A to Z of Medical Conditions

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Repetitive strain injury – signs , symptoms and causes

Repetitive strain injury

Repetitive strain injury

Repetitive strain injury (RSI) is a general term used to describe the pain felt in muscles, nerves and tendons caused by repetitive movement and overuse.

It’s also known as work-related upper limb disorder, or non-specific upper limb pain.

The condition mostly affects parts of the upper body, such as the:

forearms and elbows

wrists and hands

neck and shoulders

Symptoms of RSI

The symptoms of RSI can range from mild to severe and usually develop gradually. They often include:

pain, aching or tenderness

stiffness

throbbing

tingling or numbness

weakness

cramp

At first, you might only notice symptoms when you’re carrying out a particular repetitive action.

But without treatment, the symptoms of RSI may eventually become constant and cause longer periods of pain. You may also get swelling in the affected area, which can last for several months.

What to do if you think you have RSI

If you develop symptoms of RSI and think it may be related to your job, speak to your employer or occupational health representative.

It may be possible to modify your tasks to improve your symptoms.

See your GP if symptoms continue, despite attempts to change how you work.

Read more about diagnosing RSI.

What causes RSI?

RSI is related to the overuse of muscles and tendons in the upper body.

Certain things are thought to increase the risk of RSI, including:

repetitive activities

doing a high-intensity activity for a long time without rest

poor posture or activities that require you to work in an awkward position

Cold temperatures and vibrating equipment are also thought to increase the risk of getting RSI and can make the symptoms worse. Stress can also be a contributing factor.

A variety of jobs can lead to RSI, such as working at an assembly line, at a supermarket checkout or typing at a computer.

It’s important to work in a comfortable environment which has been appropriately adjusted. Your employer has a legal duty to try to prevent work-related RSI and ensure anyone who already has the condition doesn’t get any worse.

Read more about workplace health.

How RSI is treated

The first step in treating RSI is usually to identify and modify the task or activity that is causing the symptoms. If necessary, you may need to stop doing the activity altogether.

To relieve symptoms, your GP may advise taking a course of anti-inflammatory painkillers (such as aspirin or ibuprofen), or using a heat or cold pack, elastic support or splint.

You may also be referred to a physiotherapist for advice on posture and how to strengthen or relax your muscles. Some people find that other types of therapy help to relieve symptoms, including massage, yoga and osteopathy.

Read more about treating RSI.

How to prevent RSI

Most employers carry out a risk assessment when you join a company to check that your work area is suitable and comfortable for you. You can request an assessment if you haven’t had one.

There are also things you can do to help reduce your risk of RSI, such as:

maintaining good posture at work – see how to sit at a desk correctly

taking regular breaks from long or repetitive tasks – it’s better to take smaller, more frequent breaks than one long lunch break

trying relaxation techniques if you’re stressed

If you work at a computer all day, make sure your seat, keyboard, mouse and screen are positioned so they cause the least amount of strain.

See tips on preventing RSI for more detailed advice about using a mouse and keyboard at work.

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Urethritis – What are the signs, symptoms and treatments?

Urethritis

Urethritis

Urethritis is inflammation of the urethra, the tube that carries urine from the bladder out of the body. It’s usually caused by an infection.

The term non-gonococcal urethritis (NGU) is used when the condition isn’t caused by the sexually transmitted infection gonorrhoea.

NGU is sometimes referred to as non-specific urethritis (NSU) when no cause can be found.

Urethritis is the most common condition diagnosed and treated among men in GUM clinics or sexual health clinics in the UK.

 

Symptoms of non-gonococcal urethritis

Symptoms of NGU in men include:

a white or cloudy discharge from the tip of the penis

a burning or painful sensation when you pee

the tip of your penis feeling irritated and sore

In women, NGU rarely causes any symptoms.

Read about the symptoms of NGU.

When to seek medical advice

Visit your local genitourinary medicine (GUM) clinic or sexual health clinic if you’re experiencing symptoms of NGU or you may have been exposed to a sexually transmitted infection (STI).

You should still seek treatment if the symptoms of NGU disappear on their own, as there’s a risk you could pass the infection on to someone else.

Find sexual health services.

Diagnosing non-gonococcal urethritis

Two tests can be used to diagnose NGU, and both may be carried out to ensure the diagnosis is correct.

