Objective. To determine the prevalence, interrelation, and impact of musculoskeletal disorders of the upper limb in the general population. Methods. A total of 9,696 randomly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening questionnaire and a standardized physical examination in symptomatic subjects. Age-and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs. The overlap and impact on daily activities and healthcare utilization were explored. Results. Among 6,038 first-stage responders, 3,152 reported upper limb symptoms and 1,960 were subsequently examined. Of subjects with pain, 44.8% had 1 or more specific soft-tissue disorders. Site-specific prevalence rates were as follows: shoulder tendinitis 4.5% among men and 6.1% among women; adhesive capsulitis 8.2% among men and 10.1% among women; lateral epicondylitis 1.3% among men and 1.1% among women; de Quervain's disease 0.5% among men and 1.3% among women; other tenosynovitis of the hand or wrist, 1.1% among men and 2.2% among women. Specific disorders tended to cluster (P < 0.001) in individuals, with particular overlap at the shoulder. Compared with subjects with nonspecific pain, those with specific disorders more often reported inability to perform everyday tasks (P < 0.05), consultation with a doctor (P < 0.05), and use of prescribed medication (P < 0.05). Conclusion. Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders. These disorders have a substantial impact on physical function and use of health care.

Altogether, we summarized 38 primary reports, with analyses based either on a comparison of job titles (22) or of physical activities in the job (13) or both (3). We found reasonable evidence that regular and prolonged use of hand-held vibratory tools increases the risk of CTS >2-fold and found substantial evidence for similar or even higher risks from prolonged and highly repetitious flexion and extension of the wrist, especially when allied with a forceful grip. The balance of evidence on keyboard and computer work did not indicate an important association with CTS. Discussion Although the papers that we considered had limitations, a substantial and coherent body of evidence supports preventive policies aimed at avoiding highly repetitive wrist-hand work. There is a case for extending social security compensation for CTS in the United Kingdom to cover work of this kind.

Background: Occupational activities are suspected of having an adverse impact on outcomes of pregnancy. Aim: To assess the evidence relating three major adverse outcomes (preterm delivery, low birthweight (LBW) and pre-eclampsia/gestational hypertension) to five common occupational exposures (prolonged working hours, shift work, lifting, standing and heavy physical workload). Methods: A systematic search of Medline and Embase (1966-December 2005) using combinations of keywords and medical subject heading terms was conducted. For each relevant paper, standard details were abstracted that were then used to summarise the design features of studies, to rate their methodological quality (completeness of reporting and potential for important bias or confounding) and to provide estimates of effect. For studies with similar definitions of exposure and outcome, pooled estimates of relative risk (RR) in meta-analysis were calculated. Results: 53 reports were identified-35 on preterm delivery, 34 on birth weight and 9 on pre-eclampsia or gestational hypertension. These included 21 cohort investigations. For pre-term delivery, extensive evidence relating to each of the exposures of interest was found. Findings were generally consistent and tended to rule out a more than moderate effect size (RR .1.4). The larger and most complete studies were less positive, and pooled estimates of risk pointed to only modest or null effects. For small-for-gestational age, the position was similar, but the evidence base was more limited. For pre-eclampsia and gestational hypertension, it was too small to allow firm conclusions. Conclusions: The balance of evidence is not sufficiently compelling to justify mandatory restrictions on any of the activities considered in this review. However, given some uncertainties in the evidence base and the apparent absence of important beneficial effects, it may be prudent to advise against long working hours, prolonged standing and heavy physical work, particularly late in pregnancy. Our review identifies several priorities for future investigation.