- radial tunnel syndrome
This is caused by pressure on the posterior interosseous nerve within
the tunnel formed by five anatomical structures at the lateral
epicondyle (outer aspect of the elbow) and is the explanation for one
of the many causes of pain in the elbow. Diagnostically the pain is
worsened if the middle finger is pressed backwards and improved by
anaesthetic block within the radial tunnel. The syndrome may be work
related and tends to improve with rest. Surgery may help by
decompressing the posterior interosseous nerve within the radial
tunnel. But it may not. The use of local anti-inflammatory drugs may
also be beneficial.
- radicular pain
As far as the upper limbs are concerned this is pain due to pressure or
entrapment of the cervical nerve roots. The nerve roots can be nipped
by being stretched over a disc herniation or compressed by disc
material or bony encroachment into the intervertebral foramen.
- radiculopathy
This refers to the actual pathological process which causes the
radicular pain. It may be due to disease, compression, or reduction in
local blood supply by other causes.
- ramazzini
Bernardino Ramazzini (1633-1714) is described as the father of
occupational medicine. He was professor of medicine at the University
of Modena and later in Padua. His great work De MorbisArttj'tcum
Diatriba is one of the most important books in the history of medicine.
He was well in advance of his times and investigated the medical
aspects of a great many of the occupations then current in Italy. He
stated:
'Medicine, like jurisprudence, should make a contribution to the
well being of workers and see to it that, so far as possible, they
should exercise their callings without harm.'
- raynaud's phenomenon or disease
This was named after Dr Maurice Raynaud who in 1862 wrote a thesis
entitled De L’ Asphyxia Locale et de la Gangrene Symetrique des
Extremities. It is peripheral vascular disturbance probably due to
abnormal activity of the vasoconstrictor nerves which leads to
constriction of the arteries in the fingers and thumb, precipitated by
cold, emotion and by many other factors (see Vibration White Finger).
The digits become blanched, painful and cold and in severe cases it can
lead to gangrene. It also follows any hand surgery in about 2% to 3% of
patients and there is no way of predicting who will be affected.
- referred pain
This pain manifesting itself at a distance from the actual nerve root compression or nerve injury.
- reflex sympathetic dystrophy
This is an unpleasant complication which may follow fractures about the
wrist. In its early stages the condition is characterized by swelling
of the soft tissues, exquisite tenderness to pressure, and pain on
motion. Later, circulatory changes occur in the soft tissues and bone,
the skin becomes purplish and cold, and there may be excessive
perspiration. Much later the joints of the fingers and wrists become
increasingly stiff and even the shoulder and elbow may be affected
secondarily from voluntary immobilization of the arm in one position.
X-rays reveal a mottled decalcification or osteoporosis of the bones.
No treatment is entirely satisfactory but minimal immobilization with
active and passive exercises, sympathetic blocks, and occupational and
physical therapy seems to be as effective as any other treatment. Until
symptoms and signs are relatively static, or a definite improvement is
apparent, surgery should be delayed.
- regional allodynia - regional pain disorder
Diffuse pain and tenderness outside any single anatomical structure or
boundary, worse with hand use but with little improvement in pain free
function, even after prolonged reduction in hand use activities, even
in the absence of any definable rheumatological or orthopaedic. This is
a condition of unknown causation.
- regional pain syndrome
Pain often referred from a central point where there is an element of nerve entrapment.
- repetitive strain injury
This is the term previously given to damage to muscles, nerves,
tendons, tendon sheaths or other soft tissues resulting from overuse or
misuse usually in the upper limbs. The lower limbs, back shoulders and
other parts of the body however, can also be affected. Unfortunately
the term does not conform to conventional criteria for the description
of disease and this can lead to confusion - particularly if litigation
is contemplated - for it implies the existence of a physical condition
with an identifiable cause. Physical signs may be imprecise or absent,
the word 'strain' is not used in its true mechanical sense - but in a
lay sense - and 'injury' suggests a single culpable event. However, the
term 'RSI' has wide understanding in lay circles and the RSI
Associations do valuable work for their members and it is reasonable
that the term continues - if only to prevent it being replaced by
something equally imprecise and providing the qualifications to its use
are appreciated.
- rheumatoid arthritis (ra)
Rheumatoid arthritis is a chronic non-bacterial inflammation of joints
which causes thickening of the synovial membrane and chronic
inflammatory changes. The articular cartilages are later softened and
eroded. Osteoarthritis may be due to occupational hazards leading to
wear and tear in the joints but rheumatoid arthritis is a disease
without any known occupational associations.
- rotator cuff syndrome
This refers to a cuff of soft tissue over the tip of the shoulder made
up of the supra-spinatus tendon and the adjoining flat tendons which
are blended together to form what is often called the rotator cuff
Injury to the cuff produces pain at the tip of the shoulder reflecting
down the upper arm, and the inability to abduct the arm without pain.
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