Common Occupational Upper Extremity Musculoskeletal Disorders

Family physicians play a valuable role in the diagnosis, management, and treatment of musculoskeletal disorders that result from occupational exposures, including overexertion, repetitive motion, and vibration. Carpal tunnel syndrome is a common peripheral nerve entrapment syndrome often identified in workers whose jobs require repetitive hand motion. Treatment of carpal tunnel syndrome includes splinting, rehabilitation exercises, and oral or injected corticosteroids; surgical release is considered in patients for whom conservative treatment has failed or who have severe symptoms. Lateral epicondylitis is an elbow disorder resulting from overuse; it is diagnosed clinically and managed with bracing, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and physical therapy. Rotator cuff tendinopathy is a degenerative disorder of the rotator cuff musculature and tendons and is often identified in people who perform repetitive work overhead. Rotator cuff tendinopathy is diagnosed clinically and generally managed nonoperatively with nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections; imaging may be considered to confirm the diagnosis after initial conservative treatment. Trigger finger is a stenosing tenosynovitis of the flexor ten-dons of the hand and occurs among people whose jobs require repetitive gripping. Corticosteroid injection is a first-line treatment for trigger finger. A careful history can assist the clinician in determining whether an injury is work related. Providing appropriate work restrictions for injured workers to allow a safe return to work may expedite recovery.