Musculoskeletal disorders of the upper extremity associated with computer work: A systematic review

The epidemiological literature is critically reviewed to evaluate the evidence supporting a causal relationship between computer work and musculoskeletal symptoms and disorders (MSDs) of the hand, wrist, forearm, and elbow. Since 1990, 33 publications were found that met the selection criteria - 11 were prospective in design and 22 were cross-sectional. All prospective studies that measured extent of computer use found a positive association between computer work and upper extremity musculoskeletal symptoms. The two prospective studies to conduct physical examinations both found a relationship between hours of computer use and increased risk of upper extremity diagnoses. Of the 22 cross-sectional studies, 17 studies found positive associations. Two of the five studies reporting no association found increased risks of certain disorders under certain combinations of computer use and other factors. The remaining three studies were limited by either a small sample size or low variation of computer use hours within the study population. We conclude that there is consistent evidence of a positive relationship across numerous prospective and cross-sectional studies with increased risk most pronounced beyond 20 hours/week of computer use or with increasing years of computer work. The disorders confirmed with physical examinations are wrist tendonitis and tenosynovitis, medial and lateral epicondylitis, and DeQuervain's tenosynovitis. The risk of carpal tunnel syndrome is increased with use of a computer, especially with mouse use for more than 20 hours per week.