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Common Occupational Upper Extremity Musculoskeletal Disorders

Scott Hall, MD
Matthew R. Compton, DO

American Family Physician. 2025;111(5):451-458.

Author disclosure: No relevant financial relationships.

This clinical content conforms to AAFP criteria for CME.

Family physicians play a valuable role in the diagnosis, management, and treatment of musculoskeletal disorders that result from occupational exposures, including overexertion, repetitive motion, and vibration. Carpal tunnel syndrome is a common peripheral nerve entrapment syndrome often identified in workers whose jobs require repetitive hand motion. Treatment of carpal tunnel syndrome includes splinting, rehabilitation exercises, and oral or injected corticosteroids; surgical release is considered in patients for whom conservative treatment has failed or who have severe symptoms. Lateral epicondylitis is an elbow disorder resulting from overuse; it is diagnosed clinically and managed with bracing, nonsteroidal anti-inflammatory drugs, corticosteroid injections, and physical therapy. Rotator cuff tendinopathy is a degenerative disorder of the rotator cuff musculature and tendons and is often identified in people who perform repetitive work overhead. Rotator cuff tendinopathy is diagnosed clinically and generally managed nonoperatively with nonsteroidal anti-inflammatory drugs, physical therapy, and corticosteroid injections; imaging may be considered to confirm the diagnosis after initial conservative treatment. Trigger finger is a stenosing tenosynovitis of the flexor ten-dons of the hand and occurs among people whose jobs require repetitive gripping. Corticosteroid injection is a first-line treatment for trigger finger. A careful history can assist the clinician in determining whether an injury is work related. Providing appropriate work restrictions for injured workers to allow a safe return to work may expedite recovery.

An occupational musculoskeletal disorder is an injury or condition of bone, muscle, nerve, cartilage, tendon, ligament, or other soft tissue that is caused or exacerbated by occupational activities. Common causes include overexertion, repetitive motion, and vibration. Injuries are considered to be work related if the work caused or contributed to the resulting condition or significantly aggravated a preexisting condition.1 Family physicians play a valuable role in evidence-based diagnosis, management, and treatment of occupational musculoskeletal disorders, which facilitate early recovery and return to work.

WHAT’S NEW ON THIS TOPIC

Occupational Musculoskeletal Disorders
Between 2021 and 2022 in the US private sector, 502,380 workplace musculoskeletal disorders resulted in at least 1 day away from work, with an incidence rate of 25 disorders per 10,000 full time–equivalent workers.
Factors associated with delayed return to work include older age, female gender, greater pain or disability, greater physical demands of work, previous workers’ compensation claims, having a secondary income source, and psychosocial factors, especially anxiety and depression.
23% to 40% of individuals who have carpal tunnel syndrome improve without any specific treatment.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical RecommendationEvidence RatingComment
Corticosteroid injections can be used to improve symptoms in carpal tunnel syndrome and rotator cuff tendinopathy.19,21,23,51,52 AMultiple systematic reviews, high- and moderate-quality studies consistently showing benefit, mostly in the short term
Corticosteroid injections can be used to improve symptoms of trigger finger.58 BLimited-quality patient-oriented evidence
Corticosteroid injections for lateral epicondylitis have limited effectiveness and should rarely be used.30,33,34 BMultiple systematic reviews show inconsistent results and high recurrence rates
Nonoperative treatment is preferred over subacromial decompression surgery for subacromial pain.54 AHigh-quality evidence indicates no benefit in pain or quality of life from subacromial decompression surgery
Earlier return to work with appropriate job modifications can aid in recovery of occupational musculoskeletal disorders.62 CLimited-quality evidence suggests early return to work portends better outcomes

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

SCOTT HALL, MD, CAQSM, is an associate professor in the Department of Family and Preventive Medicine at the University of Utah, Salt Lake City.

MATTHEW R. COMPTON, DO, MOH, CAQSM, is an occupational medicine resident in the Department of Family and Preventive Medicine at the University of Utah.

Address correspondence to Scott Hall, MD, CAQSM, at u0341520@utah.edu.

Author disclosure: No relevant financial relationships.

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