study largely depends on the location of the injury and the structures that are involved. Plus, the potential need to rule out sequelae can also dictate which imaging studies need to be done. In some cases, an ultrasound will be enough to evaluate the injury. However, an X-ray or computed tomography (CT) study may be necessary to evaluate bony structures or an MRI to get a closer look at soft tissues. Make sure you understand why each study is getting ordered and the question it is meant to answer to have a sense of your level of risk.
The Treatment and Prevention of Repetitive Stress Injuries
The ultimate plan for treatment of a repetitive stress injury depends on what is causing it and the severity of the symptoms. These injuries are not themselves indicative of permanent damage and will heal at home with rest. Physicians often used the acronym RICE to help patients remember how to treat the injury at home. RICE stands for rest, ice, compression, and elevation. Rest is key for letting the injury heal adequately to prevent further issues. Cold compresses can help with pain and swelling. Compression also reduces swelling to promote recovery. Elevation means keeping the injury above the level of the heart whenever possible, which will also speed healing.
You may also need some over-the-counter medications to help with pain, such as ibuprofen, which is also an anti-inflammatory. Sometimes, your physician will refer you to physical or occupational therapy. Physical therapy focuses on increasing strength and flexibility to reduce the chance of re-injury.
Occupational therapy can help develop strategies to prevent future injury. In general, prevention depends on listening to your body and always giving it adequate time to recover. Stretch before and after physical activity. When you have pain, do not simply ignore it. Preventing future injury also means preventing conditions that may require surgical intervention.