A framework for the classification and diagnosis of work-related upper extremity conditions: systematic review

Abstract

Objective: A frequently cited problem in epidemiological research is the inadequate operational definition of umbrella terms such as Musculoskeletal Disorders (MSD). Specific conditions attached to these labels and their corresponding signs and symptoms are also poorly defined. The purpose of this study was to identify internationally applied terminology and definitions appropriate to work-related upper extremity (UE) conditions.

Methods: An extensive literature search of 15 electronic databases supplemented by personal communications with representatives from national and international health and safety organizations was undertaken to identify recognized terminology and definitions appropriate to work-related UE conditions.

Results: Information specific to the umbrella terms and their corresponding conditions was obtained from 15 countries. The findings revealed a lack of international consensus over appropriate terminology to encapsulate the wide range of conditions falling within the umbrella terms used by these countries. UE conditions could be classified into 3 broad categories: (1) 14 "specific conditions" with evidence-based diagnostic criteria; (2) 34 "other specific conditions" with no clearly defined diagnosis; and (3) "nonspecific conditions" requiring a clear pattern of signs and symptoms to be present for a diagnosis to be made. A dynamic model for classifying work-related UE conditions is proposed which places greater emphasis on specific diagnosis.

Conclusions: A systematic approach to the classification and diagnosis of work-related UE conditions is attractive, as it is likely to lead to more precise estimates of the prevalence and cost of UE conditions, as well as improved quality of information on the efficacy of medical and workplace interventions.