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Published Online First: 20 June 2006. doi:10.1136/oem.2005.025122
Occupational and Environmental Medicine 2006;63:754-761
Copyright © 2006 by the BMJ Publishing Group Ltd.
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ORIGINAL ARTICLE

Why are manual workers at high risk of upper limb disorders? The role of physical work factors in a random sample of workers in France (the Pays de la Loire study)

M Melchior1, Y Roquelaure2,3, B Evanoff4, J-F Chastang1, C Ha2, E Imbernon2, M Goldberg1,2, A Leclerc1 and the Pays de la Loire Study Group

1 U687-IFR69, INSERM (National Institute of Health Research) Saint-Maurice, France
2 Department of Work and Health, InVS (National Institute of Health Surveillance), France
3 Faculty of Medicine, Angers, France
4 Washington University School of Medicine, WA, USA

Correspondence to:
Correspondence to:
Dr M Melchior
INSERM U687, HNSM, 14 rue du Val d’Osne, 94415 Saint-Maurice Cédex, France

Objective: To investigate the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers compared with other workers in a random sample of 2656 French men and women (20–59 years old) participating in a study on the prevalence of work related upper limb disorders conducted by France’s National Institute of Health Surveillance.

Methods: Prevalence ratios (PR) of physician-diagnosed musculoskeletal disorders of the shoulder, elbow, wrist, and hand (any of six leading disorders, rotator cuff syndrome, carpal tunnel syndrome) in manual versus non-manual workers were calculated using Cox regression models with a constant time of follow up and robust variance.

Results: 11.3% of men and 15.1% of women were diagnosed with an upper limb disorder. The risk was especially high in manual workers (PRs: 1.40 to 2.10). Physical work factors accounted for over 50% of occupational disparities overall, 62% (men) to 67% (women) for rotator cuff syndrome, and 96% (women) for carpal tunnel syndrome. The authors calculated that under lower levels of physical work exposures, up to 31% of cases among manual workers could have been prevented.

Conclusions: In working men and women, upper limb musculoskeletal disorders are frequent. Physical work exposures, such as repetitive and forceful movements, are an important source of risk and in particular account for a large proportion of excess morbidity among manual workers.

Abbreviations: INSERM, Institut National de la Santé et de la Recherche Médicale; InVS, Institut National de Veille Sanitaire

Keywords: biomechanical exposures; manual worker; musculoskeletal diseases; occupational exposures; upper extremity


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