Newpharmablog. Health News

This is another example of a painful condition which is epidemic in its increase and yet appears to be without cause. It occurs particularly in office workers who use typewriter keyboards or computer mice. It has not suddenly appeared but used to be given names, such as writers’ cramp and tennis elbow. It appears first as a tingling or numbness in the fingers. As it develops, it becomes so painful that the hand cannot be used and long rests are needed before it dies down. The pain may spread up the arm and invade the shoulder and neck. Pain and tenderness may persist after very long periods of rest. The victim becomes unable to work. The standard medical examination reveals no cause.There is a very similar disease called carpal tunnel syndrome which has almost identical symptoms. However, in this case a test to measure the ability of nerves to conduct from the hand to the arm shows that they are conducting slowly and nerve entrapment is suspected. The two major nerves to the hand could become trapped where they pass under a band of fibrous tissue on the front of the wrist. This band of tissue holds the nerves, tendons and blood vessels close to the bones of the wrist, and is called the carpal tunnel. It is believed that, with heavy continuous use, the band swell and straps the nerves. A simple operation cuts the band and liberates the nerves from the pressure on them, sometimes completely curing the condition.Repetitive strain injury (RSI) not only has no obvious signs of damage but seems to occur in outbreaks in particular workplaces. This tended to make industrial doctors, employers and insurance companies suspicious that they were dealing with some form of mass hysteria of the type we have described for low back pain. Attempts to solve the problem were made by calling in ergonomic specialists who adjusted the tilt of the keyboards, put backs on the chairs, tilted the seats and changed the lighting. Although temporary effects were achieved, the workforce returned to their old problems. In two large telephone companies in the United States, one had serious problems but the other had few complaints, despite the fact that the equipment and tasks were identical. This observation exaggerated the belief that the disease was in the mind rather than the body. The belief was further supported when a difference was noted between the two companies. The one with problems paid workers on commission for each call answered, while in the other the workers were on a weekly wage.The growing belief that it was ‘all in the head’ received a further boost when a large publishing company recognized that, unlike the so-called workshy, movement-intolerant workers of Boeing complaining of back pain, the workers who complained of RSI tended to be eager-beaver ambitious types, while their more happy-go-lucky, slobbish workmates had fewer complaints. All of this had led to angry confrontations in many countries between workers with the condition and compensation agencies who refused to recognize this as a ‘real’ disease because they believed it had no organic cause.Very recently, workers with RSI have been examined in London using an unusual but simple neurological test. The palm was tested for the ability to detect a carefully controlled vibration. To the great surprise of doctors and scientists, the ability of the RSI patients to detect vibration was greatly reduced on the palm of the hand but was completely normal on the back of the hand. Furthermore, when they tested workers from the same company with the same job who were not complaining of RSI, they found that many of them were beginning to lose their ability to detect vibration. These tests immediately put an entirely new interpretation on the disorder because they provide evidence for a subtle disorder of the peripheral nerves in the hands and arms or in the brain cells that detect vibration. If some of these nerve fibres or cells are not functioning properly, the disorder is reclassified as one of nerve damage rather than as a psycho-social disorder. It is well known that in some cases of overt single-nerve damage, the pain spreads far beyond the territory of the damaged nerve. This means that the widespread of pain on the body of these RSI patients joins a well-known category of pain, rather than being a bizarre distribution that had previously made unfriendly doctors suspicious that RSI was simply a form of hysteria.We are left with a question: if RSI is now to be awarded the honour of having a ‘real’ cause rather than a self-inflicted psycho-social cause, why has it become more common? It could be that, in the past, complainers were simply dismissed, particularly as the majority were women, but women have now learned to fight. The numbers of people who regularly type as part of their job has greatly increased with the appearance of computers and with the near disappearance of the specialist typist. And there has been a subtle change with computer keyboards. The carriage return of the old-fashioned typewriter, which gave the typist a brief rest at the end of every line, has disappeared. The use of the mouse forces the worker into very fast, detailed movements and puts them almost into the category of violinists. Musicians have been famously plagued with painful cramps similar to RSI. Finally, forced pace and the additional task of making running corrections may have increased the mechanical strain of muscles and nerves.There are important consequences of the transition of RSI to a disease with a cause other than the psychological inadequacy of the victim.*48\219\2*

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. This entry was posted on Saturday, June 11th, 2011 at 4:33 am and is filed under Pain Relief-Muscle Relaxers. You can follow any responses to this entry through the RSS 2.0 feed. Both comments and pings are currently closed.