This clinical review will describe the epidemiology, clinical presentation, and management of the following work‐related musculoskeletal disorders (WMSDs) of the distal upper extremity: deQuervain's disease, extensor and flexor forearm tendinitis/tendinosis, lateral and medial epicondylitis, cubital tunnel syndrome, and hand‐arm vibration syndrome (HAVS). These conditions were selected for review either because they were among the most common WMSDs among patients attending the New York State Occupational Health Clinics (NYSOHC) network, or because there is strong evidence for work‐relatedness in the clinical literature. Work‐related carpal tunnel syndrome is discussed in an accompanying paper. In an attempt to provide evidence‐based treatment recommendations, literature searches on the treatment of each condition were conducted via Medline for the years 1985–1999. There was a dearth of studies evaluating the efficacy of specific clinical treatments and ergonomic interventions for WMSDs. Therefore, many of the treatment recommendations presented here are based on a consensus of experienced public health‐oriented occupational medicine physicians from the NYSOHC network after review of the pertinent literature. A summary table of the clinical features of the disorders is presented as a reference resource. Am. J. Ind. Med. 37:75–93, 2000. © 2000 Wiley‐Liss, Inc.

The grounded theory approach identified workers' main health problems, and the organizational factors and exposures linked with them. Perceptions about work organization/psychosocial exposures appeared more diverse than physical exposures. Prevention among all participants focused on mechanized equipment, but EMS workers also wanted more organizational support.

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Lost workdays due to employee injuries were reduced 96% after Methodist Rehabilitation Center installed ceiling lifts to transfer patients. Credit: Methodist Rehabilitation Center Mississippi,U.S. Radiation Safety Technician at Mount Sinai Hospital checks for contamination after inpatient therapy procedure.

All the observed associations of risk factors disappeared and were further away from patient handling on the causal pathway to MSDs. Patient handling involves numerous work elements and dynamic physical activities. Understanding the work elements of patient handling and conducting interventions based on specific patient handling tasks can substantially reduce MSDs among hospital workers.

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Reduced dorsal hand skin temperature after acclimating to an ambient temperature of 18-22 degrees C in those with more severe UEMSDs may reflect an underlying dysfunctional sympathetic nervous system. Further testing in epidemiological cohorts would be desirable to evaluate the generalizability and feasibility of this physiological measurement for UEMSD severity in the workplace.

Carpal tunnel syndrome (CTS) is a clinical entity characterized by pain, paresthesias, and numbness in the distribution of the median nerve with weakness and atrophy of the thenar muscles in advanced cases. It is universally accepted that CTS is the clinical concomitant of compression of the median nerve as it passes through the carpal canal. It is reported to be the most common of the entrapment neuropathies. Increasing evidence suggests that occupational factors, including forceful use of the hands, repetitive use of the hands, and hand‐arm vibration, are etiologic for CTS. When occurring as a result of occupational exposures, the term “work‐related carpal tunnel syndrome” is applied. Clinical approaches to the diagnosis and treatment of work‐related CTS are described in this paper. Particular attention is paid to the clinical features and pathophysiology of CTS, the epidemiology of work‐related CTS, ascertainment of work‐relatedness in the clinical setting, treatment including both work and non‐work interventions, and control of occupational ergonomic risk factors that may contribute to the illness. Am. J. Ind. Med. 37:62–74, 2000. © 2000 Wiley‐Liss, Inc.