Understanding “RSI”: A Review of the Role of Peripheral Neural Pain and Hyperalgesia

Abstract

Both the pathogenesis and pathophysiology of the occupational cervico-brachial pain syndrome known in Australia as Repetition Strain Injury (RSI) have been elusive. Because the standard physical examination does not support a diagnosis of tissue injury in most patients, a somatic basis for their pain experience has been denied by many medical practitioners.This paper outlines the clinical features of pain and hyperalgesia of peripheral nerve origin, and reviews current concepts of their pathophysiology. When RSI symptomatology is evaluated against this background, the syndrome appears to be neurogenic. The hyperalgesic responses to palpation of upper limb nerve trunks and to upper limb tension testing reported by these patients are consistent with this explanation. We therefore propose a hypothesis for RSI which is based upon the models of entrapment neuropathy and peripheral neuropathic pain.