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Rheumatology Advance Access originally published online on February 17, 2009
Rheumatology 2009 48(5):528-536; doi:10.1093/rheumatology/kep013
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© The Author 2009. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For Permissions, please email: journals.permissions@oxfordjournals.org

Associations between work-related factors and specific disorders at the elbow: a systematic literature review

Rogier M. van Rijn1, Bionka M. A. Huisstede1, Bart W. Koes1 and Alex Burdorf2

1Department of General Practice and 2Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.

Correspondence to: Rogier M. van Rijn, Department of General Practice, Erasmus MC, Room wk-109, PO Box 2040, 3000 CA Rotterdam, The Netherlands. E-mail: r.vanrijn{at}erasmusmc.nl


  Abstract

Objectives. To assess the exposure–response relationships between work-related physical and psychosocial factors and lateral epicondylitis, medial epicondylitis, cubital tunnel syndrome and radial tunnel syndrome in occupational populations.

Methods. A systematic review of the literature was conducted on the associations between type of work, physical load and psychosocial aspects at work and the occurrence of specific elbow disorders. Associations between work factors and these elbow disorders were expressed in quantitative measures: odds ratio (OR) or relative risk (RR).

Results. Handling tools >1 kg (ORs of 2.1–3.0), handling loads >20 kg at least 10 times/day (OR 2.6) and repetitive movements >2 h/day (ORs of 2.8–4.7) were associated with lateral epicondylitis. Psychosocial factors associated with lateral epicondylitis were low job control (OR 2.2) and low social support (OR 1.8). Handling loads >5 kg (2 times/min at minimum of 2 h/day), handling loads >20 kg at least 10 times/day, high hand grip forces for >1 h/day, repetitive movements for >2 h/day (ORs of 2.2–3.6) and working with vibrating tools >2 h/day (OR 2.2) were associated with medial epicondylitis. The occurrence of cubital tunnel syndrome was associated with the factor ‘holding a tool in position’ (OR 3.53). Handling loads >1 kg (OR 9.0; 95% CI 1.4, 56.9), static work of the hand during the majority of the cycle time (OR 5.9) and full extension (0–45°) of the elbow (OR 4.9) were associated with radial tunnel syndrome.

Conclusions. Several physical and psychosocial factors at work may result in an increased occurrence of specific disorders at the elbow.

KEY WORDS: Musculoskeletal disorders, Lateral epicondylitis, Medial epicondylitis, Cubital tunnel syndrome, Radial tunnel syndrome, Review

Submitted 7 October 2008; revised version accepted 13 January 2009.
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