Repetitive Motion Disorders Health Article

Conservative treatment

Conservative treatment for overuse injuries typically includes:

• Resting the affected part. Complete rest should last no longer than two to three days, however. What is known as "relative rest" is better for the patient because it maintains range of motion in the affected part, prevents loss of muscle strength, and lowers the risk of "sick behavior." Sick behavior refers to using an injury or illness to gain attention or care and concern from others.
• Applying ice packs or gentle heat.
• Oral medications. These may include mild pain relievers (usually NSAIDs); amitriptyline or another tricyclic antidepressant; or vitamin B6.
• Injections. Corticosteroids may be injected into joints to lower inflammation and swelling. In some cases, local anesthetics may also be given by injection.
• Splinting. Splints are most commonly used to treat overuse injuries of the hand or wrist; they can be custom-molded by an occupational therapist.
• Ergonomic corrections in the home or workplace. These may include changing the height of chairs or computer keyboards; scheduling frequent breaks from computer work or musical practice; correcting one's posture; and similar measures.
• Transcutaneous electrical nerve stimulation (TENS). TENS involves the use of a patient-controlled portable device that sends mild electrical impulses through injured tissues via electrodes placed over the skin. It is reported to relieve pain in 75–80% of patients treated for repetitive motion disorders.

Surgery

Repetitive motion disorders are treated with surgery only when conservative measures fail to relieve the patient's pain after a trial of six to 12 weeks. The most common surgical procedures performed for these disorders include nerve decompression, tendon release, and repair of loose or torn ligaments.

Complementary and alternative (CAM) treatments

CAM treatments that have been shown to be effective in treating repetitive motion disorders include:

• Acupuncture. Studies funded by the National Center for Complementary and Alternative Medicine (NCCAM) since 1998 have found that acupuncture is an effective treatment for pain related to repetitive motion disorders.
• Sports massage, Swedish massage, and shiatsu.
• Yoga and tai chi. The gentle stretching in these forms of exercise helps to improve blood circulation and maintain range of motion without tissue damage.
• Alexander technique. The Alexander technique is an approach to body movement that emphasizes correct posture, particularly the proper position of the head with respect to the spine. It is often recommended for dancers, musicians, and computer users.
• Hydrotherapy. Warm whirlpool baths improve circulation and relieve pain in injured joints and soft tissue.

Recovery and rehabilitation

Recovery from a repeated motion disorder may take only a few days of rest or modified activity, or it may take several months when surgery is required.

Rehabilitation is tailored to the individual patient and the specific disorder involved. Rehabilitation programs for repetitive motion disorders focus on recovering strength in the injured body part, maintaining or improving range of motion, and learning ways to lower the risk of re-injuring the affected part. Professional musicians, dancers, and athletes require highly specialized rehabilitation programs.

Clinical trials

As of early 2004, there were four clinical trials related to repetitive motion disorders sponsored by the National Institutes of Health (NIH) that are recruiting subjects. One is a comparison of amitriptyline (an antidepressant medication) and acupuncture as treatments for CTS. A second study will evaluate the effectiveness of a protective brace in preventing overuse disorders associated with hand-held power tools. The third study will evaluate the effects of fast-paced assembly-line work on the health of rural women. The fourth study is a comparison of surgical and nonsurgical treatments for CTS.

Prognosis

The prognosis for recovery from repetitive motion disorders depends on the specific disorder, the degree of damage to the nerves and other structures involved, and the patient's compliance with exercise or rehabilitation programs. Most patients experience adequate pain relief from either conservative measures or surgery. Some, however, will not recover full use of the affected body part and must change occupations or give up the activity that produced the disorder.

BOOKS

National Research Council and Institute of Medicine (IOM). Musculoskeletal Disorders and the Workplace: Low Back and Upper Extremities. Washington, DC: National Academy Press, 2001.

"Neurovascular Syndromes: Carpal Tunnel Syndrome." The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.

Pelletier, Kenneth R., MD. The Best Alternative Medicine, Part II, "CAM Therapies for Specific Conditions: Carpal Tunnel Syndrome." New York: Simon & Schuster, 2002.

"Tendon Problems: Digital Tendinitis and Tenosynovitis." The Merck Manual of Diagnosis and Therapy, edited by Mark H. Beers, MD, and Robert Berkow, MD. Whitehouse Station, NJ: Merck Research Laboratories, 2002.