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Upper Limb Disorders

It is estimated that1in every 50 workers

will suffer an RSI-related condition, with

a third of sufferers under the age of 45,

costing the UK economy billions annually.

A thorough understanding of treatment

is paramount if the disability and lost

productivity caused by RSIs is to be minimised.

WRULDs are categorised as either Type

1or Type 2. Type1disorders are clinically

detectable tissue abnormalities, usually

characterised by swelling, inflammation

or compression of soft tissues. Common

examples include Carpal Tunnel Syndrome,

De Quervain’s Tenosynovitis and Cubital

Tunnel Syndrome. Type 2 conditions are

much more difficult to define, presenting

as non-specific pain and tingling, which

may be myofascial or neurological in origin.

In today’s workplaces, we often find ourselves

undertaking tasks that require repetitive

actions, in static postures for prolonged

periods of time. This is particularly true with

regards to the increased use of technology, for

example computers, tablets and smartphones.

The propensity for soft tissue to become

strained and fatigued following this type of

repetitive stress may lead to the development

of WRULDs, which, over time, may become

significantly disabling. The implication to

occupational productivity can be extreme.

Early detection and treatment to address

development of RSI is essential, with some

research suggesting the recovery outcome

from long-standing complaints may be less

favourable.

It is generally accepted that there is

no one specific treatment that provides

an effective resolution to RSI. Instead,

a multifaceted approach should be

employed which addresses both the physical

and psychological aspects of the condition.

This is necessary if the best outcomes are

to be achieved. Whilst periods of time off

work may provide short-term relief, they

rarely provide long-term recovery. A study

published by the Health & Safety Executive

in 2008*, put forward evidence to support

the implementation of a biopsychosocial

model for the treatment of upper limb

disorders. Their evidence highlighted the

following points:

• Promote self-management – give

evidence-based information and advice

– adopt a can-do approach, focusing on

recovery rather than what has happened

• Intervene using stepped care

approach – treatment only if required

(beware detrimental labels and over-

medicalisation), encourage and support

early activity, avoid prolonged rest, focus

on participation including work

• Encourage early return to work – stay

in touch with absent worker, use

case management principles, focus on

what worker can do rather than what

they can’t, provide transitional work

arrangements (only if required, and

time-limited)

• Endeavour to make work comfortable

and accommodating – assess and

control significant risks, ensure physical

demands are within normal capabilities,

but don’t rely on ergonomics alone,

accommodating cases shows more

promise than prevention

• Overcome obstacles – principles of

rehabilitation should be applied early

– focus on tackling biopsychosocial

obstacles to participation – all players

communicating openly and acting

together, avoiding blame and conflict.

Upper limb therapy plays an important role

in the holistic treatment of WRULDs. Specific

treatment modalities include splinting,

deep tissue massage, myofascial release,

oedema management, trigger point release,

acupuncture, muscular stretches and graded

strengthening. These treatments can improve

tissue condition and provide pain relief.

Additionally, provision of ergonomic advice

including environmental adaptation, such as

adjustments to equipment and seating, as

well as advice on posture and activity-pacing

are also areas which may be addressed.

Work Related Upper

Limb Disorders

The importance of improving treatment for

Work Related Upper Limb Disorders (WRULD), more commonly known as Repetitive

Strain Injuries (RSI) or Cumulative Trauma Disorders, can result in significant disruption

to a person’s day-to-day function.

The HandTherapy Services at London

Bridge Hospital aims to provide

holistic treatment of these conditions

through a team approach. For further

information, please contact David

Baker, Occupational Therapist – Hand

Injuries on

020 7234 2500

or email

[email protected] .

We work closely with Mr Tony

Kochhar, Consultant Shoulder and

Upper Limb Surgeon, who specialises

in the treatment of RSI at London

Bridge Hospital. He can be contacted

on

020 7234 2771

or

020 3301 3750

, or email

[email protected] .

David Baker

Occupational Therapist

*Source:The

Health & Safety Executive: Management of upper

limb disorders and the biopsychosocial model, 2008.

Upper Limb Disorders

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