The tests are:

a swab test – a sample of fluid is taken from your urethra using a swab, which is like a small cotton bud with a plastic loop at the end; it’s not painful, but can feel a little uncomfortable for a few seconds

a urine test – you’ll be asked not to urinate for at least one hour before providing a urine sample as this can help make the test results more reliable

You may also be offered tests for other STIs. It’s up to you whether to have these or not, but a test for all infections is recommended. You can discuss this with healthcare professionals at the clinic if you wish.

Some clinics will be able to give you the results on the same day. Others may need to send the samples to a laboratory for testing, in which case the test results may not be available for a week or two.

Healthcare professionals at the clinic will tell you when you’ll get your test results, and they’ll also arrange your treatment.

Read more about visiting a sexual health clinic.

Causes of non-gonococcal urethritis

NGU can have a number of possible causes, including:

irritation or damage to the urethra

sexually transmitted infections (STIs) – such as chlamydia

other infections – such as a urinary tract infection (UTI)

There are many cases of NGU where no infection is found. If no cause is found, you’ll still be offered treatment for possible infection.

Read more about the causes of NGU.

Treating non-gonococcal urethritis

A short course of antibiotics is usually prescribed to treat NGU. You may be given them before you get your test results, and symptoms should clear up after about two weeks.

It’s important that past and current sexual partners are also treated to prevent any infection spreading to others.

After treatment has been completed and the symptoms have disappeared, it should be safe to start having sex again.

Read more about treating NGU.

Preventing non-gonococcal urethritis

As NGU is usually caused by an STI, practising safer sex is the best way to reduce the chances of it developing.

Safer sex involves using barrier contraception, such as condoms, and having regular checks at sexual health clinics or GUMs.

Read a guide to contraception.

Complications of non-gonococcal urethritis

NGU can have some complications – for example, the condition can keep coming back.

You should return to the genitourinary medicine (GUM) clinic or sexual health clinic if you still have symptoms two weeks after starting a course of antibiotics.

Serious complications are rare, but may include:

reactive arthritis – when the immune system starts attacking healthy tissue, which can lead to joint pain and conjunctivitis

epididymo-orchitis – inflammation inside the testicles

Women often have no symptoms of NGU. However, it can lead to pelvic inflammatory disease (PID) if it’s caused by chlamydia and left untreated.

Repeated episodes of PID are associated with an increased risk of infertility.

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What is a coma?

Coma

Coma

A coma is a state of unconsciousness where a person is unresponsive and cannot be woken.

It can result from injury to the brain, such as a severe head injury or stroke. A coma can also be caused by severe alcohol poisoning or a brain infection (encephalitis).

People with diabetes could fall into a coma if their blood glucose levels suddenly became very low (hypoglycaemia) or very high (hyperglycaemia).

 

What is a coma?

Someone who is in a coma is unconscious and has minimal brain activity. They’re alive, but can’t be woken up and show no signs of being aware.

The person’s eyes will be closed and they’ll appear to be unresponsive to their environment. They won’t normally respond to sound or pain, or be able to communicate or move voluntarily.

Someone in a coma will also have very reduced basic reflexes such as coughing and swallowing. They may be able to breathe on their own, although some people require a machine to help them breathe.

Over time, the person may start to gradually regain consciousness and become more aware. Some people will wake up after a few weeks, while others may go into a vegetative state or minimally conscious state (see recovering from a coma, below).

Caring for and monitoring a person in a coma

Doctors assess a person’s level of consciousness using a tool called the Glasgow Coma Scale. This level is monitored constantly for signs of improvement or deterioration. The Glasgow Coma Scale assesses three things:

eye opening – a score of one means no eye opening, and four means opens eyes spontaneously

verbal response to a command – a score of one means no response, and five means alert and talking

voluntary movements in response to a command – a score of one means no response, and six means obeys commands

Most people in a coma will have a total score of eight or less. A lower score means someone may have experienced more severe brain damage and could be less likely to recover.

In the short term, a person in a coma will normally be looked after in an intensive care unit (ICU). Treatment involves ensuring their condition is stable and their body functions, such as breathing and blood pressure, are supported while the underlying cause is treated.

In the longer term, healthcare staff will give supportive treatment on a hospital ward. This can involve providing nutrition, trying to prevent infections, moving the person regularly so they don’t develop bedsores, and gently exercising their joints to stop them becoming tight.

