Repetitive Motion Disorders Health Article

Symptoms

The symptoms of repetitive motion disorders include the following:

• Pain. The pain of an RSI is typically felt as an aching sensation that gets worse if the affected joint(s) or limb is moved or used. The pain may be severe enough to wake the patient at night.
• Paresthesias. Paresthesia refers to an abnormal sensation of pricking, tingling, burning, or "insects crawling beneath the skin" in the absence of an external stimulus.
• Numbness, coldness, or loss of sensation occur in the affected area.
• Clumsiness, weakness, or loss of coordination result.
• Impaired range of motion or locking of a joint occur.
• Popping, clicking, or crackling sounds in a joint are experienced.
• Swelling or redness in the affected area are observed.

History and physical examination

The diagnosis of a repetitive motion disorder begins with taking the patient's history, including occupational history. The doctor will ask about the specific symptoms in the affected part, particularly if the patient suffers from rheumatoid arthritis, diabetes, or other general conditions as well as overuse of the joint or limb.

The next step is physical examination of the affected area. The doctor will typically palpate (feel) or press on the sore area to determine whether there is swelling as well as pain. He or she will then perform a series of maneuvers to evaluate the range of motion in the affected joint(s), listen for crackles or other sounds when the joint is moved, and test for weakness or instability in the limb or joint. There are simple physical tests for specific repetitive motion disorders. For example, the Finkelstein test is used to evaluate a patient for de Quervain's syndrome. The patient is asked to fold the thumb across the palm of the affected hand and then bend the fingers over the thumb. A person with de Quervain's will experience sharp pain when the doctor moves the hand sideways in the direction of the elbow. Tinel's test is used to diagnose carpal tunnel syndrome. The doctor gently taps with a rubber hammer along the inside of the wrist above the median nerve to see whether the patient experiences paresthesias.

Laboratory tests

Laboratory tests of blood or tissue fluid are not ordinarily ordered unless the doctor suspects an infection or wishes to rule out diabetes, anemia, or thyroid imbalance.

Imaging studies

Imaging studies may be ordered to rule out other conditions that may be causing the patient's symptoms or to identify areas of nerve compression. When surgery is being planned, x rays may be helpful in identifying stress fractures, damage to cartilage, or other abnormalities in bones and joints. Magnetic resonance imaging (MRI) can be used to identify injuries to tendons, ligaments, and muscles as well as areas of nerve entrapment.

Electrodiagnostic studies

The most common electrodiagnostic tests used to evaluate repetitive motion disorders are electromyography (EMG) and nerve conduction studies (NCS). In EMG, the doctor inserts thin needles in specific muscles and observes the electrical signals that are displayed on a screen. This test helps to pinpoint which muscles and nerves are affected by pain. Nerve conduction studies are done to determine whether specific nerves have been damaged. The doctor positions two sets of electrodes on the patient's skin over the muscles in the affected area. One set of electrodes stimulates the nerves supplying that muscle by delivering a mild electrical shock; the other set records the nerve's electrical signals on a machine.

Treatment team

A mild repetitive motion disorder may be treated by a primary care physician. If conservative treatment is ineffective, the patient may be referred to an orthopedic surgeon or neurosurgeon for further evaluation and surgical treatment. Patients whose disorders are related to job dissatisfaction, or who have had to give up their occupation or favorite activity because of their disorder, may benefit from psychotherapy.

Physical therapists and occupational therapists are an important part of the treatment team, advising patients about proper use of the injured body part and developing a home exercise program. Some patients benefit from having their workplace and equipment evaluated by the occupational therapist or an ergonomics expert. Professional athletes, dancers, or musicians usually consult an expert in their specific field for evaluation of faulty posture or technique.