Why repetitive strain injury isn’t from sitting at your desk

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In middle-age the natural, degenerative process in muscles, ligaments and tendons can be exacerbated by activities such as sport and work, including long periods of time sat behind a desk, says consultant orthopaedic surgeon, Simon Richards

In the 1980s there was an epidemic of people claiming that they had repetitive strain injury from sitting at their desks and using computers all day. The truth is that sitting and using a computer doesn’t cause an injury, but it may make symptoms worse.

Shoulder impingement is a common condition that I see at my clinic, which most commonly affects people between the ages of 40 and 60. This is caused by tendons inside the shoulder (the rotator cuff) catching in a bony tunnel. This is made worse as a person lifts or twists their arm, leading to a painful pinching feeling. Activities such as overhead lifting, and sports such as swimming and tennis can increase impingement in the shoulder. A prolonged, hunched position at a desk can narrow the gap further, which in turn can increase the symptoms. Work-based assessments are important for this reason, as well as getting physiotherapy advice on improving your posture.

I have suffered with shoulder impingement myself in the past, but over time it settled with physiotherapy and changes to my sitting posture while operating. Pain in the wrist, elbow and shoulder can often heal by itself, but if it lasts several months with no improvement, it’s important to make an appointment to see your GP.

Another common issue I see is Tennis Elbow, which involves a pain on the outer part of the elbow extending down to the forearm. Less commonly we see people with Golfer’s Elbow, which affects the inside of the elbow. Both are caused by a natural degeneration in a tendon, which is made worse by repetitive activities. An example is that clicking on a mouse will not cause the problem, but it may exacerbate the symptoms.

Carpal tunnel syndrome is a very common cause of pain further down the arm. This involves numbness, pins and needles, and pain in the hand, often extending up the forearm. It is caused by compression of a nerve running through the wrist. When the wrist is bent either up or down, it increases the compression of the nerve and thus the symptoms.

Each problem must be treated on a case-by-case basis and treatments can range from putting people’s minds at ease, right the way through to performing surgery. I describe it as a ‘therapeutic ladder’ as the higher up the rungs, the more complex and invasive the treatment options become. We start with simple advice, work-based assessments and painkillers, which may be all that is needed. On the next rung we will look at physiotherapy and splints, and then we could move to steroid injections in order to decrease any inflammation. Finally, we could consider surgical options if the other treatments have failed.

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As technology develops, we are learning about new physiotherapy techniques including sending patients for pre-operation physio to get the body moving more to aid their post-op recovery, and new splinting options.

Personally, I advise patients to use a traffic light system when it comes to pain. A green light means that the activity doesn’t hurt and so you can just carry on as normal, amber means that you are aware of some pain or discomfort, which is an early warning and so you shouldn’t push yourself any further. Meanwhile, the red light means that you should stop doing the activity as it may be causing more damage to the area and it’s time to seek professional advice.


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