Greening, Jane Barbara; (2000) Changed vibration threshold and loss of nerve movement in patients with repetitive strain injury; the peripheral neuropathology of RSI. Doctoral thesis (Ph.D.), University College London (United Kingdom).

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Abstract

Changed vibration threshold and loss of nerve movement in patients with repetitive strain injury; the peripheral neuropathology of RSI Repetitive strain injury (RSI) is a chronic pain condition affecting the upper limbs. It has been associated with tasks that require repetitive and intensive hand activities, particularly when these are carried out in constrained postures. Patients present with significant symptoms, but when examined, lack signs of specific inflammatory conditions or single peripheral nerve disorder. In consequence there have been considerable problems in the diagnosis of RSI and in designing effective treatment. Partial injury to peripheral nerves can produce significant symptoms and allodynic changes in the presence of normal nerve conduction studies. It therefore seemed possible that minor neuropathy might be an important contributor to RSI. To test this, vibration threshold was measured in patients with RSI and in a group of "at risk" office workers. Significantly raised thresholds were found, particularly affecting the median nerve, in both the patients and office workers. Following five minutes of keyboard use the patients showed a further rise in vibration threshold. Patients also showed reduced tolerance to non noxious suprathreshold vibration. These sensory changes are consistent with the changes observed in patients with diagnosed neuropathy. In further studies we imaged the median nerve at the carpal tunnel using MRI and high frequency ultrasound. The dynamics of the median nerve were studied during 30 degrees of wrist flexion and extension. A significant quantitative reduction of nerve movement was seen in patients. A correlation was found between nerve movement measured objectively and a clinical test of median nerve dynamics. How loss of normal nerve dynamics could contribute to the symptoms experienced by these patients is discussed. It is concluded that minor nerve injury forms part of the pathology of RSI and that testing vibration threshold and examining nerve movement could contribute to diagnosis and prove useful in evaluating treatment outcomes.

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