Clinical assessment, prognosis and return to work with reference to work related neck and upper limb disorders.

Objectives: To describe the clinical assessment and management of work related neck and upper limb disorders.

Methods: A total of 65 references in English were found in Pub Med for the years 1980-2002 that dealt with clinical assessment, prognosis and return to work with reference to neck and upper limb original research that dealt with test performance in diagnostic procedures. Few studies were randomised studies of prognosis and return to work with reference to neck and upper limb disorders.

Results: The clinical assessment consists of the clinical and exposure history, the evaluation of the physical and laboratory findings. The physical examination should include the following steps: (1) inspection; (2) testing for range of motion (3) testing for muscle contraction pain and muscle strength (4) palpation of muscle tendons and insertions and (5) specific tests. The characteristics of clinical tests in terms of likelihood ratio for confirming and ruling out disease have to be considered for the diagnosis. The use of terms such as RSI (repetitive strain injuries) and CTD (cumulative trauma disorders) should be avoided. If the different musculoskeletal symptoms and signs do not completely comply with criteria for a disease, it is recommended to choose an ICD (International Classification of Disease) label that focuses on the symptoms rather than the pathology. The prognosis for most work related disorders are variable. The general experience is for non-specific neck and upper arm that pain and discomfort may be decreased but not eliminated in the majority of cases. It is important to start rehabilitation early. Long periods of sick leave are generally counterproductive. Disputed workers' compensation claims and an adverse work setting also are likely to impede successful rehabilitation. Since most patients with musculoskeletal disorders are also exposed to ergonomic stressors accommodation of the injured worker has to take the whole work system into account (task, technology, environment and organization).

Conclusions: Despite the large number of patients with neck and upper limb disorders the scientific evidence for clinical assessment, to determine the prognosis and for successful procedures for return to work are few.