Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limbs: a meta-analysis

Am J Ind Med. 1991;19(1):87-107. doi: 10.1002/ajim.4700190111.


In the past 10 years there has been growing awareness among occupational health professionals worldwide of the large burden of illness associated with musculoskeletal disorders of the neck and upper limbs. It has been suggested that these disorders are associated with highly repetitive work and are due, at least in part, to ergonomic factors. This review examines the epidemiologic evidence of the relationship between workplace ergonomic factors such as repetition, force, static muscle loading, and extreme joint position and the development of muscle, tendon, and nerve entrapment disorders of the neck and upper limbs of exposed workers. An extensive search for relevant studies was undertaken. Of 54 potentially relevant studies identified, three met the a priori inclusion criteria. The validity of these studies was assessed, and one study was found to have major flaws. Criteria to demonstrate causality were also applied and were met in the most rigorously conducted study. When the results of these studies are compared and aggregated where appropriate, they provide strong evidence of a causal relationship between repetitive, forceful work and the development of musculoskeletal disorders of the tendons and tendon sheaths in the hands and wrists and nerve entrapment of the median nerve at the carpal tunnel. The comparison of exposed to controls for hand/wrist tendinitis gives an unadjusted common odds ratio of 9.1 (95% CI 4.9-16.2). The adjusted odds ratio for carpal tunnel syndrome is 15.5 (95% CI 1.7-141.5) based on the most rigorous study.

Publication types

  • Meta-Analysis

MeSH terms

  • Activities of Daily Living
  • Arm
  • Bone Diseases / etiology*
  • Carpal Tunnel Syndrome / etiology
  • Ergonomics / methods*
  • Ergonomics / standards
  • Hand Injuries / etiology
  • Humans
  • Meta-Analysis as Topic
  • Muscular Diseases / etiology*
  • Neck
  • Occupational Diseases / etiology*
  • Odds Ratio
  • Tendinopathy / etiology*
  • Tendon Injuries / etiology
  • Wrist Injuries / etiology