Chronic upper limb pain syndrome (repetitive strain injury) in the Australian workforce: a systematic cross sectional rheumatological study of 229 patients.

The epidemic of chronic upper limb pain is the most important and controversial issue in industrial rheumatology in Australia today. Two hundred and twenty-nine consecutive patients referred with chronic upper limb pain which had been labelled "repetitive strain injury" or "overuse syndrome" were assessed according to a protocol designed to give insight into the questions: Is the pain genuine or falsely reported, i.e., malingering? If genuine is it due to a physical injury, a pain syndrome, or a mixture of both? Twenty-nine patients fulfilled criteria for specific rheumatological diagnoses (fibrositis 15, rotator cuff syndrome 3, rheumatoid arthritis 3, cervical referred pain 3, lateral epicondylitis 2, de Quervain's tenosynovitis 1, carpal tunnel syndrome 1, and psoriatic monoarthritis 1). In the remaining 200 (mean age 37 years, range 19-58, 91.5% female) many different pain patterns and nonspecific associated symptoms were recorded. Eighty-nine percent had greater than or equal to 2 Smythe tender points, 1.5% had 1 tender point, and 9.5% had no tender point. Diffuse pain and greater than 7 tender points is sufficient to diagnose fibrositis, and localized pain and a smaller number of tender points strongly suggests a genuine chronic rheumatic pain syndrome. Stress, personal susceptibility and poor motivation appeared important in some cases. The liberal workers' compensation system, early labeling as repetitive strain injury, and social acceptability appeared important in the development of the epidemic.