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WRULD (work-related upper limb disorder)
or RSI (repetitive strain injury)

What is RSI?

If you suffer from pain and stiffness in any of your upper limbs, you may have something called upper limb disorder (ULD). This used to be known as repetitive strain injury (RSI), and can affect lots of different parts of the body, including the neck, shoulder or any part of the arm or hand including the fingers.

The term ULD is generally used to describe a condition that is connected with a particular activity that you do over and over again. Not surprisingly, it is often caused by something that you do at work, in which case it is called WRULD (work-related upper limb disorder).

What are the symptoms?

The symptoms vary from one person to another but pain is the main symptom. Generally, you get the pain when you are doing the activity that causes it, but it may get so bad that you suffer from it all the time, even when you’re not doing anything.

Apart from pain, you may also experience stiffness, tingling, numbness, heaviness, weakness, tightness and cramp. The symptoms may even feel as though they are “jumping around” from one place to another. They also tend to spread. For instance, the pain might start in the wrist, but spread into the upper arm, shoulder and neck within days or weeks.

Tiredness is also common if your sleep is affected. Pain may come and go depending on what you are doing and whether you are under stress (which exacerbates the condition).

Whatever the symptoms, don’t ignore them. They may be slight at first but they are an indication that something is wrong and should be looked at.

Who is affected?

Just about anyone may be affected if they are engaged in repetitive work or have to handle heavy objects. People at risk therefore include secretaries, computer operators, hairdressers, cleaning staff, machinists, assembly line workers, fruit pickers and anyone who uses hand-held power tools.

What causes it?

WRULD can be caused by a number of different work tasks that involve repetitive activity or a job that requires little or no movement. It can also be caused by poor posture and even stress.

It stands to reason, therefore, that the more a task is repeated, the greater the risk. The speed at which you do the job, however, is not necessarily the main issue. Moving your arm at low speed may be just as risky as small, quick movements.

Likewise, if you have to hold something or maintain a certain posture which involves little or no movement, you may well end up with WRULD. Computer work can cause this “static muscle loading” unless you take regular breaks.

For instance, you may be at risk when using your keyboard if you tend to hold your hands and arms in a certain position. If your back is not well supported, you can get static muscle activity there and in the muscles of the neck.

If you have to handle heavy objects or carry out fast movements, you are also likely to be at risk.

What should your employer do?

Your employer has a duty under the Health and Safety at Work etc Act 1974 and Management of Health and Safety at Work Regulations 1999 to prevent any cases of work-related ULDs from arising, or to do something to prevent existing cases from getting worse.

The Health and Safety Executive (HSE) advises that your employer should:

• Assess the risks in the workplace by looking at what you do to see if it could cause you harm
• Reduce the risk by changing the way they organise your work, for instance by offering regular short breaks instead of one longer break or by redesigning your work station
• Provide you with information and training
• Encourage you to report any signs and symptoms early
• Allow anyone returning to work to carry out light duties or work reduced hours to begin with

What can you do to minimise the risk?

In order to minimise the risk of developing WRULD (or of making an existing condition worse), you can:

• Try to avoid carrying out activities for long periods of time. The risk of injury generally increases with the amount of time you carry out a task
• Try to avoid working in cold temperatures or handling cold items
• Try to avoid working in a dim light as you are more likely to adopt an awkward position when doing so
• Try to avoid activities which involve friction
• Try to slow down the speed at which you work if you carry out a lot of repetitive activities

It may not be possible for your employer to prevent all cases of WRULDs, because different workers respond differently to the risks. However, if you develop a WRULD, you must ensure that you do whatever you can to prevent it from getting any worse.

The first and most important thing is to report any signs and symptoms to your employer as soon as they appear and seek medical help if appropriate. If your employer fails to take the necessary steps to safeguard your health and safety, then contact your union safety representative and start a claim for damages.

Case Study

Take the case of Andrea Osbourne, a Guardian Newspapers night editor who worked almost exclusively using a mouse at speed for nine hours a night and up to 45 hours a week, without a break. No risk assessment was carried out when she started the job in February 2001.

By May 2002 she had developed stiffness and pain in her right elbow. Soon she was unable even to lift a kettle. Her GP diagnosed repetitive strain injury, gave her a cortisone injection and told her the waiting list for NHS physiotherapy was so long she should seek help from her employer. The Guardian refused to allow her to consult the company physiotherapist.

Andrea carried on working because the injection had eased the pain. Another request to see the company physiotherapist was refused as she was told the facility was only available to permanent members of staff (she was a casual worker). The HR department advised that the pain was caused by a neck problem and was nothing to do with the mouse. Even the Guardian’s own medical report stated that her condition would not have developed had it not have been for her work.

The pain returned in early 2003 and was so intense that Andrea was unable to bend her elbow. The pain eased during the day but finally, in March 2003, it had become constant and she was unable to continue working. She was told by a hospital consultant that she
would never be able to do that type of work again and was advised to seek an alternative career.

She was unable to work and suffered financial difficulties. Gradually, following nine months of rest and physiotherapy, the movement returned in her right elbow and she eventually secured a lower paid job in new media. Following a claim by Thompsons, she was eventually paid £37,500 in compensation.

Andrea said: “The Guardian showed absolutely no sympathy. Because I was employed as a casual and didn’t have a permanent contract, they refused my requests for physiotherapy and made no attempt to find a way for me to work which would have reduced the repetitive strain in my elbow. The paper has all but ended my career in website editing and production.”

Marion Voss, Andrea’s solicitor at Thompsons said: “The Guardian failed in its duty of care to Andrea. This is one of the worse cases Thompsons has seen of a newspaper employer refusing to follow basic health and safety procedures. When so much is being talked about by HR professionals and the insurance industry about the importance of rehabilitation, that the paper refused Andrea treatment that might have enabled her to keep working is disgraceful.