Abstract
Musculoskeletal disorders (MSDs) related to working conditions are the leading cause of work disability. MSD related to work is due to non-traumatic injury of soft tissue structures such as the muscles, tendons, ligaments, and nerves that are caused and/or exacerbated by a person’s interactions with the work environment. Diagnostic criteria for MSD differ for different disorders, ranging from clinical diagnoses based on symptoms and signs for some to diagnoses based on structural and functional criteria for others. MSDs are multifactorial disorders, where both nonoccupational factors and occupational factors interact in both etiology and recovery. Biomechanical exposures increase risk for MSD based on their intensity (or level), frequency, and duration. Exposures can be estimated through expert judgments, systematic observations, and direct measurements or through use of a job exposure matrix. Psychosocial factors may play an important role in recovery and disability from MSD, and in non-specific pain disorders, and can be defined on many scales based on validated questionnaires.
In addition to the general considerations above, specific causal associations exist between disorders and working conditions, mainly between disorders and biomechanical factors. There is good evidence for associations between biomechanical factors such as hand-arm elevation and shoulder load in the etiology of rotator cuff tendinopathies, the most common shoulder disorder. There is also a positive association between epicondylitis and nerve entrapment at the elbow and combined biomechanical exposures (strength, repetition, and/or awkward posture) involving the wrist and/or the elbow. For carpal tunnel syndrome, associations are consistently found with forceful and repetitive hand exposures, particularly when combined, with strong evidence of a dose-response relationship. Hand-arm vibration syndrome is seen in specific populations exposed to vibrating tools. There is an association between neck pain and biomechanical factors such as static work with maintained awkward postures. Whole-body vibration and vehicle driving, carrying or pulling heavy loads, awkward postures, and psychological demands including lack of support from the social environment are consistently associated with non-specific back pain. Occupational determinants of hip and knee osteoarthritis have been found in several studies in jobs with high biomechanical exposures from carrying loads and from kneeling/squatting (for knee osteoarthritis).
There are many determinants of musculoskeletal disorders, which vary according to nature and location of the disorder. A better global approach toward prevention of these disorders requires a life course perspective and consideration of all relevant risk factors, both those common to many MSD and those specific to particular MSD.
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Descatha, A., Evanoff, B.A., Leclerc, A., Roquelaure, Y. (2019). Occupational Determinants of Musculoskeletal Disorders. In: Bültmann, U., Siegrist, J. (eds) Handbook of Disability, Work and Health. Handbook Series in Occupational Health Sciences, vol 1. Springer, Cham. https://doi.org/10.1007/978-3-319-75381-2_8-1
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