Hand Repetitive Strain Injury (RSI) often develops quietly. Many people who spend hours typing, performing household tasks, or engaging in sports feel well and remain active, yet already have inflammation at the tendon sheath.[PT1] This is why identifying problems early before severe symptoms or disability occurs is important.
What Cause Hand RSI?
The most common drivers of hand RSI include:
- Frequent use of keyboards, mouse, or mobile devices
- Repetitive housework (cleaning, cooking, wringing cloths)
- Sports such as racquet games, golf, gym training, Pilates, or yoga
- Carrying babies or pets for long periods
Over time, these activities cause repeated stress to tendons and surrounding tissues, increasing the risk of inflammation, pain, and functional impairment. Prevention focuses on early detection and timely intervention.
Common Hand RSI Conditions
The two most common conditions are De Quervain's tenosynovitis and trigger finger.
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De Quervain's tenosynovitis is a condition affecting the tendons across the wrist that moves the thumb.
[PT1]With age and repeated use, the tendon covering becomes inflamed, causing friction and pain along the thumb side of the wrist. Symptoms include:
- pain and swelling around thumb side of the wrist
- pain when moving the thumb or twisting the wrist
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Trigger finger is an age-related degenerative condition of the flexor tendon and pulley complex. It happens when a finger tendon becomes irritated and thickened, making it difficult to glide smoothly. This causes:
- catching or locking of the finger
- clicking when moving the finger
- pain during movement
Treatment Approaches
Treatment for both conditions follows a similar graduated approach, starting with conservative measures and progressing to more invasive options when necessary.
Conservative Treatment
Initial management may include:
- activity modification
- hand therapy
- splinting
- medication
However, improvement can be slow and success rates vary between individuals. Splinting may occasionally cause irritation, and patients should be prepared for a gradual recovery process.
Injection Treatment: The Standard First-Line Approach
Injection treatment is often offered as the standard initial treatment for both conditions. The procedure is performed during consultation and contains local anaesthetic and non-soluble steroids.
For De Quervain's tenosynovitis, injections are 75% effective in relieving symptoms, with up to 3 injections given at intervals of more than 6 months. For trigger finger, injections are 70% effective initially, though only about 50% remain improved at 2-year review. Up to 2 injections per finger may be given at intervals exceeding 6 months.
Patients should expect increased pain for 1-2 days following injection, with symptom improvement typically occurring within a week. Possible risks, though uncommon, include:
- skin colour changes
- infection
- rarely, tendon rupture
Surgery
Surgery becomes necessary when symptoms return after injection treatments, offering definitive treatment for both conditions.
For
De Quervain's tenosynovitis, the surgical procedure involves releasing the tight tissue around the affected tendons through a small incision.
For
trigger finger, surgical treatment involves releasing the tight A1 pulley of the affected finger to eliminate the triggering mechanism.
Both procedures are performed under local anaesthesia as day surgery, allowing patients to return home the same day. However, patients should understand that in trigger finger, the entire tendon and pulley complex has undergone degenerative changes, meaning recovery takes time and may never be completely normal.
The procedures carry a 5% risk of surgical complications, which may include:
- bleeding
- infection
- tendon injury
- nerve injury
- vascular injury
- recurrence of symptoms
Recovery to comfortable usage typically requires around 6 weeks, though residual stiffness and pain should be expected. Hand therapy treatment may be necessary to optimise recovery and restore function.
Early Detection and Preventive
Hand RSI is largely preventable. Paying attention early - through awareness, ergonomic modifications, and timely treatment - can prevent serious disability before it occurs. Take the next step in protecting your hands -
book an appointment with our Hand Surgeons today.