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Repetitive strain injury (RSI) is one of a group of upper limb disorders which affect hundreds of thousands of workers every year in Britain across a number of industries. An HSE survey in 1995 estimated that over half a million people suffered from some form of work-related upper limb disorder with each sufferer taking thirteen days off sick a year as a result of the injury.

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RSI, sometimes known as Cumulative Trauma Disorder, is often associated in the public mind with keyboard operations and indeed keyboard operators are greatly at risk, but WRULDs are common in a number of industries where large numbers of repetitive movements take place, where forceful action is required or where workers have to adapt to an environment which results in poor posture.

RSI covers a wide range of injuries to muscles, tendons and nerves. Usually hands, wrists, elbows or shoulders are affected. Knees and feet can also suffer, especially if a job involves a lot of kneeling or operating foot pedals on equipment.
The more common workplace strain injuries are sometimes called Work Related Upper Limb Disorders or WRULDs. These can lead to permanent disabilities, and must be countered at an early stage.

Typical WRULD symptoms include:

• tightness, discomfort, stiffness, soreness or burning in the hands, wrists, fingers, forearms, or elbows
• tingling, and a feeling of cold, or numbness of the hands resulting in a need to massage your hands, wrists, and arms
• swelling of hands and limbs
• clumsiness or loss of strength and coordination of the hands or upper limbs
• pains and cramps in the upper back, shoulders, or neck.

Symptoms can initially be slight but nagging. However the injuries tend to be cumulative so if not acted on in the early stages the condition will deteriorate. In extreme cases WRULD can be debilitating preventing sufferers from driving or getting dressed unaided.

Medically WRULD can encompass a number of conditions variously known as:

• tenosynovitis (de Quervain's syndrome) a DSS prescribed disease;
• carpal tunnel syndrome - (rarely successful in occupational claims unless following tenosynovitis. Prescribed disease where contracted as a result of use of a hand-held vibrating tool);
• cellulitis (or "best hand") (DSS prescribed disease);
• epicondylitis (also referred to as "tennis elbow" or "golfer's elbow");
• diffuse fibromyalgia;
• ganglions (on their own, they are unlikely to be the basis of a viable claim);
• peritendinitis crepitans (one of the so-called original classic RSI conditions);
• tendinitis/tendonitis (one of the so-called original classic RSI conditions);
• tendinosis;
• rotator cuff syndrome (unlikely to be a viable claim)
• Dupuytren’s contracture;
• writers cramp (DSS prescribed disease)
• bursitis - (occupational causes are rare but Bursitis at the elbow is a prescribed disease);
• thoracic outlet syndrome,
• trigger finger/thumb;
• myofascial pain syndrome;
• cubital tunnel syndrome
• ‘housemaid’s knee’ or ‘beat conditions’; and
• overuse injury.

Another condition, known as Reflex Sympathetic Dystrophy or Complex Regional Pain Syndrome (causalgia), may follow as a result of the initial condition.

Legal duty of employers

With sometimes limited visible symptoms, sufferers from WRULD can suffer skepticism on the part of employers and sometimes co-workers but the conditions listed above are recognised medical injuries. Employers have a legal duty under the Heath and Safety at Work Act 1974 and Management of Health and Safety at Work Act 1999 to prevent Work Related Upper Limb Disorders and to stop existing conditions getting worse. Failing to address the issue is negligence on the employers part and may result in a successful claim against them.

Employers need to show that they are:

• assessing the risks - this means looking around your workplace to see which jobs may cause harm;
• reducing the risk of ULDs - this could mean changing the way work is organised;
• they are helping sufferers back to work.

A worker can have developed a ULD in previous employment or outside the workplace. In such cases the employer must take steps so as not to exacerbate the condition.

The guidelines are that work practices and the workplace should be adapted to suit the worker and not to force the worker to adapt to comply with harmful work practices and conditions which cause injury.

Your employer is compelled to assess the risks that WRULDs might occur as a result of methods of working and working conditions and then act on them

HSE use the following table to show working circumstances where WRULD is possible or even likely and indicates what action a responsible employer might take. Failure to act responsibly has resulted in successful personal injury cases. Landmark cases include one taken against Midland Bank (now HSBC) which was upheld by the Court of Appeal in 1999.

Special regulations for operators of computers and VDUs

To prevent health problems associated with visual display units (VDUs) and display screen equipment (DSEs) employers must comply with the Health and Safety (Display Screen Equipment) Regulations 1992.

The health problems associated with VDU use include:

• upper limb disorders (including pains in the neck, arms, elbows, wrists and hands (often known as repetitive strain injury or RSI)
• back ache
• facial dermatitis
• epileptic fits
• fatigue and stress
• temporary eye strain and headaches

An employer is required to:

• analyse workstations to assess and reduce risks
• ensure that workstations meet the specified minimum requirements
• plan work activities so that they include breaks or changes of activity
• provide eye and eyesight checks on request and special; spectacles if needed
• provide information and training

Always take legal medical and legal advice if you believe you are suffering from a work related upper limb disorders. injurywatch.co.uk's free legal helpdesk is always a good place to start.

Areas where an employer may be negligent include:

• failure to break up work periods for repetitive tasks
• failure to adapt workplace to better accommodate work practices
• failure to adapt working practices to better accommodate workforce
• failure to take into account individual conditions of worker

As always, gather the evidence:

• see a doctor -the effect of your injuries might be obvious in most cases, but injuries don't always show up straight away
• keep a dossier. Include a diary recording all the details of the incident, who you saw and all the expenses or losses you incurred, including receipts
• record the details of your working practices - taking photographs of the working conditions and work in progress
• gather personal details of all the people who were aware of, or may have been affected by the working conditions
• gather information (backed up by witness statements from others) as to how long the situation had been known to your employer, but remained unrectified
• note and detail any measures (such as changes in working practices) which had been taken to warn of or otherwise diminish the risk
• note and detail any measures (such as a cramped workspace, or workplace practices, or having the pace of work governed by an external process or production line) which exacerbated the risk
• your legal team should be able to obtain a precise assessment of your condition and its likely causes.