RSI Specialist and Treatment

Question:  I was diagnosed by my GP as having an RSI in my left arm over the last week or so (although I had no tests at the time – based purely on the symptoms presented) and have been put on Voltarol (Diclofenac) for 2 weeks and referred to a physiotherapist. After reading some of the mail from this mailing list (and other sources of information) I’m becoming very concerned about the side-effects of this drug (Voltarol) and am thinking of stopping them immediately. I’m also concerned about the lack of knowledge and awareness surrounding RSI in general, and the fact that Voltarol is apparently an anti-arthritic drug. Is the prescription of such a drug a common occurrence amongst GPs or should I be thinking about changing my doctor? Further, are there any fellow sufferers from Scotland on the mailing list and, if so, do you know of any RSI specialists I could be referred to in either Aberdeen or Glasgow??

Answer 1: Voltarolis not just an anti-arthritic drug: it is an anti-inflammatory, and as such can be used to treat all sorts of inflammation including soft tissue injury/inflammation. Whenever you have injury, you tend to get inflammation in the soft tissues(and sometimes in the joints as well), and anti-inflammatory drugs can be very helpful, but it would be better if a rheumatology specialist or a consultant orthopedic surgeon saw you and prescribed, because I think they are in a better position to judge what you need. OK, even they get it wrong quite frequently, but they do have more specific knowledge than your GP. Voltarol can be very nasty for some people: I had it for a while, and then stopped being able to tolerate it, but that was because I have been on anti-inflammatory since I was 15(I am now 40), and most of them now my body just cannot cope with. The main side effects I had with Voltarol were bloating and abdominal pain, but it was very effective for the pain I had at the time…I have IBS, so it was even more upsetting for me to have.

Anti-inflammatory can be really helpful, but they shouldn’t be the “be all and end all!” It sounds as if your doctor is going on the right track in that he has referred you to a physio: they will be able to advise you more specifically about what you should and should not be doing, and hopefully ease your symptoms. The Voltarol may help in the short term, but it is certainly not a drug to be on long term. In my case, I have lots of other problems as well, including Hypermobility Syndrome(HMS or EDS type 3), and arthritis in my neck, back, hips and knees, as well as all the soft tissue inflammation that goes with chronic RSI…like torn rotator cuff tendons, chronic tendonitis, chronic tennis and golfers elbows in both.

I am not a good advert for sorting RSI out, but that is mainly due to the HMS and the fact I am a violinist in the City of Birmingham Symphony Orchestra, so my whole life is spent in repetitive movements! But the physio 2x weekly, combined with anti-inflammatory and painkillers has kept me in the job. If you can find a good physio, they are worth their weight in gold! When I have periods without the physio, it makes me realise what a difference she really does make, because the pain is so much worse! So if you are able to have physio at an early stage, as it sounds as if yours is, then a good physio should be able to alleviate the symptoms quite considerably, and advise you on lifestyle changes etc… So you are right to be wary of the Voltarol, but don’t throw the baby out with the bathwater: if you do take it, make sure you have it with food, and if necessary get your doctor to prescribe a good anti acid drug treatment…But more importantly, do get a second opinion on the RSI, and do go to the physio, even if it means going privately, as I have to!

Answer 2: Voltarol is an anti-inflammatory drug, used to treat the inflammation that can occur with various types of arthritis, rather than an anti-arthritis drug. To all those out there interested in IMS, I have not been able to acquire a nationwide list of practitioners, but did find out that Mike Cummings (BMAS) at the Homeopathic Hospital in London also does it. I go to Mike Baird in Edgbaston, Birmingham (Private). I will see if I can find out more when I am reviewed by Grahame Brown at the end of July. I am sorry that GP seemed rushed and disinterested when you saw him. Having spent all my life working for the NHS and viewing private practice with disdain, I have to confess to using it when it suited me. My NHS appointment would not be until the end of July, and when I did see GP the consultation/examination took approx. 50 minutes – I know only too well that that would just not be the case in an NHS scenario.

Answer 3: I took Diclofenac for my knees prior to me having physio and seeing a consultant and my boyfriend was recently prescribed them for a severe muscular injury in his back. Both of us were fine. As long as you read the label and stop if any symptoms show you will be ok. Also for 2 weeks you should be fine. The only worries are really if you take them for a long period of time in which case your doctor should call you in every so often to check on your progress. Still – if you are overly concerned (and I was too at the time) then stop taking them as the stress could aggravate your problems.

Answer 4: Voltarol can have its uses. I took it for 6 weeks as an anti inflammatory, when first diagnosed as the inflammation was so bad. I suffered no side effects, although I have suffered in the past when taking anti inflammatory, can’t remember which ones. The main problem can be indigestion and stomach problems, so follow instructions and take with food. If you suffer the side effects, then ask GP for something else.

Answer 5: 2 books I have found very useful in my trials with RSI:-

  • a) Repetitive Strain Injury: A Computer User’s Guide by Emil Pascarelli and Deborah Quilter.
  • b) The Repetitive Strain Injury Recovery Book by Deborah Quilter.

Don’t if anyone has used these as a resource!!

Answer 6: I’ve stopped taking Diclofenac now as it wasn’t doing me or my RSI any good. I’m still attending physiotherapy though and had some blood tests taken in the last week. My GP is also considering referring me to either a rheumatologist or neurologist in the next few months. What kind of specialist is Dr Marc Bransby Zachary (below) from the Southern General Hospital in Glasgow? I could perhaps suggest him to my GP. Throughout my treatment so far it has been suggested that I could have either tennis elbow or carpal tunnel syndrome. Could both conditions produce the same symptoms (a continuous numbness with occasional pain in the arm, from the shoulder down to the fingertips – thumb and index finger in particular)?? Also, if it is CTS, should I have been given either splints or wrist supports by now. Both my GP and physio seem reluctant to do so.

P.S. Reading through some of the mail in this mailing list I was surprised to hear that many people with RSI have a history of chronic fatigue. I was diagnosed with ME about 7 years ago, although I thought I had got over it by now (even though I can still get very tired from time to time and my concentration is still affected). 

Answer 7: What kind of specialist is Dr Marc Bransby Zachary (below) from the Southern General Hospital in Glasgow? Consultant Orthopaedic surgeon (with a special interest in upper limb surgery) (enquiries to Mrs. Cant on direct line 0141 201 1473) I saw him, at Southern General Hospital, 1345 Govan Road, Glasgow g51 4tf

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