title: Repetitive strain injury.
abstract: Repetitive strain injury remains a controversial topic. The term repetitive strain injury includes specific disorders such as carpal tunnel syndrome, cubital tunnel syndrome, Guyon canal syndrome, lateral epicondylitis, and tendonitis of the wrist or hand. The diagnosis is usually made on the basis of history and clinical examination. Large high-quality studies using newer imaging techniques, such as MRI and ultrasonography are few. Consequently, the role of such imaging in diagnosis of upper limb disorders remains unclear. In many cases, no specific diagnosis can be established and complaints are labelled as non-specific. Little is known about the effectiveness of treatment options for upper limb disorders. Strong evidence for any intervention is scarce and the effect, if any, is mainly short-term pain relief. Exercise is beneficial for non-specific upper limb disorders. Immobilising hand braces and open carpal tunnel surgery release are beneficial for carpal tunnel syndrome, and topical and oral non-steroidal anti-inflammatory drugs, and corticosteroid injections are helpful for lateral epicondylitis. Exercise is probably beneficial for neck pain, as are corticosteroid injections and exercise for shoulder pain. Although upper limb disorders occur frequently in the working population, most trials have not exclusively included a working population or assessed effects on work-related outcomes. Further high-quality trials should aim to include sufficient sample sizes, working populations, and work-related outcomes.
authors.affiliation: Institute for Research in Extramural Medicine, VU University Medical Centre, Amsterdam, Netherlands; Institute of Health Sciences, Faculty of Earth & Life Sciences, VU University, Amsterdam, Netherlands. Electronic address: mw.vantulder@vumc.nl.
authors.forename: Maurits
authors.initials: M
authors.lastname: van Tulder
authors.affiliation: Finnish Office for Health Care Technology Assessment, Helsinki, Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Malmivaara
authors.affiliation: Deptartment of General Practice, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands.
authors.forename: Bart
authors.initials: B
authors.lastname: Koes
mesh_terms: D002349:Carpal Tunnel Syndrome / Q000145:classification / Q000503:physiopathology / Q000628:therapy; D002986:Clinical Trials as Topic; D012090:Cumulative Trauma Disorders / Q000145:classification / Q000503:physiopathology / Q000628:therapy; D005081:Exercise Therapy; D006801:Humans; D019547:Neck Pain / Q000145:classification / Q000503:physiopathology / Q000628:therapy; D016896:Treatment Outcome