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More research needed to help workers with upper limb disorders

A severe lack of evidence is holding doctors back from providing the right treatment for workers suffering from upper limb disorders, according to new research by the NHS Plus funded Occupational Health Clinical Effectiveness Unit (OHCEU) at the Royal College of Physicians.

Upper limb disorders is an umbrella term for a number of common conditions of the shoulder, arm, wrist and hand, including carpal tunnel syndrome, which is estimated to affect around 5% of UK adults.
The review by the OHCEU's Guideline Development Group (GDG) looked for evidence on the best way to manage four specific conditions; carpal tunnel syndrome, non-specific arm pain, tenosynovitis and lateral epicondylitis.

The GDG found only four papers of acceptable quality looking at how people with these conditions could be helped in their workplace. The group is now calling for researchers to build an evidence base to inform future management.
The group believe research is needed in the following areas:

  • Establishing clear and consistent definitions for the various disorders studied.
  • Assessing outcomes such as job retention and sickness absence in relation to multidisciplinary rehabilitation.
  • The effect of modern keyboard design on occupational outcomes in comparison with current standard workstation equipment.

Despite the scarcity of evidence, the GDG was able to make a number of recommendations for occupational health practitioners and employers with employees suffering from these conditions. These include:

  • Allowing people with carpal tunnel syndrome to try out alternative computer keyboards.
  • Offering or facilitating a multidiscipline rehabilitation to workers with non-specific arm pain who have been absent from work for more than four weeks.

Commenting on the new guideline, Dr Sian Williams, Clinical Director of the OHCEU, said: "The major benefit of this review is that it has revealed the lack of high-quality research on workplace management of upper limb disorders. Our recommendations provide a starting point for clinicians and employers managing workers with upper limb disorders and for researchers planning studies in this area."
Royal College of Physicians