Understanding Nerve Routes and RSI

One of the chief complaints among today’s workers is of pains in the upper extremities, including Repetitive Strain Injuries, or RSIs. Each year RSIs and other upper extremity pains cost millions of dollars in healthcare, and result in more than 5 million sick days. RSI is the term used to refer to several conditions that affect the hands, wrists and elbows of those who perform repetitive tasks with their hands. RSI causes hand pain, hand numbness and hand tingling, and can lead to a loss of strength and mobility in the hands. Understanding how the nerve routes work can help us understand the types of problems that can occur.

The hands and wrists contain three major nerves; the radial, median and ulnar nerves. These are known as the peripheral nerves and they originate in the spinal column. As they leave the spinal column, they travel through the nerve route along the soft tissues of the shoulders, arms and hands, finally ending in the fingers. These nerves must be able to move freely within the soft tissue in which they travel. But, sometimes, this free movement can become restricted, causing pain, tingling, numbness and lost mobility.

Nerves can be compressed early on just as they are exiting the vertebral column and this is generally referred to a nerve root impingement or irritation. This can be due to discs, vertebrae positioning, inflammation and/or local muscle spasms.

One way that the peripheral nerves can become disrupted is through compression. Compression can occur due to swelling of tendons that run along the same route as the nerve. In fact, Carpal Tunnel syndrome is caused by nerve entrapment, or compression of the median nerve due to tendon swelling, arthritis or diabetes at the wrist.

Nerves can also get caught as they enter or exit ligaments and facial openings or get irritated between bones and the adjacent soft tissue. The nerves can be squeezed by chronically tight muscle in spasm.

Thoracic Outlet Syndrome

One particular problem that is caused by problems in the nerve route is Thoracic Outlet Syndrome. (This is also often misspelled as "Thorasic Outlet Syndrome") There are several locations to which Thoracic Outlet can refer. The most commonly referenced area is a space between the rib cage and the collar bone. This syndrome occurs when the nerves now part of the brachial plexus are compressed between these boney structures or squeezed by tight muscle in the area such as the scalenes or pectoralis minor. Thoracic Outlet Syndrome can cause severe pain, stiffness, and a cold feeling that can radiate down into the hands and fingers. Thoracic Outlet Syndrome is often seen in people who perform repetitive tasks that require them to hold their arms overhead.

Cubital Tunnel Syndrome

Another nerve route problem is Cubital Tunnel Syndrome. The Cubital tunnel is located on the inside of your elbow, at your ‘funny bone’. This problem occurs when there is pressure on the ulnar nerve, which runs through the Cubital tunnel. This syndrome causes numbness and tingling in the fingers. Repetitive motions that involve bending and straightening the elbow can lead to Cubital Tunnel Syndrome.

Physical therapy is useful for treating most problems that result from nerve entrapment and other nerve problems in the upper extremities. Some doctors also prescribe massage therapy and anti-inflammatory medications. However, a diagnosis must first be made by a doctor to determine exactly which nerve issue is causing the pain. Once this diagnosis has been made, a proper course of treatment, including medications and or physical therapy can be determined. It is critical to take measures to treat these conditions as quickly as possible to avoid more severe pain and additional nerve damage and more extreme courses of treatments like surgery.