Five Misconceptions About Repetitive Strain Injuries 

Repetitive strain injuries (RSIs) are among the most common conditions I treat as a hand and upper extremity surgeon. Carpal tunnel syndrome, trigger finger, tennis elbow, and other overuse conditions affect office workers, athletes, musicians, healthcare professionals, and active individuals of all ages. 

Despite how common these conditions are, they are frequently misunderstood. Misconceptions about what causes them — and how they are treated — often delay proper evaluation and recovery. 

In recognition of Repetitive Strain Injury Awareness Day, here are five common myths I frequently address in my practice. 

1. Repetitive Motion Alone Causes Carpal Tunnel Syndrome 

Carpal tunnel syndrome is caused by compression of the median nerve at the wrist. While many people assume that typing or computer use directly causes the condition, the scientific evidence is more nuanced. 

High-force repetitive activities, vibratory tool use, and certain medical conditions — including diabetes, thyroid disease, pregnancy, obesity, and genetic predisposition — are more strongly associated with carpal tunnel syndrome than low-force keyboard use alone. 

In many cases, patients may have an underlying anatomic susceptibility, and repetitive activity simply brings symptoms to light rather than serving as the sole cause. 

2. Surgery Means a Large Incision and a Long Recovery 

When carpal tunnel syndrome progresses or does not respond to conservative treatment, surgical release of the ligament compressing the nerve remains the most effective solution. 

However, surgery does not necessarily mean a traditional open operation performed in a hospital with general anesthesia. 

Ultrasound-guided carpal tunnel release is a minimally invasive surgical technique performed under local anesthesia through a very small incision. Using real-time ultrasound imaging, the transverse carpal ligament is released with precision while minimizing disruption to surrounding tissues. 

As the first surgeon in Connecticut to introduce this technique, I have seen how real-time ultrasound guidance allows for precise release of the ligament while minimizing disruption to surrounding tissues. This approach typically results in less postoperative discomfort and a faster return to normal activities compared with traditional open or endoscopic surgery. 

3. Pain Is Always the First Sign 

Pain is often a late symptom in repetitive strain conditions. 

Early warning signs may include: 

• Numbness or tingling in the fingers 

• Grip weakness 

• Hand fatigue 

• Stiffness 

• A feeling that the hand “isn’t functioning normally.” 

In nerve compression syndromes such as carpal tunnel, symptoms may progress gradually before significant pain develops. Early evaluation can prevent long-term nerve dysfunction. 

4. Chronic Tendon Conditions Are Purely Inflammatory 

Many chronic overuse injuries, such as tennis elbow, are not primarily inflammatory. Instead, they often involve tendon degeneration — a process known as tendinosis — where the collagen structure of the tendon weakens over time. 

Because of this, treatment strategies focus on structured rehabilitation, activity modification, and optimizing biomechanics rather than relying solely on rest or anti-inflammatory medication. 

Understanding whether a condition involves tendon degeneration, nerve compression, or joint pathology is critical to selecting the right treatment. 

5. Ergonomics Alone Prevents Injury 

Proper workstation setup and posture are important, but they cannot fully protect against tissue overload. 

The frequency of activity, force applied, recovery time, overall conditioning, and underlying medical factors all play a role. Even the most ergonomic setup cannot compensate for repetitive strain performed without adequate rest or muscular balance. 

Prevention requires thoughtful load management — not just better equipment. 

The Bottom Line 

Repetitive strain injuries are common, but they are highly treatable. Early diagnosis allows for more conservative management and improved outcomes. 

Whether symptoms involve tendon pain, nerve compression, or joint dysfunction, individualized evaluation is essential. Advances in minimally invasive techniques — including ultrasound-guided carpal tunnel release — have expanded treatment options and improved recovery for many patients. 

If you are experiencing persistent numbness, weakness, or discomfort in the hand or arm, early assessment can make a meaningful difference in long-term function and comfort.