Protecting the Hands Against Repetitive Strain Injuries

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 Clinicís 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. Itís 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, itís usually because other treatments arenít providing relief. Very often weíre 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 donít 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 itís 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 patientís wrists can also be a factor. Swelling generally accompanies any repetitive strain injury, and people with small wristsóparticularly femalesócan be more prone to RSI because thereís 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 donít 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 youíre doing. If you experience pain, stiffness, swelling, weakness and numbness that wonít go away, see a physician as soon as possible.

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. For additional health information, please contact the Center for Consumer Health Information at the Cleveland Clinic (216) 444-3771 or toll-free (800) 223-2273 extension 43771. If you prefer, you may visit or This document was last reviewed on: 5/1/2003