CANS (complaints of arm, neck and/or shoulder)
RSI / CANS / Mouse arm

CANS is a collective term for "complaints of the arm, neck and/or shoulder". This general term is used for symptoms that can cause pain, stiffness, loss of strength and/or tingling in the area from the neck to the hand.

CANS is often regarded as a work-related problem, but this is not necessarily the case. Symptoms can also develop at home or on the sports field. These are known in the vernacular as mouse arm, tablet neck, smartphone wrist, Gameboy thumb or WhatsApp thumb.

Description of condition

CANS is the new name for symptoms that we used to call RSI. RSI stands for repetitive strain injury. The name suggests that the symptoms are always the result of repeatedly performing the same activity or movement. Since this is by no means always the case, the term RSI has been replaced by the more general name CANS (complaints of the arm, neck and/or shoulder).

Approximately one in four employees appear to suffer, to a greater or lesser extent, from physical symptoms associated with CANS. CANS symptoms have an insidious start and gradually get worse if nothing is done about the cause. These symptoms can lead to serious limitations both at work and at home.

CANS can be categorized into specific and non-specific symptoms. Some specific complaints are, for example, tennis elbow, golfer’s elbow, thoracic outlet syndrome (TOS) or tendonitis. When no clear diagnosis can be made, we talk a bout a non-specific complaint.

Cause and history

CANS is generally caused by performing the same actions with the arm frequently (and maybe forcefully). However, CANS can also occur if someone holds the same position for a long time, causing excessive strain on the arm, neck or shoulders. Some examples of this are: sitting at a computer for a long time while maintaining a poor posture, assembly line work, painting, sports, etc. Therefore, these symptoms are not caused by an accident in which someone injures the arm, neck or shoulder.

Classification of risk factors
Many factors are known to increase the risk of CANS. These are divided into three categories:

Category 1
The first category includes personal factors such as female gender and poor physical health.

Category 2
The second category includes environmental factors. This may include a poorly designed workplace, heavy workload or an irritating boss or maybe colleagues.

Category 3
Lastly there are activity-related factors that make up the third category. These are actions that must be performed and a lack of variety in these.

CANS is actually always based on a combination of multiple factors included above.

Signs & symptoms

Because CANS is a very broad term, the symptoms can also vary greatly.

The most common symptoms are:

• Pain and/or stiffness in the neck, shoulders, arm or hand.
  
• Loss of strength.
  
• Tingling.
  

Other characteristics include:

• Symptoms that develop gradually and get progressively worse.
  
• Symptoms that are aggravated by tension, pressure or stress.
  
• Symptoms that are aggravated when a posture is maintained for a long time, or when certain movements are repeated over and over again.

Diagnosis

A doctor or physiotherapist will ask about the symptoms and how they developed. If the symptoms developed as a result of an accident or a fall, CANS is ruled out in the first place.

During the physical examination, it will be determined whether specific CANS or non-specific CANS is involved. The posture, muscle tension and mobility of the joints will be assessed. Generally, additional testing is not necessary in the event of these symptoms.

Treatment

It is important to act quickly at the onset of symptoms in order to prevent aggravation. The relationship between strain (what is required from the body) and capacity (what the body can handle) must be restored.

If the cause of the symptoms is not removed, the symptoms will not disappear either. Together with a physiotherapist, it is possible to examine which risk factors cause and/or maintain the symptoms.

The way in which the symptoms are dealt with is very important. The treatment will focus on (working) posture, mobility of the joints and physical condition. Although it can sometimes take a long time, recovery from CANS is generally quite possible.

Exercises

You can check your symptoms using the online physiotherapy check or make an appointment with a physiotherapy practice in your locality.

References
Heemskerk, M.A.M.B., Staal, J.B., Bierma-Zeinstra, S.M.A., Haan, G. de, Hagenaars, L.H.A., Lanser, K., Windt, D.A.W.M. van der, Oostendorp, R.A.B. & Hendriks, H.J.M. (2010). KNGF-richtlijn. Klachten aan de arm, nek en/of schouder (KANS). Jaargang 120. Nummer 1.