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)

Maria Melchior ^1*, Yves Roquelaure ², Bradley Evanoff ³, Jean-Francois Chastang ¹, Catherine Ha ⁴, Ellen Imbernon ⁵, Marcel Goldberg ¹ and Annette Leclerc ¹

¹ INSERM
² Faculté de Médecine, Angers
³ University of Washington
⁴ InVS
⁵ INVS

^* To whom correspondence should be addressed. E-mail: maria.melchior{at}st-maurice.inserm.fr.

Accepted 13 June 2006

Abstract

We investigated the reasons for the excess risk of upper limb musculoskeletal disorders among manual workers as compared to other workers in a random sample of 2 656 French workers (age 20-59) participating in a study on the prevalence of work-related upper limb disorders, launched by France’s National Institute of Health Surveillance. 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 vs. non-manual workers were calculated using Cox regression models with a constant time of follow-up and robust variance. 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. We calculated that under lower levels of physical work exposures, up to 31% of cases among manual workers could have prevented. Thus, 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.

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

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