Forearm Pain diagnosed as ‘RSI’ is just a diagnosis of “I don’t know why”
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I have an axe to grind.
I have desperate patients arriving at the clinic, with long-term forearm pain, reporting they’ve previously been diagnosed with “RSI”, yet with no management plan.
They say:
“I’ve got RSI, my (Healthcare Provider) said”.
I then ask:
“Ok, then what did your (Healthcare Provider) then say was the plan…?”
I’m going to say it right now: RSI is not a diagnosis.
It’s a throwaway term given to patients when the Healthcare Provider (HCP) giving it has no idea of what’s going on or what to do about it.
It’s sometimes amusing that Patients with upper limb pain or injury would go and seek medical attention, paying good money at times, and report to their HCP:
“Mr HCP! I have an injury that came on with repetitive use”
For that HCP to then turn around in their flashy white coat and $100k student loan debt and say:
“AH HAAAA! You have a ‘Repetitive Use Injury’”
Then reach into a filing cabinet and hand out an A4 piece of paper with general workplace ergonomic information on it and a list of stretches that
- Do nothing (at best)
- Make the pain/injury worse (at worst)
Otherwise known as a ‘recipe’, and there are no recipes when it comes to management of injuries and pain healthcare.
Some patients are switched onto this rubbish and call it out for what it is:
But is a specific diagnosis needed?
There are some cases where ‘non-specific’ labels are being used for common conditions such as back pain and shoulder pain. This is because the ‘diagnosis’ or ‘label’ of the pain/injury being used won’t usually change the management of what is usually a self-limiting injury (one that resolves naturally with time).
Here is an example case study to ponder:
A middle age desk-worker patient arrives at their HCP with forearm pain, the HCP says “it’s RSI”, and provides some basic ergonomic and postural information, and also some stretches where they push the wrist down and hold, and/or hold the wrist up and hold, perhaps (if it’s workers compensation) they even arrange expensive ergonomic assessments in the workplace +/- ergonomic equipment purchases.
Based on the above case study, here are real-life examples of why diagnostics do matter, turns out the above person (or people) had one of the below:
- Carpal Tunnel Syndrome — the wrist down stretch will make it worse, this requires more than ‘basic’ ergonomic information to manage, it also requires immobilisation.
- “Tennis Elbow” (Lateral Elbow Tendinopathy) — none of the ergonomic or postural info matters, the patient needed rehab, and the wrist down stretch made it worse.
- Radial Tunnel Syndrome — ‘basic’ ergonomic information wasn’t enough to manage it, also had some cervical spine inputs that the HCP didn’t check for or manage which continued to stir up the radial nerve branch, also the wrist down stretch made it worse.
- Cubital Tunnel Syndrome — turns out it was a problem with constant elbow flexion…. which the ergonomic information provided actually recommended as part of “good posture” so the patient followed the HCP advice exactly and made it worse, they needed sleep posture advice as well.
- DeQuervains Tenosynovitis — had nothing to do with the workplace, it was from breastfeeding postures in the patient who is a mother but didn’t mention it, but it would have come up during a physical examination which was missing as the HCP just handed out a diagnosis of “RSI” without doing an assessment. This condition needed specific activity modification advice and immobilisation, the wrist down stretch made it worse.
The above are just a handful of the cases of “RSI” being given to patients, who inadvertently thought RSI was a clinical entity or diagnosis that is well known and easy to manage because hey, “I’ve been diagnosed….”. In some cases, interventions then involved very expensive and not — very-evidence based ‘Ergonomic Assessments’ were then provided by Ergonomic-based companies (who just also happen to sell expensive Ergonomic Equipment).
Little did these patients know that RSI is just a fancy term that parrots back to the patient their reported mechanism of injury. There is little to no value in using the term and it often prolongs patient outcomes rather than directly addresses their pain or injury.
Not does the term ‘RSI’ have no value, it’s potentially nocebic (language that can do harm), patients will have heard of ‘RSI’ from others who have had pain/disability for a long-time, and these patients will immediately attach ‘chronicity’ to their condition, and it almost becomes self-fulfilling.
“I have RSI, which means it’s chronic”
These patients will then drift away from the “evidence-based” medical world and go and try everything under the sun (eg: acupuncture, cupping, zapping, stabbing etc) to help with their “chronic pain”.
If you have been diagnosed with RSI, please seek a second opinion from a good HCP (Good Physiotherapist, Good GP, Good Sports and Exercise Medicine Physician) (select here to see what a Good Physio does in an appointment) who will listen to your entire story, perform a comprehensive physical examination, order follow up investigations when needed (if they don’t change management, don’t get the XR/Ultrasound/MRI), fully explain what is going on and what the plan is to manage it in a way that the patient understands.
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