RSI: Integrating the major theories

The dimensions of the RSI problem (incidence, cost, and affected groups) are described. Psychiatric, medical, and psychological explanations of causation are examined. The psychiatric explanation that RSI is a conversion disorder is not supported in the literature. There is research support for the medical/ergonomic explanation that pain and fatigue result from poor operating posture and, to a lesser extent, from excessive force and repeated movement. However, the existence of a distinct clinical entity apart from accepted disorders (tenosynovitis and the like) is not supported. The association of RSI with psychological factors has received research support and, although a causal relationship cannot yet be assumed, a psychological explanation cannot be discounted. A “best” theory is proposed on the basis of Littlejohn and Miller's 1986 classification of RSI into: (a) well-known clinical entities (Type I); (b) chronic pain syndromes without identifiable degeneration or inflammation (Type II); and (c) chronic pain syndromes in which pain becomes the dominant symptom of a Type I disorder (Type III).