Relationships and Mechanisms Between Occupational Risk Factors and Distal Upper Extremity Disorders

Hum Factors. 2021 Feb;63(1):5-31. doi: 10.1177/0018720819860683. Epub 2019 Jul 17.


Objective: The relationships between workplace risk factors and upper extremity injuries from epidemiological and laboratory studies were examined.

Background: Epidemiological studies are associated with several limitations, affecting the strength of association between risk factors and the development of injuries.

Method: In this narrative review, we identified epidemiological and laboratory studies (published primarily since 1997) investigating exposure to workplace risk factors (force, repetition, posture, vibration) and risk of hand/wrist tendon-related disorders, epicondylitis, and carpal tunnel syndrome (CTS).

Results: Forceful exertions are strongly associated with hand/wrist tendon-related disorders, epicondylitis, and CTS. Dose-response relationships were found for epicondylitis (repetition) and CTS (posture). Interactions demonstrate multiplicative effects of risk factors for injury risk. Laboratory studies display clear associations between task demands and biomechanical measures linked to mechanisms for upper extremity injuries with animal models providing further evidence of a dose-response between risk factors and injury.

Conclusion: Forceful, repetitive work requiring non-neutral postures are associated with increasing risk of hand/wrist tendon-related disorders, epicondylitis, and CTS as evidenced by epidemiology studies and laboratory-based investigations of humans and animals.

Application: Understanding the relationship between exposure levels of workplace risk factors and upper extremity disorders can improve injury prevention and rehabilitation strategies.

Keywords: biomechanics; epidemiology; injury; musculoskeletal system; upper extremity.

Publication types

  • Review

MeSH terms

  • Carpal Tunnel Syndrome* / epidemiology
  • Carpal Tunnel Syndrome* / etiology
  • Humans
  • Musculoskeletal Diseases*
  • Occupational Diseases* / epidemiology
  • Risk Factors
  • Upper Extremity