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Work-related upper limb disorders
Carpal tunnel syndrome, wrist tenosynovitis, epicondylitis and rotator cuff injury are caused or aggravated at work when repetition, force, awkward posture and lack of rest combine – and management starts by changing the task, not only by treating the patient.
Why it matters in the exam
The exam describes assembly-line workers, cashiers, computer users, hairdressers, butchers or construction workers with pain, numbness or weakness in the upper limb, and asks for the diagnosis, the main occupational risk factor, the diagnostic test and the first step – almost always an ergonomic assessment and a change of task. Carpal tunnel syndrome is linked to repeated forceful and flexed wrist movements; it is confirmed by nerve conduction studies, mainly when there is weakness or surgery is being considered. De Quervain tenosynovitis is diagnosed with Finkelstein's test, and lateral epicondylitis presents with pain on gripping and on resisted wrist extension. Rotator cuff injury is common with prolonged work with the hands above shoulder height. Further items ask about legal recognition: at the National Insurance Institute such injuries are sometimes recognized under the "microtrauma" doctrine – repeated tiny injuries, each identifiable, that add up to damage. Remember also that symptoms in both hands or a systemic condition such as hypothyroidism, diabetes or pregnancy do not exclude a work link, but call for a search for other factors.
Key points
- Repetition, force, posture and too little rest are the main risk factors.
- Carpal tunnel is diagnosed clinically and confirmed by nerve conduction studies.
- A positive Finkelstein test suggests De Quervain.
- Management starts with changing the task and an ergonomic assessment.
- At the National Insurance Institute such injuries are sometimes recognized under the microtrauma doctrine.
Summary table
| Disorder | Typical exposure | Characteristic finding | First-line management |
|---|---|---|---|
| Carpal tunnel syndrome | Repeated forceful wrist movements, prolonged flexion | Night numbness in fingers 1–3, Phalen and Tinel signs | Task adjustment, night splint; surgery if weakness or nerve damage |
| De Quervain tenosynovitis | Pinch grip with wrist deviation | Pain over the distal radius, positive Finkelstein test | Relative rest, thumb splint, steroid injection |
| Lateral epicondylitis | Repeated gripping and tool use | Pain at the lateral epicondyle on resisted wrist extension | Grip change, exercises, forearm strap |
| Rotator cuff injury | Prolonged work above shoulder height | Pain on raising the arm, painful arc | Lowering the work height, physiotherapy |
| Trigger finger | Strong repeated gripping of tools | A finger locking in flexion | Injection, surgical release |
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Sources
- Faculty of Occupational Medicine, Fitness for Work: The Medical Aspects, 6th ed., 2019 — Musculoskeletal disorders of the upper limb
- LaDou & Harrison, CURRENT Diagnosis & Treatment: Occupational & Environmental Medicine, 6th ed., 2021 — Musculoskeletal injuries and ergonomics
- NIOSH, Musculoskeletal Disorders and Workplace Factors, 1997 — Evidence for work-relatedness of upper-extremity disorders
Sources are given for further reading; the text is written afresh and not copied from them.
Reviewed by the Examqo AI Professor · 2026-11-06. The text may contain errors; when in doubt, check the source.