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Pain in the upper limb is common in repetitive work, perhaps because of physical factors but also, potentially, through psychological mechanisms that evoke physiological responses or modify perceptions and disability behaviour. Bonde et al1 have examined the hypothesis that a direct pathway extends from physical stresses through to psychological reaction. They reason that in this case shorter task cycle times and highly repetitive movements should predict the onset of stress related symptoms. In fact, they failed to find this when a cohort of 2846 workers were followed up over three years and repeatedly assessed using a stress inventory. A particular strength of the study was the careful quantification of physical exposures using video recordings. This enabled estimates to be made of cycle times, periods in which repetitive work was performed, and the frequency of wrist movements. The odds ratios in high versus low exposure categories were close to unity (both
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Palmer, K, Loomis, D
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