What is Work Related Upper Limb Disorder?

Work related upper limb disorder (WRULD) is a general term that covers a number of musculoskeletal conditions which affect the shoulder, elbow, forearm, wrist or hand. It is not a specific disease, but a group of conditions. Previously the terms repetitive strain or stress injury (RSI) were frequently used.

There are also specific conditions affecting the upper limbs which may be work-related if it can be shown they are due to occupational overuse. These conditions usually occur in adults of working age.

Some conditions are well defined with accepted diagnostic criteria, recognized risk factors and well established medical management. Other conditions, in which there is non-specific forearm or upper limb pain, are less well defined.

Classification

Specific Upper Limb Disorders

These include:

• Tenosynovitis (including De Quervain’s Syndrome)
• Trigger finger or thumb
• Rotator cuff syndrome
• Thoracic outlet syndrome
• Vibration induced white finger
• Reflex Sympathetic Dystrophy
• Carpal tunnel syndrome (see Carpal tunnel syndrome guidance)
• Cramp of the hand (Writer’s Cramp) (see Dystonia guidance)
• Epicondylitis (see Tennis/Golfer’s Elbow guidance)
• Tendonitis (see Tennis/Golfer’s Elbow guidance)

Non-Specific Work Related Upper Limb Disorders (WRULD)

A significant number of individuals with upper limb pain and dysfunction do not show signs which are easily recognised or fit with a definitive diagnosis. Such individuals may have pain which is not localized to one area and the pain may move from one area to another and be of a very indeterminate nature. Examination may often identify very little in the way of objective abnormality. The diagnosis is made when other specific conditions have been ruled out. Non-specific forearm pain has been defined for research purposes as ‘pain in the forearm in the absence of a specific diagnosis or pathology’ (Harrington et al. 1998). It is one of the commonest work related upper limb complaints but estimates of its prevalence vary widely. Other features which may be present include loss of function, weakness, cramp, muscle tenderness, burning and non-specific paraesthesia, and often a feeling of swelling.

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Amended November 2009