Objectives-To establish consensus case definitions for several common work related upper limb pain syndromes for use in surveillance or studies of the aetiology of these conditions. Methods-A group of healthcare professionals from the disciplines interested in the prevention and management of upper limb disorders were recruited for a Delphi exercise. A questionnaire was used to establish case definitions from the participants, followed by a consensus conference involving the core group of 29 people. The draft conclusions were recirculated for review. Results-Consensus case definitions were agreed for carpal tunnel syndrome, tenosynovitis of the wrist, de Quervain's disease of the wrist, epicondylitis, shoulder capsulitis (frozen shoulder), and shoulder tendonitis. The consensus group also identified a condition defined as "non-specific diVuse forearm pain" although this is essentially a diagnosis made by exclusion. The group did not have enough experience of the thoracic outlet syndrome to make recommendations. Conclusions-There was enough consensus between several health professionals from diVerent disciplines to establish case definitions suitable for use in the studies of several work related upper limb pain syndromes. The use of these criteria should allow comparability between studies and centres and facilitate research in this field. The criteria may also be useful in surveillance programmes and as aids to case management. (Occup Environ Med 1998;55:264-271)

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Many occupational and environmental health hazards present as an increased reporting of non-specific symptoms such as headache, backache, eye and respiratory irritation, tiredness, memory problems, and poor concentration. The pattern and number of such symptoms is surprisingly constant from hazard to hazard suggesting that common psychological and social factors, not directly related to the exposure may be involved. A recent workshop (see acknowledgements) was held to review the pattern of symptoms in varying hazardous situations and the psychological mechanisms behind the genesis and maintenance of symptoms. The involvement of both direct physicochemical and psychological mechanisms in symptom generation and reporting in any situation was discussed and is reported here. A model that identifies the issues that need to be considered in any epidemiological study based on the incidence or prevalence of non-specific symptoms is proposed. Institute of

A questionnaire survey of over 400 workers handling reactive dyes showed that over 15% had work related respiratory or nasal symptoms. Forty nine employees with symptoms were referred to chest clinics for detailed assessment attributed to reactive dyes. He had been advised by his trade union to consult his local Employment Medical Adviser. Two and a half years previously a colleague from the same dyehouse had been investigated for occupational asthma. Inhalation testing with a Levafix orange reactive dye provoked an asthmatic response; the dye was subsequently withdrawn from his place of work. This man's death at work with asthma gave urgency to this study.The first phase of the study was to identify, by means of a questionnaire administered by a physician, those dyehouse operatives with work related upper and lower respiratory tract symptoms. Symptomatic employees identified by the questionnaire were referred to one of two chest physicians who investigated the nature of their symptoms, their severity, relation with work, and the possible causative agents. The study included an estimate of the prevalence of specific IgE to dye-human serum albumin conjugates (dye-HSA) as a measure of immunological response in employees exposed to reactive dyes, and to relate this to symptoms, atopy, and smoking.In the present paper we report the clinical and immunological findings on the employees referred to 534 on 11 May 2018 by guest. Protected by copyright.

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