In search of the pathogenesis of refractory cervicobrachial pain syndrome. A deconstruction of the RSI phenomenon.
OBJECTIVE
To discuss the clinical and social phenomenon of refractory cervicobrachial pain, more popularly known as repetitive strain injury (RSI), from the standpoint of medical knowledge and to present the phenomenon as a problem of chronic musculoskeletal pain in which clinical clues suggest a neuropathic pathogenesis.


METHODS
Published articles from both medical and non-medical literature, primarily since 1980, were integrated with our clinical experience and observations.


RESULTS
Three sets of formal responses to the issue--medical, psychiatric and sociological--were identified and analysed with respect to the validity of their conclusions, which formed the conventional wisdom. Clinical observation revealed clues to disturbed nociception in a carefully defined set of subjects with chronic cervicobrachial pain. Theoretical pathophysiological correlations of these led to the formulation of an hypothesis.


CONCLUSIONS
We doubt that clinical method and diagnostic logic were rigorously applied to the RSI phenomenon, which helped to produce an unresolved controversy with widespread ramifications. Our hypothesis is that there is a central disturbance of nociception in this syndrome, induced by continual afferent barrage from nociceptors in anatomically relevant sites in the neck and upper limbs. Initial and proposed testing of this hypothesis are discussed.
Cohen
M L
ML
Department of Rheumatology, St Vincent's Hospital, Darlinghurst, NSW.
Arroyo
J F
JF
Champion
G D
GD
Browne
C D
CD
D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000209:etiology* / Q000503:physiopathology; D003937:Diagnosis, Differential; D006801:Humans; D009619:Nociceptors / Q000503:physiopathology