Information on Upper Limb Disorder (ULD)
- Suggested steps
- Useful links to further information
- Other useful references or other resources
Work-Related Upper Limb Disorders, or ULDs, is the name given to a group of clinical conditions affecting the upper limb such as Tenosynovitis, Carpal Tunnel Syndrome (CTS) and Tennis Elbow. At one time they were known as Repetitive Strain Injuries (RSI). Now they are called ULDs because it is recognised that repetition is only part of the problem, other factors are important as well. However, some doctors and others still use the term RSI, often for aches and pains that don't fit into the clinical categories.
ULDs are not necessarily caused by work. For example, CTS can be due to a hormone imbalance, particularly in females. However, many jobs carry a slight risk that people doing them will develop aches or pains in part of the arm or shoulder. If untreated, and continually aggravated, these aches can develop into a ULD. The exact cause of many ULDs is not clearly known. But it is known, in general, that there are three factors which can provoke or cause them:
- The first is the posture of the arm or the angle at which it is held. For example, the wrist works best with the hand and arm in a reasonably straight line. If it is twisted, rotated or bent this will increase the strain on the tendons and nerves which pass through the wrist to the hand.
- The second factor is the force or tension which is created in nerves and tendons. Directly applying a force, in activities such as folding boxes or twisting wires can cause this. Or, alternatively, the force may be created using tools such as pliers, scissors or knives.
- The third factor is how long a force is applied or how often the action is carried out.
- Additionally, the way that work is organised and managed can also be a factor in causing ULDs or making them worse.
The three factors are interlinked: the more awkward the posture, the lower the force or tension which can be easily and safely withstood. The more strain that is generated by an action the less often it can be held or repeated without causing problems.
- Although at present there is no specific legislation relating to ULDs they are one of the risks covered in computer work by the DSE (Display Screen Equipment) Regulations. These risks should be identified through DSE assessments (see related DSE guidance note).
- In industrial workplaces, the risks associated with ULDs should be identified through general risk assessments under the provisions of the Management of Health and Safety at Work Regulations. The HSE publication HSG60(Rev) gives a comprehensive guide to ULDs and provides a 'risk filter' which can be used to see if a full assessment is necessary. This asks about:
- Signs and symptoms amongst the workforce
- Repetitive activities
- Working postures
- Levels of manual force
- Vibration exposure
- Take steps to reduce risks found; simple and low cost changes can often be effective, as described in HSE guidance booklets.
- Where necessary, seek ergonomic advice on work and workplaces : In many cases, awkward postures, forces or repetitive movements are part of what people do as their job. Identifying these and helping to put them right is part of the science of ergonomics. Ergonomists help to study the work, point out where actions may create too much strain, and work with engineers and others responsible for designing work to try to remove or reduce the problems.
- Provide suitable education and training: training in good techniques and education to explain the reasons for these techniques, to ensure that all staff, at whatever level, recognise and appreciate the risks. This includes information on the correct way to carry out the job so that employees take care to follow the proper procedures, to use tools or equipment correctly, avoiding bad habits.
- Managers need to see that organisational factors and production pressures (e.g. targets, bonuses, etc). do not encourage actions which may carry a risk. If the correct way of doing something is unavoidably slower, then this must be taken into account.
- Encourage early reporting of symptoms by workers and make arrangements for the proper treatment and rehabilitation of ULD cases.
HSE site where general information and advice is provided about work in an office environment
HSE site on musculoskeletal disorders
The UK Ergonomics Society Site. With a list of registered consultancies who may be able to help you.www.hse.gov.uk/pubns/indg171.pdf)
(A useful leaflet, available on-line or in print, outlining some issues and considerations that may be linked to upper limb disorders in the workplace together with some useful guidance.)