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Work-related musculoskeletal disorders

Yassi, Annalee MD, MSc

Current Opinion in Rheumatology: March 2000 - Volume 12 - Issue 2 - pp 124-130
Nonarticular rheumatism, sports-related injuries, and related conditions

Work-related musculoskeletal disorders continue to be extremely common and to present an important challenge to clinicians. Debate regarding terminology and case definitions has discouraged practitioners from aggressively approaching the diagnosis and management of these conditions. Considerable progress has, however, been made recently. Previously more commonly referred to as repetitive strain injuries or cumulative trauma disorders, the new term work-related musculoskeletal disorders has fewer etiological implications. These disorders, affecting the back, lower limbs, and especially upper limbs and neck, can be extremely costly if not addressed appropriately. Generally resulting from a combination of physical factors (including repetition, force, and awkward postures) as well as other workplace environmental or organizational factors (including excessive work rates or durations, inadequate breaks, and a variety of psychosocial workplace characteristics), work-related musculoskeletal disorders can often be remediated when these factors are appropriately assessed and addressed. Clinicians must play a positive role in ensuring that this approach prevails.

Abbreviations:CTS carpal tunnel syndrome, WMSD work-related musculoskeletal disorders

Work-related musculoskeletal disorders (WMSD) continue to be the fastest growing cause of work-related disability [1]. According to the US Bureau of Labor Statistics, disorders associated with “repeated trauma” or “cumulative trauma” account for 65% of all occupational illnesses in the US [2], with almost 2 million workers reporting symptoms of carpal tunnel syndrome (CTS) alone [3]. Elsewhere the picture is similar [4]. Work-related musculoskeletal disorders that result from repetition or cumulative factors are more costly than conditions of similar pathology from acute trauma [1,5,6]. In Washington State, the average direct workers’ compensation claim costs were $12,794 for CTS, and $15,790 for rotator cuff syndrome [7]. It is estimated that compensable costs in the US for these disorders exceed $20 billion annually [8]; adding indirect costs, the figures are much higher [1,8,9]. Most authorities agree that early intervention improves prognosis [4,8]. Clinicians need to diagnose and treat these conditions, establish their relation to occupational risk factors, and intervene to minimize their occurrence.

Although repetitive and/or forceful activities often inflict injuries on several body parts simultaneously, because upper limb WMSDs are the fastest-growing group of occupational disorders [9], they will be the focus of this article. This review discusses recent advances in terminology, case definitions, and clinical approaches. It summarizes recent reviews of the epidemiology, pathophysiology, and risk factors, and notes progress made in implementing effective interventions. Last, it highlights the need to rise above the debates on residual uncertainties to serve the best interest of patients and society.

Professor and Director, Occupational and Environmental Health Unit, Departments of Community Health Sciences and Medicine, Winnipeg, Canada

Correspondence to Dr. Annalee Yassi, Director, Occupational and Environmental Health Unit, University of Manitoba, S112, 750 Bannatyne Avenue, Winnipeg, MB R3E 0W3 Canada;

© 2000 Lippincott Williams & Wilkins, Inc.