title: Are psychosocial factors, risk factors for symptoms and signs of the shoulder, elbow, or hand/wrist?: A review of the epidemiological literature.
abstract: BACKGROUND
  In 1993, an extensive review on the role of psychosocial factors in the development of musculoskeletal problems was published by Bongers et al (1993). Since then, additional reviews on this topic have been published; however, none of these focussed on upper limb problems.
  
  
  METHODS
  In this systematic review, the methodological quality of all studies was assessed and levels of evidence were apriori defined.
  
  
  RESULTS
  The large majority of the studies reported an association between at least one work-related psychosocial factor and adverse upper extremity symptoms or signs. High-perceived job stress was consistently associated with all upper extremity problems (UEP) in high and lower quality studies. Although not often studied, non-work-related stress was also consistently associated with UEP. In addition, there was some evidence for a relationship between high job demands and UEP, although the results did not meet the pre-set criterion for consistency.
  
  
  CONCLUSIONS
  High job stress and non-work-related stress reactions are consistently associated with UEP. In addition, high job demands is also in most studies associated with these disorders. Firm conclusions on the role of these factors in the etiology of UEP are not possible due to the cross-sectional nature of most studies.
authors.affiliation: TNO Work and Employment, AS Hoofddorp, The Netherlands. p.bongers@arbeid.tno.nl
authors.forename: Paulien M
authors.initials: PM
authors.lastname: Bongers
authors.forename: Anja M
authors.initials: AM
authors.lastname: Kremer
authors.forename: Jolanda
authors.initials: J
authors.lastname: ter Laak
mesh_terms: D001134:Arm Injuries / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D003430:Cross-Sectional Studies; D012090:Cumulative Trauma Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D004550:Elbow; D006225:Hand; D006801:Humans; D009468:Neuromuscular Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D009784:Occupational Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000523:psychology*; D012307:Risk Factors; D012782:Shoulder; D013315:Stress, Psychological / Q000150:complications*; D016526:Workload / Q000523:psychology*; D014953:Wrist