What you can do as a visitor

The experience of being in a coma differs from person to person. Some people feel they can remember events that happened around them while they were in a coma, while others don’t.

Some people have reported feeling enormous reassurance from the presence of a loved one when coming out of a coma.

When visiting a friend or loved one in a coma, you may find the advice below helpful:

when you arrive, announce who you are

talk to them about your day as you normally would – be aware that everything you say in front of them might be heard

show them your love and support – even just sitting and holding their hand or stroking their skin can be a great comfort

Research has also suggested that stimulating the main senses – touch, hearing, vision and smell – could potentially help a person recover from a coma.

As well as talking to the person and holding their hand, you might want to try playing them their favourite music through headphones, putting flowers in their room or spraying a favourite perfume.

Recovering from a coma

A coma usually only lasts a few weeks, during which time the person may start to gradually wake up and gain consciousness, or progress into a different state of unconsciousness called a vegetative state or minimally conscious state.

a vegetative state – where a person is awake but shows no signs of being aware of their surroundings or themselves

a minimally conscious state – where a person has limited awareness that comes and goes

Some people may recover from these states gradually, while others may not improve for years, if at all. See the page on disorders of consciousness for more information about these conditions.

People who do wake up from a coma usually come round gradually. They may be very agitated and confused to begin with.

Some people will make a full recovery and be completely unaffected by the coma. Others will have disabilities caused by the damage to their brain. They may need physiotherapy, occupational therapy and psychological assessment and support during a period of rehabilitation, and may need care for the rest of their lives.

The chances of someone recovering from a coma largely depend on the severity and cause of their brain injury, their age and how long they’ve been in a coma. But it’s impossible to accurately predict whether the person will eventually recover, how long the coma will last and whether they’ll have any long-term problems.

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Hypogonadism – the basics

Hypogonadism

Hypogonadism

Some men develop depression, loss of sex drive, erectile dysfunction and other physical and emotional symptoms when they reach their late 40s to early 50s.

Other symptoms common in men this age are:

mood swings and irritability

loss of muscle mass and reduced ability to exercise

fat redistribution, such as developing a large belly or “man boobs” (gynaecomastia)

a general lack of enthusiasm or energy

difficulty sleeping (insomnia) or increased tiredness

poor concentration and short-term memory

These symptoms can interfere with everyday life and happiness, so it’s important to find the underlying cause and work out what can be done to resolve it.

Is there such a thing as a ‘male menopause’?

The “male menopause” (sometimes called the “andropause”) is an unhelpful term sometimes used in the media to explain the above symptoms.

This label is misleading because it suggests the symptoms are the result of a sudden drop in testosterone in middle age, similar to what occurs in the female menopause. This isn’t true. Although testosterone levels fall as men age, the decline is steady – less than 2% a year from around the age of 30-40 – and this is unlikely to cause any problems in itself.

A testosterone deficiency that develops later in life (also known as late-onset hypogonadism) can sometimes be responsible for these symptoms, but in many cases the symptoms are nothing to do with hormones.

Personal or lifestyle issues

Lifestyle factors or psychological problems are often responsible for many of the symptoms described above.

For example, erectile dysfunction, loss of libido and mood swings may be the result of either:

stress

depression

anxiety

There are also physical causes of erectile dysfunction, such as changes in the blood vessels, which may happen alongside any psychological cause.

Read about the causes of erectile dysfunction.

Psychological problems are typically brought on by work or relationship issues, divorce, money problems or worrying about ageing parents.

A “midlife crisis” can also be responsible. This can happen when men think they’ve reached life’s halfway stage. Anxieties over what they’ve accomplished so far, either in their job or personal life, can lead to a period of depression.

Read more about the male midlife crisis.

Other possible causes of the above symptoms include:

lack of sleep

poor diet

lack of exercise

drinking too much alcohol

smoking

low self-esteem

Late-onset hypogonadism

In some cases, where lifestyle or psychological problems don’t seem to be responsible, the symptoms of the “male menopause” may be the result of hypogonadism, where the testes produce few or no hormones.

Hypogonadism is sometimes present from birth, which can cause symptoms like delayed puberty and small testes.

Hypogonadism can also occasionally develop later in life, particularly in men who are obese or have type 2 diabetes. This is known as late-onset hypogonadism and it can cause the “male menopause” symptoms mentioned above. However, this is an uncommon and specific medical condition that isn’t a normal part of ageing.

