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Education And Debate

ABC of Work Related Disorders: Neck and arm disorders

BMJ 1996; 313 doi: (Published 17 August 1996) Cite this as: BMJ 1996;313:419
  1. Mats Hagberg

    Terms and definitions

    Over recent years the use of terms such as repetitive strain injury (RSI) and cumulative trauma disorder have been strongly criticised. Sometimes the terms have even been used synonymously with disease terms such as carpal tunnel syndrome (compression of the median nerve at the wrist) and de Quervain's disease (inflammation of the tendons to the long thumb abductor and the short thumb extensor at the wrist). Neither carpal tunnel syndrome nor de Quervain's disease is necessarily related to repetitive strain or cumulative trauma.

    Use of these terms to describe work related musculoskeletal disorders has been criticised because they suggest a pathological mechanism that is usually not proved. A work related musculoskeletal disorder may be caused by a single strain or trauma, not necessarily a repetitive or cumulative one. Furthermore, both psychological and social factors play an important role in the genesis and perpetuation of work related musculoskeletal disorders.

    The World Health Organisation considers the cause of work related musculoskeletal diseases to be multifactorial. The work environment and the work performed are important but are not the only factors to be considered. The preferred term for conditions that may be subjectively or objectively influenced or caused by work is work related musculoskeletal disorder. This umbrella term neither defines the pathological mechanism nor the diagnostic criteria.

    Characteristics of non-specific musculoskeletal pain in neck and shoulder

    • Pain and stiffness gradually increase during work and are worst at end of working day and week

    • Pain localised to cervical spine and angle between neck and shoulder

    • Usually no radiation of pain

    • Symptoms improved by heat and worsened by cold draughts

    • Tenderness over neck and shoulder muscles

    • Reduced range of active movement of cervical spine (normal passive movement)

    • No neurological deficits

    Differential diagnosis
    • Thoracic outlet syndrome and other nerve entrapments

    • Systemic diseases

    Specific risk factors

    Certain occupations are associated with a high risk for neck and arm pain. Some risk …

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