BackgroundShoulder and elbow work-related injuries can be caused by lifting, overhead repetitive activities, forceful exertion or prolonged awkward postures [1-3]. However, psychosocial characteristics of work environment such as stress, high job demands, low job control, lack of social support and insufficient coping abilities are also reported to play an important independent role in the development or persistence of disability following an injury [4][5][6][7][8][9].The concept of psychosocial flags as risk factors for prolonged disability was first introduced by Kendall, et al. [10] and has been a subject of interest in occupational literature since its conception in late 1990s [11,12]. These authors coined the term "yellow psychosocial flags" to the features that affect how one manages his/her situation, including fears about pain or injury, expectation of passive treatment, negative pain beliefs and distressed affect. A few years later, Main and Burton [13] suggested two other flags to more specifically represent the workplace social/environmental risk factors; "blue psychosocial flags" refer to workplace and the worker's perceptions of the relationship between health and work, such as stressful, unsupportive, and excessively demanding and "black psychosocial flags" refer to the context and environment in which the worker functions, including people, system and policies, such as the insurance and compensation system under which workplace injuries are managed.The substantial economic costs associated with reduced work performance and productivity, increased sick leave and demands on the health care system make the upper extremity and particularly the