Q&A on RSI with Consultant Orthopaedic Surgeon Tony Kochhar

[RachelMumsnet]

With Repetitive Strain Injuries (RSI) a hot topic on the Mumsnet Talk boards, we've invited Tony Kochhar, consultant orthopaedic surgeon who specialises in treating RSI, to join us this week and answer your questions. Tony trained at The Royal National Orthopaedic Hospital in London and has worked with some of the best surgeons in the world, notably in New York and at the world-renowned Alps Surgery Institute in Annecy, France. He currently practises at London Bridge Hospital and in Kent, and has just set up what is believed to be the country's first clinic dedicated to treating RSIs.

Tony has seen a rise in patients visiting his practice with RSI. This is often caused by extended keyboard usage but there are other causes too: 'Baby Wrist' is associated with the use of breast pumps, bottle feeding and carrying a newborns (and is regularly discussed on the breast/bottle feeding boards on Mumsnet), 'Back to work wrist and upper limb woes'; is associated with mums who have been off on maternity leave and develop acute RSIs very quickly upon their return to work and also 'Hair straightener wrist'; it isn't just split ends you should be worrying about, holding the arm in such an abnormal position for extended periods of time can result in a number of upper limb issues.

If you've been affected by one of these conditions, or have any other questions about RSI, send your questions to Tony before the end of day on Friday 1 April and we'll link through to his answers from this page the following week.

I got an acute bout of tenosynovitis in my wrist when on maternity leave, probably from steering the pram one-handed whilst pushing my 3 year old up hills on her bike. SInce then I have returned to work and I have found it has come back in a milder version, particularly when I am using the laptop. Is there anything I can do about it, other than to abstain from using computers (which I can't do really - I need to check and respond to work emails on my days off and I use computers at work as part of teaching too)?

Hello Tony,

I have this wrist pain for over 4 months now and got already physio treatments and ultrasound heat. I use deep heat from time to time as well to relief the pain. I am doing different exercises for 10min twice a day and reduced the mouse use already. but the pain is still there. what else can i do?

Dear Tony,
I had a ganglion (sp) in my wrist when I was a teenager and it was treated with a brace and steroid injections. the pain was so bad that I couldn't even ride a bike as every bump hurt a lot. it went away after a while.
now in my 30 after second baby I have to carry a lot and my left wrist again hurst. my day job requires me to type a lot, but no heavy lifting.
I try to use a backpack more often so that I don't have to carry with the hands anymore but picking up baby/toddler is unavoidable.
can I try to use the brace again for a couple of hours a day (if it still fits)?

I have a ganglion on my wrist and it aches and aches, enough to wake me at night sometimes. The GP offered to hit me with her bible . I use ibuprofen gel if it's really bad and try to avoid one-handed pram-pushing (easier said than done, especially bad in snow :(), using the mouse and keyboard too much.

The only other thing I was offered was to have it drained but it sounds pointless to me - draining a bursa surely affords very temporary relief only as it will refill, and it doesn't really address the problem. What are your thoughts on that?

A cheeky second question and possibly outwith your remit (so feel free to ignore on both counts) prompted by carsem's post - when a physio offered me ultrasound (for an unrelated condition) I asked her what its mechanism of action was. She told me nobody knew, and that there was no evidence of a beneficial outcome with its use. I declined to have any but could you tell us more about that?

Advice for curing my chronic trochanteric bursitis (cortisone doesn't work). After 2 plus years committing to stretching & glut strengthening but not seeing any improvement yet.

Dear Tony,

I haven't actually been seen my GP about 'baby wrist', but I'm fairly confident that's what I have. My son is now 13 months old and my wrist pain has been bothering me since he was about 3 months old. It did initially affect both wrists, but now it's mainly the right one. The reason I haven't done anything about it is that for much of the time I don't notice any pain. However, sometimes when I am holding my son in a certain way - particularly when lowering him onto his changing mat - my right wrist just 'buckles'. It feels like something is 'twanging' or 'snapping' on the inner side of my wrist and sometimes the area looks a bit swollen.

I tried wearing a wrist support, but found it made the pain worse (the pressure was really uncomfortable).

My question is, is this something that is ever likely to resolve by itself as my son grows older and needs less carrying, thus giving my wrist a chance to heal? Or is it likely I am going to need physio to get my wrist back to normal?

Many thanks.

Dear Tony,
I lost the use of my left hand last year in an accident. This of course has left me using my right hand for everything, including picking up my 4 year old. And I'm getting a nice dose of RSI in that now.
I'm wearing a splint at night (well two as I wear a custom thermoplastic on the left side), but is there anything else I can do ?

