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Occupational Exposures and Neck and Upper Extremity Disorders

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SBU Assessment

Presents a comprehensive, systematic assessment of available scientific evidence for effects on health, social welfare or disability. Full assessments include economic, social and ethical impact analyses. Assessment teams include professional practitioners and academics. Before publication the report is reviewed by external experts, and scientific conclusions approved by the SBU Board of Directors.

Published: Report no: 210

SBU’s Conclusions

  • The scientific evidence suggests that the following exposures involve risks for disorders and diseases in the:
    • neck/shoulders – work involving bending/twisting the torso, heavy work (lifting, carrying, pushing, pulling), highly demanding work, little control, narrow parameters
    • for decision making, or a combination of highly demanding work and little control
    • shoulders – heavy work (lifting, carrying, pushing, pulling), long-term use of computer mouse
    • elbows and forearms – heavy work (lifting, carrying, pushing, pulling), repetitive work, long-term use of computer mouse
    • wrists and hands – biomechanical load (combination of repetitive hand motion and force).
  • The associations reported in other systematic reviews that relate problems in the neck/shoulders to working with arms raised above shoulder height or repetitive work were not found – nor were the reported associations between carpal tunnel syndrome and repetitive or heavy work. SBU found the evidence to be insufficient to draw such conclusions. A probable explanation is that the SBU review requires studies to meet different inclusion and design criteria. The SBU report does not include cross-sectional studies, while other systematic reviews are based mainly on that type of study. Cross-sectional studies may provide information about associations, but cannot reliably answer questions of whether the problems are attributed to the work per se, or other factors. SBU’s conclusion that current evidence is insufficient does not rule out the possibility of a causal association, but further research that follows subjects over time is required.
  • We found no studies of sufficient quality that addressed the causes of generalised pain, multilocalised pain*, or pain in the neck, shoulders, and arms.
  • To identify risks and effective preventive interventions, several areas are in need of further research of high scientific quality (studies with well-defined exposures and outcomes, objective methods for measuring exposures and outcomes, longitudinal measurements, and sufficient differences in exposures).

* Pain in at least three regions of the neck, shoulders, elbows, hands, thoracic spine, lumbar spine, hips, knees, or feet, where at least one of the regions includes the neck and upper musculoskeletal system.

How to cite this report: SBU. Occupational Exposures and Neck and Upper Extremity Disorders. Stockholm: Swedish Council on Health Technology Assessment (SBU); 2012. SBU report no 210 (in Swedish).

Project group


  • Christer Edling (Chair)
  • Maria Feychting
  • Johan Hallqvist
  • Catarina Nordander
  • Jorma Styf
  • Kjell Torén
  • Ewa Wigaeus Tornqvist


  • Anders Norlund (Project Director)
  • Elisabeth Källgren (Project Assistant), until December 2009
  • Jonas Lindblom (Literature search)
  • Maria Skogholm (Project Assistant), from January 2010

Other authors

Lena Holm (Chapter 4.5)

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