Upper limb disorders are musculoskeletal disorders (MSDs) that affect the shoulder, neck, elbow, forearm, wrist, hand and fingers. The Health and Safety Executive (HSE) estimates that as many as 370,000 people in Britain are affected by an upper limb disorder of some kind. In the past, these disorders have been widely known as repetitive strain injury, but it is now accepted that they can occur without a person having carried out repetitive activities. In fact, while some upper limb disorders have an exact diagnosis, the cause and treatment of some upper limb pains can be more difficult to identify.
Upper limb disorders include aches and pains in any part of the body from the shoulder to the fingers and can include problems with soft tissue, muscles, tendons and ligaments as well as the blood circulation or nerve supply to the upper limb. The symptoms, which can all be exacerbated by the work a person does include:
- sharp pain;
- stiffness or a weakness to the muscle;
- a tingling sensation;
Common types of work-related disorders of the upper limb
- Carpal tunnel syndrome is characterised by pain and/or altered sensation in the hands and fingers caused by the median nerve being compressed or trapped within the carpal tunnel at the wrist.
- Non-specific arm pain, generally in the forearm, is pain without obvious cause or particular defined symptoms. This type of pain is the most common work-related upper limb complaint.
- Tenosynovitis is the inflammation of the tendons in the wrist which cause pain when the wrist is moved. The condition also causes tenderness, swelling and redness and also a grinding or ‘popping’ feeing in the joint.
- Lateral epicondylitis is better known as tennis elbow, but most sufferers are not actually players of racket sports. Recent research shows that this is a condition of the dominant arm, most commonly experienced in middle age. Most patients recover in 12 months without any treatment. Where needed, treatment includes rest from aggravating activities (such as tennis, repetitive twisting and gripping), acupuncture, splinting and non-steroid anti-inflammatory drugs. However, if symptoms persist, surgery is an option.
Risk factors for upper limb disorders
These can be broadly broken down into four areas:
Posture: The wrist works best when the arm and hand are in a straight line. Rotating the hand can strain the tendons and nerve supply around the wrist. Some workers (for example those who use computers for long periods) can be susceptible to strain because of the need to bend their elbow and rotate their wrists.
Force: Excessive or even moderate but regular force can prompt symptoms of ULDs, particularly in activities that rotate the arm or wrist (e.g. folding boxes or twisting wires).
Repetition: Repetitive activities, like working on a factory production line, are well known causes of ULDs because unequal stress is put on different parts of the body.
Working environment: Certain factors in the work environment can contribute to triggering ULDs, including:
- the nature of work and the way it is undertaken such as repetitive tasks and the posture that’s adopted by workers;
- poor lighting (which can encourage people to adopt poor posture);
- stress (which can encourage a person to work more intensively, tense the muscles or to skip breaks);
- psychosocial factors such as having little control over workloads or working methods – a worker’s psychological response to work can influence their health (particularly their musculoskeletal health).
For more information, see the HSE guide ‘upper limb disorders in the workplace’.
Strategies for dealing with upper limb disorders in the workplace
Actively considering the causes of ULDs can help workers and reduce levels of sickness absence in an organisation.
Risk assessments are a central part of a business’s approach and HSE publications, such as the DSE (Display Screen Equipment) Regulations and Management of Health and Safety at Work Regulations outline the risk factors in offices and factories that may cause ULDs. These Regulations suggest:
- monitoring the workforce for symptoms of ULDs;
- identifying repetitive activities and using task rotation where possible;
- assessing the posture of employees as they work;
- measuring the amount of force involved in a task;
- checking how many tasks involve vibrating machinery.
Furthermore, organisations could take such steps as:
- undertaking an ergonomic review of the workplace to reduce rotating or lifting activities;
- improving workplace training around ULDs;
- reviewing target-setting and bonuses to ensure workers are not under undue pressure to rush activities;
- encouraging early reporting of symptoms.
Employees who have symptoms that suggest an upper limb disorder should seek medical advice and report any symptoms to their employer as soon as possible – early intervention and treatment is the best way to avoid long-term problems.
Fit for Work advice can be sought on any work-related health issue from the Fit for Work website or by calling the Fit for Work advice line on 0800 032 6235 (English) or 0800 032 6233 (Welsh). Those in Scotland can call 0800 019 2211 or visit fitforworkscotland.scot.
Fit for Work referrals: Employees in England or Wales who have been off work for four weeks or more due to an upper limb disorder or other health issue can be referred by their GP or employer for a referral to Fit for Work in order to identify all the obstacles preventing a return to work. See our blogs about Fit for Work referrals and eligibility for referrals to find out more.