How can I avoid wrist pain (and shoulder/neck pain) from playing musical instruments like violin, piano and harp? I have small hands that often have to stretch in unusual positions, plus I don't know how to relax my neck, shoulders etc when I am playing - I know that I am probably tense, but I have no control over actually relaxing those muscles voluntarily, it seems. When I've been playing for more than a few minutes, I end up with lots of pain - and it's particularly bad when I'm going through a bout of rsi pain from typing; I have ways to adjust the typing, but can't seem to find equivalent ways to help with the music. I get pain in my fingers/thumbs, and in my fingertips (sometimes like touching something hot), as well as sore wrists, and it can get hard to move/rotate my wrist very far without some pain.

Dear Tony

I am interested to hear more about developing acute RSI very quickly upon returning to work after maternity leave. I started work part time in January this year after 15 months maternity leave, and have since noticed a tingling/occasional throbbing pain & numbness around the tendons at the back of my right hand. I also find my right hand is much weaker & feel pain after ironing or opening a tight lid for instance. I have suffered from RSI pains in the past from using a mouse, so switched to a roller mouse which worked well in the past. However, this hasn't help much since my return to work. What can I do to alleviate this pain & bring back the strength in my right hand?

Thanks :)

dear Tony, not an RSI question, but I was hoping you can help me. I was diagnosed with teitze's 2y ago. I have got progressively worse with every rib swollen and dislodged now at the sternum and at the back. im in constant pain and have lost a lot of grip in my right hand, i get numbness down my right side and have started to develop bony lumps ON the bones now. does this sound normal and is there anything else I can do (am on anti-inflamms and painkillers)

Hello Tony,

welcome to MN.

Not an RSI problem, but knees.

The first time I had problems with my knees was shortly before the birth of my second child. Presumably the excess weight I was carrying.

It got better for a while then I had a nasty fall when using Rollerblades (without protection, idiot that I am) and they were sore for months.

That was a few years ago and they are ok, unless I put on a bit of weight then are sore again. I recently took up golf and they have started aching again.

On advice of the trainer, I have started doing gentle exercises to strengthen the muscles around the knees (have not been doing much sport over the winter). Is there anything that you could advise that would help, other than this?

Thank you.

hello Tony, i have a knee problem too

i was diagnosed with arthiritis in one knee and it was particularly bad when i used to operate a pedal (conveyor belt) at work. i always assumed this began as an RSI.

i have had physio and last year my GP suggested i lose weight to prevent a future operation - i took his advice to heart and i have lost 4 stone.

my knee is much improved and i just wanted to ask can losing weight really help that much or is it a coincidence?

thanks

Hello Tony,

I get RSI in my right hand that spreads up to my neck and causes headaches, and also into my shoulder, down to my back and even my right hip and leg when it is at its worst (I type for a living). Often it feels like I have a hot knot under my right shoulder blade. I use pain-killing cream on it at its worst, but I am concerned because I have heard a theory that constant inflammation of an area can predispose one to cancer of that area. Is that right?

Thanks for your thoughts.

Hello

I have suffered with RSI and other muscular skeletal problems off and on for the past 9 years (principally caused by working at a desk but exacerbated by carrying children).

The only treatment offered to me by by the NHS has been four physiotherapy ultrasound sessions which achieved nothing. As my condition can be quite debilitating, I have had no choice but to fund my own treatment and after a lot of expensive trial and error, I have found that a combination of Alexander Technique and Osteopathy works best to relieve my problems.

Given our increasing reliance on technology at work and home, RSI and other muscular skeletal problems are on the increase. So why is there not more widespread understanding /diagnosis of the problem and funding of appropriate treatments?

Aristocat
might just be me, but I have a certain weight - if I go over that my knees start aching. Would be interested to hear what Tony say about this.

Wrist injuries at work? My physio' reminded me how all touch typists used to be trained. They didn't have arms on office chairs, but typed with elbows always touching their lower ribs. I was advised to work my mouse on a small mousemat with a wrist rest, while keeping my elbow against my body and the mat as near to me as possible. No more reaching out and away accross the desk with my mouse hand and arm. Result? Problem soon vanished.

I have had acute RSI for about three years now. It started at work and typing, lifting (even small baby), writing all cause pain in both arms. I've gone back to work now (I'm computer programmer), and it is as bad as ever. I have seen numerous medical practitioners: Drs, physios, osteopath's, rheumatologists etc. Nothing seems to work really. Even prolonged time off work would be no guarantee of improvement. Seems like change of career might be unavoidable. Any words of advice?

Many thanks for all your questions which we've sent over to Tony. We'll post on this thread once his answers are back and the transcribed Q&A is ready.

marking place

looking forward to Tonys thoughts

Hi all, Tony's answers are here www.mumsnet.com/qanda/tony-kochhar

Just waiting for one tiny clarification, but didn't want to delay putting them up.

Thanks to Tony for the answers and thanks to everyone who posted a question.