Introduction Some evidence exits of an association between measures of occupational use of hand force and repetition and tendinitis of the wrist and epicondylitis of the elbow. However, these studies have often been limited by bias because of self-reported exposure and an outcome sensitive to time fluctuations.

Objectives To investigate occupational repetitive movements and the use of hand force as causes of distal upper extremities musculoskeletal disorders (D-UEMSD).

Methods A cohort of 202,735 workers in a private pension health scheme from 2005 to 2017 in one of 17 jobs (e.g. office work, carpentry, cleaning) was formed. Representative electro-goniometric measurements of wrist angular velocity as a measure for repetition and expert-rated use of hand force were used as exposures. Job titles were retrieved from the Danish Occupational Cohort with eXposure data (DOC*X) database. Outcome was first treatment for D-UEMSD. In a Poisson regression model, the incidence rate ratios (IRRs) of D-UEMSD were adjusted for age, calendar-year, diagnosis of rheumatoid arthritis and arm fractures. In further analyses, wrist velocity or hand force was added.

Results In men, wrist velocity had an IRR of 1.48 (95%CI 1.15–1.91) when the highest exposure level was compared to the lowest but with no clear exposure-response pattern. The effect became insignificant when adjusted for hand force. Hand force had an IRR of 2.65 (95%CI 2.13–3.29) for the highest vs. the lowest exposure with an exposure-response pattern, which remained after adjustment for wrist velocity. Among women, no increased risk was found for hand force, while wrist velocity showed a significantly protective association with D-UEMSD.

Conclusions In men, occupational exposure to hand force more than doubled the risk of seeking treatment for D-UEMSD. The results for exposure to repetition were less clear. In women, we could not find any indications of an increased risk neither for force nor repetition.