What Is It?
RSI encompasses several distinct clinical presentations. Carpal tunnel syndrome involves compression of the median nerve at the wrist, producing numbness, tingling, and weakness in the thumb, index, and middle fingers. De Quervain's tenosynovitis affects the tendons of the thumb at the wrist, causing pain with gripping and pinching. Thoracic outlet syndrome involves compression of the brachial plexus, subclavian artery, or subclavian vein between the clavicle and first rib, producing upper limb neural and/or vascular symptoms.
All RSI presentations share a psychosocial component: workplace stress consistently amplifies symptom severity and slows recovery, making the biopsychosocial management approach essential.
Common Causes
- Repetitive keyboard and mouse use maintaining the wrist in sustained extension or ulnar deviation
- Assembly-line tasks and manual trades requiring repetitive gripping, pinching, or tool use
- Poor ergonomic setup — keyboard height, mouse position, and monitor placement all influence upper limb loading
- Inadequate rest breaks — tissue repair requires periods of unloading
- Tight scalenes and pectoralis minor reducing the space available for the brachial plexus (thoracic outlet syndrome)
- High psychosocial workplace stress — directly amplifying pain sensitivity and symptom reporting
How Myotherapy Can Help
- Neural mobilisation — median, ulnar, and radial nerve sliders and tensioners to restore nerve mobility and reduce mechanosensitivity
- Soft tissue therapy — forearm flexors and extensors, scalenes, pectoralis minor, and subclavian region to reduce compression on neural and vascular structures
- Dry needling — trigger point deactivation in forearm and shoulder girdle musculature
- Ergonomic assessment and advice — workstation review and recommendations to modify sustained loading patterns
- Load management — graduated return to activity with appropriate rest intervals
Expected Outcomes
Early-stage RSI responds well to conservative management over 4–8 weeks. Established carpal tunnel syndrome with significant neurological deficit may require surgical review if symptoms do not resolve within this timeframe. Ergonomic change and load management are non-negotiable for lasting outcomes — myotherapy alone without workstation modification will produce temporary relief only.
Likely Symptom Changes
Early sessions: reduction in local forearm and wrist pain; neural mobilisation may temporarily increase tingling before reducing it — this settles within 24 hours. Progressive sessions: gradual reduction in neurological symptoms (tingling, numbness) with improved hand strength and endurance. Symptom flares at work remain likely until ergonomic changes are implemented. Pain typically resolves before neurological symptoms, which can lag by several weeks.
References
- Linton, S. J. (2000). A review of psychological risk factors in back and neck pain. Spine, 25(9), 1148–1156.
- NICE Guidelines (2016). Carpal tunnel syndrome. National Institute for Health and Care Excellence.
- Huisstede, B. M., et al. (2010). Carpal tunnel syndrome: Hand surgeons, hand therapists, and physical medicine and rehabilitation physicians agree on a multidisciplinary treatment guideline. Archives of Physical Medicine and Rehabilitation, 91(7), 998–1006.
Wrist pain, tingling hands, or forearm tightness from desk or trade work?
Shaun will assess your nerve mobility and occupational loading pattern.