Repetitive Strain Injuries occur from repeated physical movements doing damage to tendons, nerves, muscles, and other soft body tissues. Occupations ranging from meatpackers to musicians have characteristic RSIs that can result from the typical tasks they perform. The rise of computer use and flat, light-touch keyboards that permit high speed typing have resulted in an epidemic of injuries of the hands, arms, and shoulders. Use of pointing devices like mice and trackballs are as much a cause, if not more so. The thousands of repeated keystrokes and long periods of clutching and dragging with mice slowly accumulates damage to the body : another name for the condition is Cumulative Trauma Disorder. This can happen even more quickly as a result of typing technique and body positions that place unnecessary stress on the tendons and nerves in the hand, wrist, arms, and even the shoulders and neck. Lack of adequate rest and breaks and using excessive force almost guarantee trouble.

There is a Chinese saying that "To go beyond is as wrong as to fall short." In other words, how long can you tap on that keyboard or sit in that chair before you hurt yourself. We’re not designed to remain as sedentary or perform the fine motor movements for the long uninterrupted hours that we have to do in so many of our jobs. Evidence suggests that prolonged abnormal posture and repetitive movements contribute to neck, limb and back pain. These conditions are collectively known as overuse syndromes, or repetitive stress injury (RSI).

RSI is no small matter. It accounts for 34% of all lost-workday injury and illness — and costs almost $20 billion annually, according to the Bureau of Labor Statistics. The National Academy of Sciences has concluded that an estimated $50 billion is lost by businesses every year from sick leave, decreased productivity and medical costs linked to repetitive stress disorders. The Academy has published two reports since 1998 which directly link repetitive motion to workplace injury.

The damage sustained from RSI is due to structural changes in the muscle fiber as well as due to decreased blood flow. Nerves can also be involved. The immobile tissue and surrounding inflammation compress the nerve which can cause numbness or tingling and eventually weakness if the nerve is damaged severely.

The causes of RSI are controversial. While every RSI sufferer knows that a stressful day will worsen their symptoms, simply by increasing muscle tension and thereby pain, RSI is definitely not "all in the mind". The spread of RSI within a workplace may even be exacerbated by anxiety once a few people have RSI, but anxiety is not sufficient to cause RSI. Rather, RSI is caused by many shared and individual factors, including physical fitness, muscle tension, individual work habits, stress, long hours, lack of breaks, bad ergonomics, and poor, static posture.

One of the greatest risk factors leading to RSI is the restriction of circulation to muscles, tendons, and nerves during repetitive use. During static contraction (hold your arm out to the side, say), circulation is nearly stopped, which is why you can't do it for very long. The oxygen gets used up. During repeated contractions the effect is just delayed. Under the kind of demands we place on our bodies during computing, these tissues need all of the nutrients and oxygen they can possibly get from our blood. Also, the blood must flow freely to carry off the additional waste products (which cause pain) - lactic acid and carbon dioxide - produced by said use.

Other factors constrict blood flow to your extremities, setting up a vicious cycle. One factor is any existing injury. Injured tissue inflames during repetitive motions. This pressure limits circulation. Then, once one muscle hurts, all its neighbors tense up, perhaps to relieve the load. This makes sense for your normal sort of injury, but it only makes things worse with repetitive motion. More tension means less blood flow, and the cycle continues.

Tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows

Tingling, coldness, or numbness in the hands

Clumsiness or loss of strength and coordination in the hands

Pain that wakes you up at night

Feeling a need to massage your hands, wrists, and arms

Pain in the upper back, shoulders, or neck associated with using the computer.

Stay aware of your posture while you are sitting at your desk working and observe your attitude about task completion. It is as important to take care of the "tool", your body, as the task.

Do not eat your lunch at your desk. During your lunch break do an activity that involves physical exercise: walking, go to the gym, shopping.

Include full body stretches in your daily activity, emphasize the upper body. Stretch before you go to sleep at night.

Observe your sleeping position. Don't curl up your wrists or put your arm under your head when sleeping on your side. Make sure that you have the right pillow height for sleeping. The neck should be supported, but too many pillows will create problems as well. You want the head to rest comfortably. The neck should be in line with the rest of the spine.

Check that your work station is set up correctly. Monitor screen should be eye level or below eye level. New keyboards and mouse designs can help prevent strain. (See SoreHand for suggestions.)

Develop an exercise program that includes upper body strength, so that you can sit comfortably in an upright  position without slouching. The program must also include exercise for flexibility, to stretch out the contracted muscles of the wrist, arm, shoulder, neck and upper back. 

