Distal upper limb disorders and ergonomics of VDU work: a review of the epidemiological evidence

Abstract

A review is presented of epidemiological peer-reviewed publications that relate the mechanical

exposure of the arm in work with visual display units (VDU) to musculoskeletal disorders of the upper

limb. The twenty included studies were divided into those with (1-7) and without (8-21) use of physical

examination in the definition of cases. The main conclusion of this review is the documentation of

evidence for the VDU work per se, none or insufficient lower arm support and non-neutral positions of

the wrist as predictors of distal upper limb disorders (DULDs). These findings are based solely on

studies that use physical examination or objective signs to define the DULDs, and the conclusions are

not changed after inclusion of studies based only on self-reported symptoms. When the last category of

studies is included as documentation in the review, the amount of VDU work (and an exposuredose/

effect relationship) will also be documented as predictors. The referred studies indicated that not

only the VDU work per se, but also (and in particular) VDU work for more than 20 hours per week

combined with limited opportunity for rest breaks and without lower arm support is a predictor of

DULDs. Another conclusion is that critical reviews may benefit from use of

both strict criteria and less

strict criteria for inclusion of studies, to optimize the conclusions drawn from existing documentation.