This is an umbrella term for symptoms of upper limb and hand pain that may be caused by repetitive tasks, exertions, vibrations or mechanical compression, or sustained or awkward positions. As such, it has also been called "Work related Upper Limb Disorder" or WRULD.

This is a complex area, in which the role of the orthopaedic surgeon is within a multidisciplinary team. Mr. Gidwani is fortunate to be part of such teams at all three sites at which he works, due to the provision of excellent hand therapists and physiotherapists at each institution. He also works closely with the musculoskeletal radiologists and other upper limb and shoulder specialists, and attends a monthly upper limb radiology meeting with them at London Bridge Hospital to discuss complex cases.

Broadly speaking, 'RSI' cases can be divided into two groups:

1. Cases of well defined symptoms and syndromes, where through a careful history, thorough examination and the use of special tests (e.g. nerve studies, MRI scans, ultrasound scans, blood tests), a defined pathology can be diagnosed and treated in a focused manner. Examples of such conditions include carpal tunnel syndrome, trigger finger, tenosynovitis, intersection syndrome, ganglions and tennis elbow
2. Cases where the symptoms and signs are much more diffuse and despite appropriate tests, no clear diagnosis can be made.

This is not to say that it is always easy to make the correct diagnosis, or that patients in the second group do not have symptoms that are frequently debilitating. It is therefore important that these patients have access to a skilled team of physiotherapists and other professionals for ongoing treatment. Mr. Gidwani works closely with therapists who have a specific interest in this area.

Depending on the precise nature of the symptoms, Mr. Gidwani can also arrange appropriate referrals to osteopaths, specialists in pain medicine, consultant neurologists and consultant rheumatologists.

Clearly, the role of the employer is vitally important in ensuring that the workplace and workstation environment is suitable, and that appropriate breaks can be taken during the working day.