Workplace Risk Factors and Occupational Musculoskeletal Disorders, Part 2: A Review of Biomechanical and Psychophysical Research on Risk Factors Associated with Upper Extremity Disorders

Background: Work-related musculoskeletal disorders at the elbow are a common health problem, which highly impacts workers’ well-being and performance. Besides existing qualitative information, there is a clear lack of quantitative information of physical risk factors associated with specific disorders at the elbow (SDEs). Objective: To provide evidence-based quantitative measures of physical risk factors associated with SDEs. Methods: Studies were searched from 2007 to 2017 in Medline, EMBASE, and Cochrane Work. The identified risk factors were grouped in main- and sub-categories of exposure using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) framework for rating evidence. Results: 133 different risk-factor specifications were identified in 10/524 articles and were grouped into 5 main- and 16 sub-categories of exposure. The risk factors were significantly associated with lateral epicondylitis, medial epicondylitis, or ulnar neuropathy. Significant risk factors such as wrist angular velocity (5°/s, with increasing prevalence ratio of 0.10%/(°/s), or forearm supination (≥45° and ≥5% of time combined with forceful lifting) were found. Conclusions: This review delivers a categorization of work-related physical risk-factor specifications for SDEs with a special focus on quantitative measures, ranked for evidence. These results may build the base for developing risk assessment methods and prospective preventive measures.

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Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders

Human Factors The Journal of the Human Factors and Ergonomics Society ◽

10.1177/0018720819860683 ◽

2019 ◽

pp. 001872081986068 ◽

Cited By ~ 5

Author(s):

Peter J. Keir ◽

Amanda Farias Zuniga ◽

Daanish M. Mulla ◽

Kumara G. Somasundram

Keyword(s):

Risk Factors ◽

Upper Extremity ◽

Dose Response ◽

Injury Risk ◽

Epidemiological Studies ◽

Task Demands ◽

Laboratory Studies ◽

Occupational Risk Factors ◽

Upper Extremity Disorders ◽

Extremity Injuries

Objective:The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined.Background:Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries.Method:In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon–related disorders, epicondylitis, and carpal tunnel syndrome (CTS).Results:Forceful exertions are strongly associated with hand/wrist tendon–related disorders, epicondylitis, and CTS. Dose–response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose–response between risk factors and injury.Conclusion:Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon–related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals.Application:Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.

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