Work Related Upper Limb Disorders

INTRODUCTION

Musculoskeletal problems affecting the upper limbs are all common in the general population. Symptoms include aches and pains, difficulty in movement and swelling. Links between some work activities and these disorders have long been recognised. Reliable statistics on the incidence and prevalence of WRULD's are not available although one recent study indicated an occupational association in about 13% of cases attending an orthopaedic clinic. WRULD's can occur throughout industry and are not specific to one particular sector.

There is recognition that musculoskeletal conditions can arise spontaneously and without any link to work. However, it is clear that WRULD's can be caused or made worse by work, although other activities may be involved in some cases.

WRULD's are often associated with a number of serious consequences including:-

· employees experiencing problems with persistent pain or actual injury
· poor product quality or output
· high sickness absence, staff turnover, recruitment difficulties
· rise in compensation claims.

They therefore warrant prompt action. Some musculoskeletal conditions are reportable under the Reporting of Injuries, Diseases and Dangerous Occurrences Regulations 1995. These are:-

(i) cramp of the hand or forearm due to repetitive movements
(ii) beat conditions (of head, knee or elbow)
(iii) traumatic inflammation of the tendons of the hand or forearm or of the associated tendon sheaths
(iv) carpal tunnel syndrome
(v) hand-arm vibration syndrome

WHAT CAUSES WRULDs?

These can be grouped into three general areas:-

1. Force - the application of undesirable manual force
2. Frequency and duration of movement, including unsuitable rates of working or repetition of a single element
3. Awkward posture of the hand, wrist, arm or shoulder problems may be caused by only one of these or more often by a combination or interaction between two or all three.
WRULD's can occur therefore in jobs that require repetitive finger, hand or arm movements; twisting movements; squeezing; hammering or pounding; pushing, pulling, lifting or reaching movements. Both office and manual jobs can cause WRULD's, e.g., assembly line work, meat and poultry preparation, keyboard users, hand tool and powered tool users.

PREVENTIVE MEASURES

(i) Risk assessment - this should concentrate on identifying whether specific risk factors are present and the degree to which they may affect the likelihood of injury. Many people find that a checklist helps them decide:

· if employees are at risk
· whether they need to take more precautions, and
· what to do.

Leaflet IND (G) 171 (L) contains a good, easy-to-use checklist that can be used to assess WRULD's. It is important to involve those people doing the work, at possible risk from WRULD's, as they should know what the problems are.

(ii) Follow up action/solutions - these may be based on ergonomic principles of either work design or organisational arrangements as follows:-

(A) WORK DESIGN

· Reduce force levels - reduce force required, spread the force, get better mechanical advantage, consider effects of any hand protection already provided, maintenance of tools, training

(B) ORGANISATIONAL ARRANGEMENTS

· Training and instruction considerations
· New employees (at greater risk of WRULD's) considerations
· Job rotation?

CHECKLIST - WRULDs

1. Do you know if your employees are at risk from WRULD's? - YES / NO
2. If you suspect so, do you use a checklist to aid risk assessment and identify possible precautions? - YES / NO
3. Are you aware of the need to report certain YES musculoskeletal conditions under RIDDOR 1995? - YES / NO

REFERENCES/FURTHER DETAILS

1. Leaflet IND (G) 171L Upper Limb Disorders - assessing the risks
2. HS(G) 60 - Work related upper limb disorders 

3. HSE website:

4. HSE Books:
5. http://www.hse.gov.uk/pubns/wruldex.htm

6. Muscoskeletal disorders home page

7.Your Health upper limb disorders info:-

or e-mail ehs@gosport.gov.uk any time