Search for RSI on the Internet and you will find 1001 different definitions. What's more there are lots of other terms used to describe the same symptoms, such as Work-Related Upper Limb Disorder or Occupational Overuse Syndrome. However, RSI seems to be the most common and recognised term internationally. It stands for 'repetitive strain injury' and is not an illness in itself, but rather a term used to describe particular symptoms and complaints.

General description of RSI
Scientific description
The symptoms
Diagnosis: specific and non-specific RSI
Working definition of RSI
Physical examination

General description of RSI
RSI is a collective term for complaints, symptoms and syndromes that occur in the upper back, neck and shoulder region, arms, elbows, wrists, hands and fingers. It is generally caused by repetitive movement, long-term static posture or a combination of both. Individual and work-related factors may also play a role in the development of symptoms or in worsening or maintaining them. RSI can occur in many different types of work.

Scientific description
A committee of the Health Council of the Netherlands was commissioned to investigate the scientific status quo on RSI by the Minister for Health and the State Secretary for Social Affairs and Employment. Its report came out in 2002 and included a scientific definition of RSI (you can download a copy of this report and read the English summary with conclusions and recommendations). The definition that the committee came up with is almost as complex as the condition itself:

RSI is a multifactorial complaints syndrome affecting the neck, upper back, shoulder, upper and lower arm, elbow, wrist or hand, or a combination of these areas, which leads either to impairment or to participation problems. The syndrome is characterised by a disturbance in the balance between load and physical capacity, preceded by activities that involve repeated movements or prolonged periods spent with one or more of the relevant body parts in a fixed position as one of the presumed etiological factors.

The symptoms
The use of three phases to indicate how severe the complaints or problem are seems to have become a matter of course for both patients and therapists. According to the Health Council's report, however, there is no clear basis for this much used system and there is no clear relationship between the various phases and the prognosis. The committee does recognise that RSI comes in various degrees of severity. The initial phase is characterised by the fact that although there are symptoms they do not lead to participation problems. In the second phase participation problems play a central role and in the final phase chronic pain predominates.

Both the Dutch RSI association and the medical world as a whole doubt the usefulness of describing RSI in terms of phases. The main reason for this is that it can lead to false conclusions regarding the severity, the treatment method and the prognosis. For example:

• The symptoms are commonly thought to progress gradually from phase one to phase two to phase three but this is not always the case. Initial symptoms in particular can become extremely severe in a very short space of time.
• Another possible false impression is that a long period with mild symptoms is less serious than a short bout of severe symptoms. Timely intervention is extremely important in both cases.
• The condition can develop very differently from person to person. Most people recognise the above-mentioned symptoms but that doesn't make it clear what phase they are in and should not affect the type of treatment.
• Finally the most important misunderstanding: in the past it was deemed impossible to recover from phase three, a prognosis that could lead to depression and resignation. However, the vast majority of sufferers do experience a slow but sure progression towards recovery.

Diagnosis: specific and non-specific RSI
Many diagnoses fall under the umbrella term RSI. Specific RSI conditions include provable conditions such as tendinitis, epicondylitis, thoracic outlet syndrome (TOS), carpal tunnel syndrome, rotator cuff syndrome, tension neck syndrome and de Quervain's syndrome. Non-specific RSI, as the name suggests, is a form of RSI in which no specific conditions are found. It is particularly important that a thorough examination be carried out to seek both specific and non-specific forms. Unfortunately, this often doesn't happen in practice. The Health Council works on the assumption that 87 percent of RSI cases are non-specific and 13 percent specific. However, more thorough examinations and/or research could prove the ratio to be very different.

The RSI-centrum describes RSI as an umbrella diagnosis and says on its website that various different examinations can contribute towards being able to diagnose RSI. These include a description of the previous medical history and symptoms, a functional examination and the exclusion of other diseases. It stresses the need for clear insight into the symptoms and the correct treatment.

Guidelines were drawn up for the diagnosis of work-related musculo-skeletal problems in the upper extremities at the request of the Ministry Social Affairs and Employment in 1998. The connection between an illness and work can be made using these guidelines. They can be found in the European Criteria Document known as 'Saltsa report' of the Nederlands Centrum voor Beroepsziekten/Coronel Instituut voor Arbeid, Milieu en Gezondheid of the Academisch Medisch Centrum of the University of Amsterdam. You can download the report (PDF file, NB: 2128 kb!) or check the contents first.

Working definition of RSI
How can you recognise RSI? What are the symptoms? In order to facilitate the recognition of RSI among sufferers Jip Driehuizen and Carien Karsten, authors of the book 'Omgaan met RSI' (Dealing with RSI - available only in Dutch), have launched a new working definition of RSI.This description gives a practical and recognisable picture of how the symptoms can manifest themselves and we therefore find it worth mentioning. NB you may still have RSI even if you don't have all of the symptoms listed below.

You may have RSI if:

• The symptoms last longer than about six weeks.
• You have pain or unpleasant, diffuse sensations, numbness or tingling in more than one of the following locations: a particular spot between this shoulder blades, in the shoulder muscle, around the shoulder joint, around the elbow (right, left or both), in the lower arm (front, back or both), in the wrist or in one or more fingers.
• The symptoms soon get worse through fine motor movements and sitting in the same position for a long time. The most common examples are computer work and driving. The pain often gets worse after you have finished the activity.
• The symptoms are irritated by forceful hand movements such as wringing or lifting.
• The symptoms can manifest themselves in tense situations (stress).
• The symptoms often occur during or shortly after a period of dedication to a particular task, a hectic time and/or stress.
• Rest reduces the symptoms but they return as soon as you recommence the activity that caused them.
• Clumsiness occurs: for example your handwriting gets worse or you drop things.

Physical examination
A thorough physical examination should reveal:

• Considerable tension of the neck and/or shoulder muscles, and often of the lower arm muscles too.
• Tender points between the shoulder blades, on the shoulder muscle, around the shoulder and at the back of the lower arm.
• Stiff wrist movement.
• Very often reduced suppleness of the shoulder joint.
• The major nerve cord in the arm is sensitive on stretching.
• The ability to carry out (very) fine motor movements is sometimes reduced.

Source: 'Omgaan met RSI; hoe je voorkomt dat het chronisch wordt' by Jip Driehuizen and Carien Karsten, 2002