Upper-extremity musculoskeletal disorders of occupational origin.

Sufficient evidence is available at this time to conclude that several well-defined soft-tissue disorders of the upper extremities are etiologically related to occupational factors. These disorders include tendinitis of the hand and wrist, CTS, and hand-arm vibration syndrome. Force, repetition, and vibration have been established as risk factors in the etiology of these disorders. Evidence exists that other, poorly understood factors also may contribute to etiology. At this time no firm guidelines can be established regarding maximum no-effect exposure levels. We agree, however, with Armstrong (3): "Although there are no standards for excessively repetitive or forceful work, common sense dictates that these tasks be minimized to the extent possible." Tool and job redesign may be required in many situations to accomplish these goals. In addition to appropriate reductions in risk factors, medical surveillance is required and will allow greater appreciation of the extent of this growing problem, as well as ongoing assessment of the efficacy of preventive intervention.