Principles of management

• each discrete disorder of the upper limb is managed medically along conventional lines. Options include:
  • non-steroidal anti-inflammatory agents and analgesics
  • in many cases local corticosteroid injection, physiotherapy, local heat or pulsed ultrasound; splinting, and occasionally surgical decompression or release
• prognosis varies depending on diagnosis and management
  • from acute florid tenosynovitis (which settles quickly if thoroughly rested) through to epicondylitis (said to resolve in 8-12 months, but quite often lasting longer) and adhesive capsulitis (characteristically lasting 12-18 months)
• advice that should be given in relation to rest, rehabilitation and vocational alterations
  • traditionally advised measures to support a planned return to work (as well as primary prevention) include:
    • (i) job rotation, job enlargement, part-time working, or temporary job change - to provide respite from work involving repetitive monotonous use of the same muscles and tendons;
    • (ii) 'adequate' rest breaks (often advised as an alternative to (i), although little information exists on the length that the break should be);
    • (iii) task optimisation - that is, asking the employer and worker to think about the design and choice of equipment, tools, work layout and planning/throughput of tasks (often only a little thought is needed to reduce work effort and to avoid undesirable working postures. The HSE website provides useful guidelines - see www.hse.gov.uk);
    • (iv) a review of training - to ensure, likewise, that best working practices are being followed;
    • (v) permanent redeployment - if cases prove recalcitrant or recurrent, and the link with unavoidable work activity seems very strong
• many parties also advise rest from all work activities as an immediate temporary measure while the job plans referred to above are laid
  • advice seems appropriate for discrete disorders of the upper limb, where pathology and acute inflammation are evident, but less certain in relation to non-specific complaints
  • for non-specific low-back pain
    • randomised controlled trial evidence has shown that patients tend to fare better if encouraged to remain active within the limits of pain, rather than strictly resting

Reference:

• (1) ARC (October 2006). Work-Related Disorders of the Upper Limb.