WORK-RELATED UPPER LIMB DISORDERS STATISTICS INFORMATION SHEET LAST UPDATED JANUARY 2000
INTRODUCTION
Musculoskeletal disorders are by far the most common form of work-related ill-health problem in Great Britain. They can prove costly for the individual, the business and health service providers. This information sheet cites epidemiological evidence regarding the prevalence and economic impact of musculoskeletal disorders affecting the upper limbs or neck.
Much of the information for this fact sheet derives from two surveys conducted by HSE in 19902 and 19951. It is strongly recommended that those interested in the data presented below read the two publications from these surveys that will provide further information of relevance and put the data in context.
Since the publication of the results from the 1995 survey, revisions have been made to the number of working days lost due to illnesses caused by work. An information sheet3 giving detailed information of the revised data can be obtained from HSE's Epidemiology and Medical Statistics Unit.
Details of other sources of statistics quoted in this fact sheet can be found in the latest edition of HSE's publication: "Health and Safety Statistics".
STATISTICAL INFORMATION
Prevalence
Data taken from "Self-reported Work-related Illness in 1995 - Results from a Household Survey1" (SWI95), suggested that musculoskeletal disorders were by far the most commonly reported work-related illness in this survey. The SWI95 survey estimates that over one million people in Great Britain were suffering from a musculoskeletal disorder caused by work.
Of the estimated number of individuals suffering from a musculoskeletal disorder caused by work, 44% were suffering from a condition that affected the upper limb or neck area of the body, an estimated 506 000 people. Nearly three quarters of these had a condition which only affected their upper limb or neck, an estimated 375 000 people, and just over one quarter a disorder affecting only their neck, an estimated 132 000.
The above prevalence estimates include the diseases: carpal tunnel syndrome; frozen shoulder; tenosynovitis; "RSI"; tennis elbow and golfer's elbow.
One quarter of respondents with a musculoskeletal disorder affecting the upper limb or neck reported an arthritic condition and the majority of respondents reporting spondylosis in the survey described their condition as affecting their neck, fewer respondents reported that the condition affected their back.
Incidence
In the SWI95 survey almost half of the respondents reporting a condition affecting the upper limb or neck area had been suffering for at least 5 years, nearly one fifth of respondents, an estimated 91,000 people first became aware of their condition in the last 12 months.
A second source of incidence statistics is the Industrial Injuries Scheme (IIS) administered by the DSS. Only a limited number of specifically work-related musculoskeletal disorders are prescribed under IIS. For upper limbs these are: beat hand; beat elbow; cramp of the hand or forearm and inflammation of the hand; forearm or associated tendon sheaths (tenosynovitis). In 1997/98 there were 514 new cases diagnosed as having some degree - if only minimal - of disablement due to a prescribed musculoskeletal disorder affecting the upper limbs4 . Carpal tunnel syndrome caused by hand-held vibrating tools is also a prescribed disease, in 1997/98 400 new cases were assessed.
A third source of incidence statistics is the OPRA and MOSS surveillance schemes4 run by Manchester University. Occupational physicians have been reporting work-related musculoskeletal disorders, along with other types of occupational disease, to OPRA since 1996 and rheumatologists have been reporting work-related musculoskeletal disorders to MOSS since October 1997. An estimated 3314 new cases of upper limb disorders (including hand/arm/wrist, elbow and shoulder) were seen by participating occupational physicians in 1998. This includes 605 new cases (all males) of hand-arm vibration syndrome (HAVS) and vibration white finger (VWF). A further 1596 new cases were seen by rheumatologists participating in the MOSS scheme, in the same period. This estimate also includes 84 new cases of HAVS and VWF.
Another source of statistics is from RIDDOR4 . From April 1996, the musculoskeletal disorders which are included in the DSS list of prescribed diseases became reportable diseases under RIDDOR. In 1998/99 there were 628 new cases of musculoskeletal disorders affecting the upper limbs reported and 101 new cases of carpal tunnel syndrome caused by hand-held vibrating tools. However, comparisons with other data sources eg OPRA, MOSS suggest substantial under reporting, as with other diseases reportable under RIDDOR.
Trends
Comparisons between the prevalence estimates reported in the 1990 survey (SWI90) and the 1995 survey (SWI95) indicates that the overall unadjusted prevalence for all work-related illnesses in England and Wales was very similar between the two surveys. However, the relative proportion of work-related musculoskeletal disorders was higher in the 1995 survey. This increase may be largely related to methodological differences between the surveys and an increased awareness of occupational musculoskeletal complaints.
The number of new cases assessed for disablement benefit due to a prescribed disease affecting the upper limbs reached a peak in 1992/93 (1081 new cases), and has decreased each year since then. This figure does not include carpal tunnel syndrome which only became a prescribed disease in 1993. Much of the increase can be attributed to increased awareness of the possible work-related nature of these conditions.