A diagnosis of late-onset hypogonadism can usually be made based on your symptoms and the results of blood tests used to measure your testosterone levels.

What to do

If you’re experiencing any of the above symptoms, see your GP. They’ll ask about your work and personal life, to see if your symptoms may be caused by a mental health issue, such as stress or anxiety.

If stress or anxiety are affecting you, you may benefit from medication or a talking therapy, such as cognitive behavioural therapy (CBT). Exercise and relaxation can also help. Read about:

stress management

treating anxiety

help for low mood and depression

exercise for depression and exercise to relieve stress

Do I need HRT?

Your GP may also order a blood test to measure your testosterone levels. If the results suggest you have a testosterone deficiency, you may be referred to an endocrinologist (a specialist in hormone problems).

If the specialist confirms this diagnosis, you may be offered testosterone replacement to correct the hormone deficiency, which should relieve your symptoms. This treatment may be either:

tablets

patches

gels

implants

injections

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Hyperhidrosis

Hyperhidrosis

Hyperhidrosis

Hyperhidrosis is a common condition in which a person sweats excessively.

The sweating may affect the whole of your body, or it may only affect certain areas. Commonly affected areas include the:

armpits

palms of your hands

soles of your feet

face and chest

groin

Both sides of the body are usually affected equally – for example, both feet or both hands.

The sweating doesn’t usually pose a serious threat to your health, but it can be embarrassing and distressing. It can also have a negative impact on your quality of life and may lead to feelings of depression and anxiety.

Read more about the complications of hyperhidrosis.

What is excessive sweating?

There are no guidelines to determine what “normal” sweating is, but if you feel you sweat too much and your sweating has started to interfere with your everyday daily life, you may have hyperhidrosis.

For example, you may have hyperhidrosis if:

you avoid physical contact, such as shaking hands, because you feel self-conscious about your sweating

you don’t take part in activities, such as dancing or exercise, for fear they will make your sweating worse

excessive sweating is interfering with your job – for example, you have difficulty holding tools or using a computer keyboard

you’re having problems with normal daily activities, such as driving

you’re spending a significant amount of time coping with sweating – for example, frequently showering and changing your clothes

you become socially withdrawn and self-conscious

When to see your GP

Visit your GP if you feel that your sweating is interfering with your daily activities, or you suddenly start sweating excessively.

Many people with hyperhidrosis are too embarrassed to seek medical help or believe that nothing can be done to improve it. But treatment is available.

Also visit your GP if you are having night sweats, because it can sometimes be a sign of something more serious.

Your GP will usually be able to diagnose hyperhidrosis based on your symptoms, although occasionally you may need blood and urine tests to check for an underlying cause (see below).

What causes hyperhidrosis?

In many cases, hyperhidrosis has no obvious cause and is thought to be the result of a problem with the part of the nervous system that controls sweating. This is known as primary hyperhidrosis.

Hyperhidrosis that does have an identifiable cause is known as secondary hyperhidrosis. This can have many different triggers, including:

pregnancy or the menopause

anxiety

certain medications

low blood sugar (hypoglycaemia)

an overactive thyroid gland (hyperthyroidism)

infections

Read more about the causes of hyperhidrosis.

How hyperhidrosis is treated

Excessive sweating can be challenging to treat and it may take a while to find a treatment right for you.

Doctors usually recommend starting with the least invasive treatment first, such as powerful antiperspirants. Lifestyle changes may also help, including:

wearing loose and light clothes

avoiding triggers, such as alcohol and spicy foods, that could make your sweating worse

wearing black or white clothes to help minimise the signs of sweating

If this doesn’t help, you may be advised to try treatments such as iontophoresis (the affected area is treated with a weak electric current passed through water or a wet pad), botulinum toxin injections, and even surgery in a few cases.

Hyperhidrosis is usually a long-term condition, but some people experience an improvement with time and the treatments available can often keep the problem under control.

Read more about treating hyperhidrosis.

Who is affected

Hyperhidrosis is common. It’s been estimated to affect between one and three in every 100 people which means there are likely to be hundreds of thousands of people living with it in the UK.

Hyperhidrosis can develop at any age, although primary hyperhidrosis typically starts during childhood or soon after puberty.