Upper limb disorders

Employers must protect workers from the risks of developing upper limb disorders (ULDs) caused by work. Upper limb disorders include aches and pains in the shoulders, arms, wrists, hands and fingers, as well as in the neck. They can be caused or made worse by work, for example on assembly lines, in construction, meat or poultry processing and in work with computers.

Protect your workers

You must:

• do a risk assessment
• protect your workers from injury, for example from repetitive work
• protect your workers from the health risks of working with display screen equipment, such as PCs, laptops, tablets and smartphones
• protect your workers from exposure to vibration, for example from hand-held tools

Consult and involve your workers and make sure they know how to report any injuries.

Causes of upper limb disorders at work

Upper limb disorders are more common in tasks at work that involve:

• prolonged repetitive work, particularly using the same hand or arm action
• uncomfortable or awkward working postures
• sustained or excessive force
• carrying out a task for a long time without suitable rest breaks
• working with hand-held power tools for long periods of time

Other things that may have an influence are:

• a poor working environment (including temperature and lighting)
• poor work organisation (including workload, job demands and lack of breaks)
• individual differences and vulnerability (some workers are more affected by certain risks)

Workers may be more likely to suffer upper limb problems if there is more than one risk factor in their work.

Symptoms

Your workers may have symptoms in their upper limbs such as:

• aches and pains, tenderness, weakness, tingling, numbness, cramp, burning, redness and swelling
• stiffness, pain or reduced movement in their joints

A number of disorders can affect upper limbs, such as:

• carpal tunnel syndrome (CTS)
• tendonitis or tenosynovitis
• osteoarthritis
• cramp of the hand or forearm from prolonged periods of repetitive movement
• hand-arm vibration syndrome (HAVS)

Some of these are reportable.

Encourage workers to report any signs and symptoms at an early stage, before they become more serious, so you can take steps to reduce the risk. People with ULDs usually completely recover if the problem is recognised early and treated appropriately.

If your workers have symptoms, consider taking advice from an occupational health provider on a worker's fitness for work and any restrictions or adaptations to their work.

Assess the risk

As an employer, you have a duty to assess risks in your workplace:

• Look around your workplace to see which tasks may cause harm and why
• Decide how likely it is that people might be harmed
• Identify the factors that create a risk of harm and decide how to control them

Ask workers about any risks from their work - often they may be able to suggest solutions.

You can use HSE's simple filter to help you identify jobs with higher potential risks that are worth looking at in more detail.

Note that the 2-hour period in the filter is not a fixed limit and it should be applied taking account of the task and the person carrying it out. For example, if there is a lot of repetition and/or force required for a period shorter than 2 hours, or the worker has a medical condition affecting their neck or upper limbs, you should do a full risk assessment.

If the risk filter indicates you need to do a more detailed assessment, the Assessment of Repetitive Tasks tool (ART) lets you assess individual risk factors and prioritise your control measures using a colour-coding and scoring system. The scores provide clear action levels as a result of your assessment. However, the ART tool may not amount to a full risk assessment, as some aspects, such as individual factors, are not covered.

You can use HSE's ULDs risk assessment worksheets from Upper limb disorders in the workplace to carry out a more detailed assessment than the ART tool provides. The worksheets help you to analyse the risk factors in your workplace in more detail and include space to note down problems, causes and possible control options.

If items weigh more than 8 kg and the task involves manual handling, consider using the MAC tool (Manual handling assessment charts).

Psychosocial factors

As well as considering the physical aspects of the work, you also need to take account of psychosocial risk factors. These may affect workers' psychological responses to their work and workplace conditions. Examples are high workloads, tight deadlines and lack of control over the work and working methods, which may make people more likely to develop and report ULDs.

Reduce the risk of upper limb disorders

You may not be able to prevent all cases of upper limb disorders, but there are things you can do to help prevent symptoms happening or getting worse, whether they are caused by or made worse by work.

The most effective ways to avoid or reduce the risk are:

• consider the risks when designing new workstations or planning new tasks so that the risks can be planned out - it is cheaper than changing them later
• eliminate part or all of the task using, for example, automation or powered tools

If you cannot eliminate the risk:

• focus first on reducing the risk of the higher-risk activities or those that affect most workers
• make sure tools and equipment fit the workers' hands and are suitable for the task
• make sure workstations are at a suitable height for comfortable working (and that suitable chairs and footrests are provided). Consider adjustable workstations
• change the workstation layout to improve the posture of the workers, particularly when they are applying force
• reduce the amount of force, vibration, repetition and prolonged fixed postures
• reduce the length of time that operators do the same task, allowing regular changes in posture
• improve the working environment (cold temperatures and draughts can contribute to discomfort)

Test any changes on one or two workers before making changes for everyone and monitor regularly to make sure your controls are working.

There are more specific examples of how to reduce the risk.

If a task is causing or contributing to a ULD, the worker may need to stop doing that task for a while. Temporary modified duties could help them recover.

The NHS has evidence-based advice about upper limb disorders at work and there is other useful advice for workers.

The law

There are no specific regulations about managing the risks of upper limb disorders, but employers have legal duties under the Health and Safety at Work Act and the Management of Health and Safety at Work Regulations. The Health and Safety (Display Screen Equipment) Regulations and the Control of Vibration Regulations may also apply.