Occup Environ Med 63:754-761 doi:10.1136/oem.2005.025122
  • 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)

  1. M Melchior1,
  2. Y Roquelaure2,3,
  3. B Evanoff4,
  4. J-F Chastang1,
  5. C Ha2,
  6. E Imbernon2,
  7. M Goldberg1,2,
  8. A Leclerc1,
  9. and the Pays de la Loire Study Group
  1. 1U687-IFR69, INSERM (National Institute of Health Research) Saint-Maurice, France
  2. 2Department of Work and Health, InVS (National Institute of Health Surveillance), France
  3. 3Faculty of Medicine, Angers, France
  4. 4Washington University School of Medicine, WA, USA
  1. Correspondence to:
 Dr M Melchior
 INSERM U687, HNSM, 14 rue du Val d’Osne, 94415 Saint-Maurice Cédex, France
  • Accepted 13 June 2006
  • Published Online First 20 June 2006


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.


  • Published Online First 20 June 2006