Between my GP and the hand consultant that I saw in London, both of whose only advice was to take Ibuprofen and wear a wrist support, it ended up being a 3 month gap from first experiencing shooting pain in my right arm and actually seeing a physiotherapist who knew anything about RSI treatment.
During this time I was sent on a merry round of examinations and referrals. First to a Rheumatologist for possible arthritis or Lupus, and when those tests ended up negative and the cortisol shot he gave me didn’t work, I was sent for a Spect CT scan of my whole body and my wrists in particular which showed no inflammation in my wrists but a problem in my ankle (!). After seeing a foot doctor, I was sent for a Dexa scan and on to an Endocrinologist because the scan showed I had Osteopenia. The Endocrinologist sent me for an MRI scan and more blood tests and found I had a microadenoma in my pituitary gland which though I’m glad they managed to catch, was causing problems that had nothing to do with the pain in my wrist! I was also referred on to a Psychiatrist for depression, because as far as the doctors were concerned there was nothing wrong with my wrists and the pain I was feeling in them must all be in my head. While all this was going on I had a few weeks off work but otherwise struggled on and moved house (which inevitably involved a lot of lifting and carrying and packing and unpacking) and my right and left arm deteriorated to the point at which the pain became constant. I refused to see a Psychiatrist because I didn’t believe my pain was caused by depression (rather the other way round) and asked to see a physiotherapist instead. By then it was too little too late, and despite seeing her twice a week for nearly 3 months I still found myself left with no choice but to quit my job and move home because the pain of doing everyday activities made working and looking after myself impossible.
It’s now been since March 2013 that my right arm has not been working properly, and June 2013 for my left as it had to do so much more work to compensate after my right arm became damaged. Although they are much better than what they were like at their worst (see my cartoon ‘The Perils of Having RSI‘) they are still a long way from normal and I’m not entirely sure whether I will be able to work a full 8 hour day in an office ever again.
If I could do anything differently after first experiencing pain in my arm it would be:
1)Read ‘It’s not carpal tunnel Syndrome‘ by Suparna Damany, MSPT and Jack Bellis. This book details the symptoms and syndromes associated with RSI (Repetitive Strain Injury) and covers prevention and therapy of the disease.If you have any pain in your upper body from office work stop faffing around on your computer and READ IT NOW!!!!
I only just finished reading it last week (it’s now June 2015) and I wish I’d done it when my friend told me about it last year. Unfortunately, I got distracted by my pregnancy and thought that I had the situation under control with treatment from my new Belgian physio. Since seeing her I can now do lots of things that I used to take for granted (like stack the dishwasher and chop vegetables and hold my baby) without pain again, but if I’d carried out the stretches and exercises as well as improving my work station as recommended in the book I might be a lot further a long towards also using a computer and playing tennis or carrying my own suitcase. Ah well. There’s no time like the present, so as of 01/07/2015 I’ve started a new exercise and stretching routine – I’ll let you know how it goes!
2) Research and find a doctor who is a specialist in RSI problems so that a diagnosis can be made quickly and treatment started as soon as possible. With RSI the pain tends to move around the upper body and it can be difficult to pinpoint where the root cause of the problem is. Don’t let yourself be fobbed off by a GP or consultant with ibuprofen and a wrist splint- at best these will help alleviate your symptoms but won’t heal them.
For example, I thought my problem was in my wrists because they felt hot and inflamed when I did things like typing or using the mouse, but the first physiotherapist I saw could actually feel the twists and lumps that were in the extensor muscles of my forearm that support my wrists and she diagnosed myofascial forearm pain. She gave me some good stretches to try and smooth out those muscles and used deep tissue massage and ultrasound to try to relax them.
This helped but wasn’t enough and a year later in Brussels (April 2014) I went to see an orthopaedic consultant and had an echography done of my right arm because the pain was still returning when I tried using a computer. She diagnosed lateral epicondylitis (tennis elbow). She recommended surgery as the pain had been going on for such a long time, but after researching surgery outcomes I decided not to go down this route. Instead I began seeing a new physio who confirmed the lateral epicondylitis diagnosis in my right arm and detected medial epicondylitis (golf elbow) there too, and both in my left arm as well but to a lesser degree.
I think I must have had all of those problems over the course of my illness – myofascial pain, lateral and medial epicondylitis in my right and left arms as well as thoracic outlet syndrome and postural misalignment. At my worst I measured 75-Incapacitation on the nerve problem scale detailed in ‘It’s not Carpal Tunnel Syndrome’ , and an 8-Severe Pain on the pain scale. If I’d been diagnosed earlier and started treatment immediately I might have avoided some of these problems (at least in my left arm) and stopped my RSI progressing to Third degree RSI and loss of strength in my arms.
3) Stop working and wear wrist and elbow supports (including at night) for up to 6 weeks, so that you can get the pain under control and rest your arms properly.
Thankfully I only need to wear wrist splints at night after I’ve had a particularly busy day now (today for example after typing this! And sometimes after pushing the pram for long periods).
4) Use Flexium gel and Biofreeze for pain management. I’ve found using a heat rub gel when the muscles feel tight but not sore has also been helpful. I prefer using gels for pain management than pills because taking Ibuprofen over prolonged periods can upset your stomach.
5) Find a good physiotherapist who has experience with RSI treatment as soon as possible and see them at least twice a week. Make sure you are very active about the physiotherapy that you receive. By that I mean don’t just think like I did that you can have physio in isolation and it will make everything go away. You need to do stretches and exercises on your own everyday as well and really build up all the muscles in your upper body if you want to get your RSI under control.
I’ve had a variety of different types of physiotherapy over the past couple of years. At the beginning deep tissue massage and ultrasound really helped to get rid of a number of trigger points in my muscles, but I can also recommend a physio who uses the ‘hook’ treatment (not common in the UK, but used in France and Belgium). The hooks look pretty evil but can really get deep into the muscle where the physio cannot reach to loosen them. I’m also now trying PCP therapy (a continuous pressure therapy technique) and this seems to be helping too.
6) Improve your workstation configuration and posture. Change your working method to include more breaks and make use of voice recognition software to reduce the amount of keystrokes you make.
This one I still haven’t done, and anyone watching me work would look at me hunched over my laptop in horror! I only just found out after reading ‘It’s not Carpal Tunnel Syndrome’ that you are not supposed to rest your hands while you are typing- they should be floating over the keys.. help. My desk is a disaster zone. When we move house in a few months I’m going to set up my working area with a new desktop computer, voice recognition software and an ergonomic keyboard and touchpad so my arms can stop regressing every time I try and type something!