Here are a few tips:

-- Breaks should be taken every 30-45 minutes for at least 5 minutes. If you need assistance there are free downloadable timers that will help remind you to do so.
-- Stretch your arms, hands, neck, and back during breaks. This yoga site demonstrates some exercises. Other sites are listed below.
-- Maintain posture alignment. Don't slouch on the couch with the laptop.
-- Work stations should be reviewed initially and with each office move. Adjust your chair, monitor, keyboard, mouse, laptop. Alternate keyboards and mice periodically.
--Shift your gaze from the computer screen to the distance. And don't forget to blink!
--Limit non-essential computer use. This may be heresy -- but do give the surfing, gaming, emailing, and text messaging a rest.
-- If pain occurs or persists, see your doctor, who may recommend wrist brace, ice packs, anti-inflammatory medication such as ibuprofen, cortisone injections, physical therapy, and most importantly, rest to allow healing. Don't procrastinate in addressing your symptoms -- the sooner you tend to them, the better off you are.

Promoting habits for healing and health is a matter of personal taste. Investigate and learn what works for you. Good methods to try are the following. (Many of the following methods helped me.)

• For more effective posture, breathing, and coordination: Try the Feldenkrais method or the Alexander technique.
• For stretching and gentle body movement: Try Yoga, Chi Kung, Ba Duan Jin, or Tai Chi.
• For reducing stress (which can cause a large negative physical reaction): Try meditation, visualization excercises, taking deep breaths, sensory deprivation tanks,or going for a walk.
• For learning to let go of neck, shoulder and upper back muscles: Try biofeedback. (In my opinion: the most efficient way to learn.)
• For working through sore, stiff, or sensitive muscles: Try massage, physiotherapy, trigger point therapy, acupressure or shiatsu.
• For vitamin therapy: Try 200 mg./day of B6. Anti-oxidant vitamins E, C, and beta carotene have also helped some people.
• For inproving nutritive intake: Try cutting out sugar, and drink lots of water.
• For keeping your hands warm and flexible: Try wearing Handeze or some other fingerless gloves. Squeezing rubber racketballs, working with soft putty, or playing with Chinese health balls throughout the day have also helped many people.
• For increasing hand vitality and working through soreness: Try warm-cold contrast baths. (Put your hands/wrists in one bucket of warm water for 60 sec, and then put them in a bucket of cold water for 60 sec, and repeat for 10 min).
• For reducing inflammation and pain: Try ice or a package of frozen vegetables (like peas) on the affected area.
• For relieving neck strain after sleeping: Use a cervical roll or one of those "contour pillows" and don't sleep on your stomach.
• For daily comfort at your work: Change your chair (see ergonomics below). It is usually the first piece of "ergonomics" that one would want to change when getting this sort of injury, because posture is so important.
• For general well-being: Take frequent rest breaks (recommended is 5 min rests every 20 min or better yet, a thirty second break every three minutes, and get up out of your chair at least once an hour), drink lots of water, excercise, stretch, and move around often, and sleep well.

Try focusing more on treatment for your neck, shoulders, and upper back instead of your wrists (of course ice your wrists, and stretch them as needed). I had tenosynovitis, tendonitis in both wrists, and after alot of reading, decided that I had/have thoracic outlet syndrome as well.

Tightness, and learned poor posture at the neck and shoulders has a huge effect on the arms/wrists. At least that was my experience. Try stretches that open up the chest (like pretending you're going through the door, and keeping your hands on the doorframe, or kneeling on the floor with resting your arms on the floor over your head and then to the side.) A physical therapist should be able to show you some good ones for stretching out the shoulders and chest.

Instructions Preparation Grasp wrist or hand from behind and pull arm to opposite side   Execution Tilt head away from lowered shoulder by positioning ear toward front of opposite shoulder. Hold stretch. Repeat to other side. Comments None. Muscles Target Trapezius, Upper Other Splenius

Instructions Preparation Position arm across neck. Place opposite hand on elbow. Execution Push elbow toward neck. Hold stretch. Repeat with opposite arm. Comments None Muscles Target Deltoid, Posterior Other Infraspinatus Teres Minor Trapezius, Middle Trapezius, Lower Rhomboids

Instructions Preparation Position arm across chest. Place opposite hand on elbow. Execution Push elbow toward chest. Hold stretch. Repeat with opposite arm. Comments None Muscles Target Deltoid, Lateral Other Infraspinatus Teres Minor Trapezius, Middle Trapezius, Lower Rhomboids

Instructions Preparation Stand facing very close to stationary bar. Grasp stationary bar with both hands just below chest height. Execution Lean back allowing body and hips to fall back and shoulders to be pulled forward. Hold stretch. Comments None Muscles Target Rhomboids Other Trapezius, Middle Trapezius, Lower

Instructions Preparation Stand facing stationary bar. Grasp stationary bar with one hand approximately waist height. Execution Bend over allowing hips to fall back. Slightly lean torso toward stretched arm. Hold stretch. Repeat with opposite side. Comments None Muscles Target Back, General Other Latissimus Dorsi Teres Major Deltoid, Posterior Trapezius, Lower Rhomboids Infraspinatus Teres Minor