The estimated number of new cases of work-related musculoskeletal disorders affecting the upper limbs reported to OPRA by occupational physicians between 1996 and 1997 fell from 2748 to 2018 but rose to 3314 in 1998.
Age and Sex Distribution
The SWI95 survey reported that the average prevalence rate for musculoskeletal disorders affecting the upper limbs or neck was nearly a fifth higher for females than for males (1.3% of females and 1.1% of males who have ever worked). For both males and females prevalence rates were highest in the older working age group (age 45 to retirement), 1.9% of males and 2.7% of females who have ever worked.
The number of new cases of work-related musculoskeletal disorders affecting the upper limbs, reported to OPRA and MOSS in 1998, was 2540 for females and 2370 for males. For both males and females the most frequently reported diagnostic site was hand/wrist/arm with females reporting 1796 cases and males reporting 1647 cases, in 1998.
Occupational Distribution
In the SWI95 survey occupational rates were produced for individuals who ascribed their illness to their current or most recent job. Occupations with the highest rates for musculoskeletal disorders affecting the upper limbs or neck were: 'armed forces'; 'construction'; 'textile processing' and 'other processing'. Over 2% of those currently or recently working in these occupations were suffering from a musculoskeletal disorder affecting the upper limb or neck caused by work.
Occupations with the highest annual rates (estimated cases per million employed per year) of work-related musculoskeletal disorders affecting the upper limbs reported to OPRA by occupational physicians between 1997 and 1998 were 'metal dressing operatives', 'road construction and maintenance workers' and 'assemblers/line workers (vehicles and other metal goods)' and those reported by rheumatologists in 1998 were 'Computer operators, data processing operators, other office machine operators'; and 'Typists and word processor operators'.
Contributing Factors
Respondents to the SWI95 survey were asked their opinion of what caused (at work) the condition which affected their upper limbs or neck, 38% of people thought that repetitive work or typing was the cause, 37% suggested manual handling and 27% believed the posture they adopt at work caused the problem.
Days off work
The revised economic impact figures3 from the SWI95 survey provided an estimate of 4.2 million working days lost in Britain in 1995 due to a musculoskeletal disorder affecting the upper limbs or neck, caused by work. On average this survey estimated that each sufferer took 13 days off work in 1995 because of their complaint.
Cost to employers
Calculations based on a recent HSE report5 have estimated that musculoskeletal disorders affecting the upper limbs or neck caused by work cost employers between £208 million and £221 million (1995/96 prices). The costs, which have been estimated using results from SWI95, are based on a number of assumptions and are only intended to be broadly indicative.
References cited
1. Self-reported work-related illness in 1995, Jones et al. HSE Books (1998), ISBN 0071761509X.
2. Self-reported work-related illness- Results from a trailer questionnaire on the 1990 Labour Force Survey in England and Wales, Hodgson et al. HSE Books (1993), ISBN 0717606074.
3. Information sheet 2/99/EMSU Economic Impact: Revised data from the self-reported work-related illness survey in 1995 (SWI95) to obtain a copy phone 0151 951 3051.
4. Health and Safety Statistics 1998/99 HSE Books (1999), ISBN 0717617165.
5. The costs to Britain of workplace accidents and work-related ill health in 1995/96. HSE Books, ISBN 0717617092.
FURTHER INFORMATION
Some other HSE publications on Upper Limb Disorders
Work Related Upper Limb Disorders in the Clothing Industry. Report on Special Project (National). HSE Field Operations Division 1994
Upper Limb Disorders: Assessing the Risks. HSE Books 1996, ISBN 0717607518.
Work Related Upper Limb Disorders. A Guide to Prevention. HSE. HMSO 1990. ISBN 0717604756
Upper Limb Disorders (ULDs) - Summary and Action Programme. HSE and the Industrial Relations Service, London, 1993
Work Related Upper Limb Disorders in the Printing Industries. Health and Safety Commission. Printing Industry Advisory Committee. HSE, 1994.
A pain in your workplace. HSE Books, ISBN 0-7176-0668-6.
Some other information sources
Upper Limb Musculoskeletal Disorders in Highly Repetitive Industries : Precise Anatomical Findings. Ranney, D. Ergonomics, July 1995. Vol 38, No 7, 1408-1423.
The Ergonomics Society web site provides links with other sources of information and can be found at : http://www.ergonomics.org.uk/
Sources of Information
All HSE publications are available through HSE books, PO Box 1999, Sudbury, Suffolk, CO10 6FS. Tel: 01787 881165 or Fax: 01787 313995.
Health and Safety enquiries: HSE Infoline Tel: 0541 545500.
Details of any additional sector specific surveys may be identified by approaching the appropriate trade association and or trade union.
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