Hand Overuse Syndromes
Hand overuse syndromes are also called repetitive strain injuries (RSI) or cumulative trauma syndromes. Normally the hand copes well with the stresses of everyday living due to the body’s remarkable healing abilities. However there is a threshold for injury above which some residual tissue damage occurs. Repeated stress applied beyond this threshold can result in cumulative trauma in excess of the body’s reparative capacity. This disease process is termed an overuse syndrome and is most frequent in the upper limb. Most overuse syndromes involve musculo-tendinous and ligamentous structures or peripheral nerves at sites of irritation or weakness. The common features of all these conditions are symptoms that appear some time after the stress has been initiated and then resolve with rest, only to recur after resumption of stressful activity. With time, pathological changes will occur that result in persistent symptoms even at rest. Intermittent symptoms of pain, swelling, crepitus, muscle weakness or numbness will become constant with time.
There are a number of named syndromes that result from overuse or repetitive strain injury, including neurological syndromes as well as musculo-tendinous and ligamentous syndromes:
Carpal Tunnel Syndrome (median nerve compression)
Pronator Syndrome (median nerve compression)
Radial Nerve Entrapment Syndrome (superficial radial nerve compression or posterior interosseous nerve compression)
Cubital Tunnel Syndrome (ulnar nerve compression)
Thoracic Outlet Compression (brachial plexus compression)
Musculo-tendinous and ligamentous syndromes:
Trigger Finger (stenosing tenovaginitis of flexor tendon)
DeQuervain’s Disease (stenosing tenovaginitis of thumb extensor tendons)
Tennis Elbow (lateral epicondylitis)
Rotator Cuff Tendonitis of shoulder (rotator cuff muscles and biceps)
Hypothenar Hammer Syndrome
Ganglion tumours of the hand and wrist
If you have been diagnosed with a repetitive strain injury, contact Dr. David Ross, plastic surgeon in Melbourne to discuss the most effective treatment plan.
Conservative and Surgical Treatment of Overuse and Repetitive Strain Injuries
The principle of treatment is based on identifying the injured structure and removing the stresses that produced the injury, while the tissues recover. This will often require a sustained period away from work in patients with work related repetitive strain injury. Oral anti-inflammatory agents, steroid injections, immobilization, and physiotherapy can help relieve symptoms and aid healing. Hand surgery is used as an adjunctive treatment modality in the management of repetitive strain injuries in two situations. If there is an anatomical defect such as a tight fibrous tunnel around a nerve or tendon it can be decompressed surgically (as in a carpal tunnel release) or if inflamed tissue is affecting hand function it can be removed (as in a synovectomy). When symptoms have been resolved by hand surgery or a combination of treatment modalities it is important that a graded exercise program be commenced to strengthen the injured tissues gradually so that they can resist the stress of return to prior manual activities. If this is not successful, permanent alternative work activities will need to be considered. Correct diagnosis and management is essential for a satisfactory outcome in the treatment of hand overuse syndromes. It is important that your assessment is undertaken by an experienced hand surgery specialist.
Dr. Ross will be happy to answer any questions you have about hand surgery and the treatment of repetitive strain injuries. If you feel you have a hand overuse syndrome or repetitive strain injury, please contact our Melbourne practice to schedule a consultation.