Upper limb disorders and work: the importance of physical and psychosocial factors

Upper limb, shoulder, and neck disorders cause both acute and chronic pain, as well as significant functional impairment. They impose a heavy financial burden on societies, industries, and individuals. Our understanding of the pathology of many of the disorders is poor. The epidemiological pursuit of causal relationships is hampered by the nature of the disorders and by the diverse and interactive exposures both at, and away from, the workplace. Current studies suggest that forceful, repetitive manual work, along with prolonged static loading and exposure to vibration are established areas of risk. Much less is known about the possible contribution of psychological factors. Perception of work characteristics, for example, low decision latitude and lack of social support, appear to show increased associations with a number of upper limb disorders, although mechanisms to explain these observations are still broadly theoretical. Research into individual factors is limited, but age and gender both appear to be important.