Management of work-relevant upper limb disorders

This review, using a best evidence synthesis, examined the evidence on management strategies for work-relevant upper limb disorders. Articles were found through systematic searching of electronic databases together with citation tracking. Information from included articles was synthesised into high-level evidence statements, which were distilled into key messages. The results covered the following main themes: classification/diagnosis, epidemiology, associations/risks and management/treatment. The focus was on return to work and took account of distinctions between non-specific complaints and specific diagnoses. Neither medical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for vocational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. Successful management strategies appear to require all the players (workers, employers and healthcare) to be onside, and acting in a coordinated fashion. The biopsychosocial model applies; biological considerations should not be ignored, but it is psychosocial factors that are important for occupational as well as clinical outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled.