title: Management of work-relevant upper limb disorders: a review.
abstract: BACKGROUND
  Upper limb disorders (ULDs) are clinically challenging and responsible for considerable work loss. There is a need to determine effective approaches for their management.
  
  
  OBJECTIVE
  To determine evidence-based management strategies for work-relevant ULDs and explore whether a biopsychosocial approach is appropriate.
  
  
  METHODS
  Literature review using a best evidence synthesis. Data from articles identified through systematic searching of electronic databases and citation tracking were extracted into evidence tables. The information was synthesized into high-level evidence statements, which were ordered into themes covering classification/diagnosis, epidemiology, associations/risks and management/treatment, focusing on return to work or work retention and taking account of distinctions between non-specific complaints and specific diagnoses.
  
  
  RESULTS
  Neither biomedical treatment nor ergonomic workplace interventions alone offer an optimal solution; rather, multimodal interventions show considerable promise, particularly for occupational outcomes. Early return to work, or work retention, is an important goal for most cases and may be facilitated, where necessary, by transitional work arrangements. The emergent evidence indicates that successful management strategies require all the players to be on side and acting in a coordinated fashion; this requires engaging employers and workers to participate.
  
  
  CONCLUSIONS
  The biopsychosocial model applies: biological considerations should not be ignored, but psychosocial factors are more influential for occupational outcomes. Implementation of interventions that address the full range of psychosocial issues will require a cultural shift in the way the relationship between upper limb complaints and work is conceived and handled. Dissemination of evidence-based messages can contribute to the needed cultural shift.
authors.affiliation: Centre for Health and Social Care Research, University of Huddersfield, Huddersfield, UK. kim@spineresearch.org.uk
authors.forename: A Kim
authors.initials: AK
authors.lastname: Burton
authors.forename: Nicholas A S
authors.initials: NA
authors.lastname: Kendall
authors.forename: Brian G
authors.initials: BG
authors.lastname: Pearce
authors.forename: Lisa N
authors.initials: LN
authors.lastname: Birrell
authors.forename: L Christopher
authors.initials: LC
authors.lastname: Bainbridge
mesh_terms: D012090:Cumulative Trauma Disorders / Q000209:etiology / Q000523:psychology / Q000628:therapy; D019317:Evidence-Based Medicine; D006801:Humans; D009140:Musculoskeletal Diseases / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D009784:Occupational Diseases / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D034941:Upper Extremity