Rheumatology 2001; 40: 716-717
© 2001 British Society for Rheumatology
Letters to the Editor |
Occupation and upper limb disorders
Rheumatology and Rehabilitation Research Unit, University of Leeds, 36 Clarendon Road, Leeds LS2 9NZ, UK
SIR, The editorial by Coggon et al. [1] calls for further research on the pathogenesis, diagnosis, natural history and treatment of upper limb disorders. Particular emphasis is placed on occupational factors, although the authors are careful to avoid such pejorative terms as ‘work-related’. While we agree in principle with this plea, we consider that good quality research of the kind they envisage will be very difficult to perform. The main reason for this is the difficulty in finding a large stable workforce with a cooperative management. Furthermore, within this workplace, jobs should be sufficiently varied to provide a spectrum of different physical exposures. It may be possible to use workers from different industries to provide the latter conditions, but investigators would then lose control over workplace organizational determinants. In fact, many industries have already adopted ergonomic modifications into their workplace as a result of efforts by such bodies as the Health and Safety Executive in the UK [2] and the Occupational Safety and Health Administration in the USA [3], despite the absence of randomized controlled trials. However, it is important to note that ergonomic interventions are not simply concerned with physical load but also with factors such as work systems, control and organization.
There is a parallel between non-specific mechanical low back pain and non-specific upper limb disorder [4], although the demographic characteristics of the populations are different. In the absence of more complete data relating to upper limb disorders, perhaps we should apply the available evidence about low back pain. In low back pain, we know that psychosocial factors and workplace organizational factors are more important in symptom presentation than physical factors, although physical factors play a part [5].
The results of the studies suggested by Coggon et al. may not be available for some time, but many of the answers they require may already be available from the low back pain literature.
Notes
Correspondence to: W. J. Taylor. 
Accepted 18 December 2000
References
-
Coggon D, Palmer KT, Walker-Bone K. Occupation and upper limb disorders. Rheumatology2000;39:1057–9.
[Free Full Text] - Health and Safety Executive. Work related upper limb disorders—a guide to prevention. London: HMSO, 1990.
- Occupational Safety and Health Administration. Proposed ergonomics standard. 1999. Available from URL: http://www.osho.gov/ergonomics-standard.
-
Helliwell PS. Occupational rheumatology: are we using the wrong model? Br J Rheumatol1992;31:73–4.
[Free Full Text] - Burton AK, Waddell G. Occupational health guidelines for the management of low back pain. Evidence review? London: The Faculty of Occupational Medicine, 2000. Available from URL: http://www.facoccmed.ac.uk
Reply
MRC Environmental Epidemiology Unit (University of Southampton), Southampton General Hospital, Southampton SO16 6YD, UK
We agree that parallels between back pain and non-specific upper limb pain may be informative. However, analogies may not be exact, and they require empirical confirmation. While some study designs would require co-operation from employers, in our experience this can be achieved.
Accepted 18 December 2000
CiteULike 
Connotea 
Del.icio.us What's this?
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||