Work-related upper limb disorders (WRULDs) – a time to be concerned?

As HSE statistics reveal that half a million workers are suffering from new or longstanding musculoskeletal disorders and with over six million working days lost each year, the subject of upper limb disorders in the workplace is arguably as relevant today as it was thirty-five years ago. In this short series of articles, we will consider:

• The historical development of legislation to protect both blue- and white-collar employees and the litigation experience of the 1990s.
• The interplay between psychosocial factors and upper limb disorders.
• With the current proliferation of technology and increased working from home, whether this will result in a spike in new claims and how best in these circumstances, employers should protect themselves.

WRULDs are often referred to by the inaccurate and misleading sobriquet, “RSI” or “Repetitive Strain Injuries”.

Brian Pearce, ergonomist, writing for the publication “Tort Litigation” in 1998 (Authors MacDonald and Georges) grouped upper limb disorders in anatomical terms as follows:

Tendon disorders: 

Tendonitis, Tenosynovitis, De Quervain Tenosynovitis, Trigger Finger, Tennis and Golfers elbow.

Nerve disorders: 

Carpal Tunnel Syndrome, Reflex Sympathetic Dystrophy and Cubital Tunnel Syndrome.

Muscle disorders: 

Myalgia, Writer’s Cramp.

Whilst all these conditions have the potential to be caused or exacerbated by work, similarly, all may develop either idiopathically, through constitutional susceptibility or through activities undertaken outside the workplace.

Guidance and legislation 

The first guidance provided by The Health and Safety Executive (HSE), on upper limb conditions was the document MS10, published in 1977, “Beat conditions/Tenosynovitis”. The document referenced

“rapid, repetitive, twisting and gripping movements are common to certain industries”. 

The examples of occupations deemed ‘at risk’ of workers developing tenosynovitis included “pottery glaze dipping, brick making, assembly line work and the trussing of chickens”.

MS10 received very little attention at the time and its focus was entirely on blue collar industries. Technological advances in the late 1970’s and early 1980’s saw a growth in data inputting work, often using primitive computers/keyboards, particularly in the banking/financial sectors, with clerks employed solely to input tens of thousands of pieces of data via a keyboard on a daily basis.

This prompted the HSE to turn its attention and provide guidance to white collar workers through the document “Visual Display Units”, which was published in 1983.

1990 saw the publication of “Work Related Upper Limb Disorders – A Guide to Prevention” by the HSE. This guidance required an employer to assess whether the work gave rise to a foreseeable risk of an upper limb disorder developing.

In order to assess the risk, employers were asked to consider whether the work entailed the use of (undesirable) force, posture (awkward twisting and gripping movements) and repetition. The guidance provided no “cliff edge” definition of what constituted a foreseeable risk – simply acknowledging that for the risk to be foreseeable, the task or activity would “usually” have two of the factors featured, but it was not mandatory - a foreseeable risk could still be present even if only one factor was present. No definition of repetition was provided in the guidance.

This document was replaced in 2002 by “Upper Limb Disorders in the Workplace”, which included the added risk factors duration of exposure, working environment and psychosocial factors – the first recognition that a worker’s psychological response to work and workplace conditions has an important influence on health in general and in musculoskeletal health in particular.

Further guidance to white collar workers was provided by the Display Screen Equipment Regulations of 1992 (as amended), whose content may be summarized below:

firstly, the Regulations only applied to those who use computers/keyboards for continuous periods of an hour or more. The duties imposed on the employer were to:

Analyse workstations to assess and reduce risks.

• Make sure controls are in place – eg enforcing rest/screen breaks.
• Provide information and training.
• Provide eye tests on request.
• Review assessments when the user or DSE changes.

The known health risks were recorded to be “fatigue, eye strain, upper limb problems and backache”.

The Australian Phenomenon or “Kangaroo’s Paw”

The late 1980s and early 1990s saw, on the part of unions and certain elements of the media, the promotion in the UK of what was often referred to as “RSI” or Repetitive Strain Injury.

This was through a series of mostly first instance court cases and journalists sympathetic to the cause – perhaps reflective of the fact that both the Financial Times and the Reuters News Agency were themselves the recipients of “RSI ” claims and litigation from journalists and newsroom staff.

Several Press articles referred to the likelihood or probability of a future ‘epidemic’ of claims. In 1994, The Law Society Gazette reported that the TUC had estimated the future cost to employers and insurers in compensation would amount to £500 million (The Gazette 11^th May 1994). 

Others saw this as an imported disease - in recognition that ‘RSI’, was high profile in Australia and in the early to mid-1980’s had attracted several thousand personal injury lawsuits. The late Auberon Waugh, famously writing in The Spectator Magazine (15 November 1986), in an article entitled

 “Introducing Kangaroo’s Paw – A wonderful new disease from Australia”: 

“I prophecy a tremendous future for this wanker’s disease in Britain – as soon as a few

 more people learn about it, it will go through the country like a dose of salts”.

The Australian RSI epidemic largely disappeared following the Government’s successful defence of a test case in Melbourne in 1987, (Cooper v The Commonwealth of Australia). The Australian experience was later described by M Awerbeck (“RSI – has the Australian epidemic burnt out?” – (2004)) in these terms: ‘this was not an epidemic of recognizable disorders but an epidemic of non-specific or diffuse arm pain’.

Key litigation 

Initially, litigation was split between both blue- and white-collar employments. The court awarded the claimant, Inskip, over £59,000 in damages for her claim against Vauxhall Motors after she was forced to take early retirement by reason of loading 500 heavy gear wheels onto a machine each working day.

The growth of data inputting in the late 1980’s and early 1990’s led to several claims against banks and other financial institutions – most notably Alexander and others v Midland Bank, where five test case claimants recovered damages from their employer for fibromyalgia accepted to have arisen from the encoding of data - in the context of high numbers of keystrokes, strict deadlines and a “no talking” rule in the office .

here were signs, however, that by 1993, employers (and their insurers), were tackling the issue of RSI or non-diffuse arm pain head-on. 

Firstly, Judge Prosser in Mughal v Reuters (1993), expressed the view (one that has been followed now for several decades) that for clinicians “the correct and logical approach is to define the disorder and then consider causation”. He cautioned against the glib use of terms such as RSI, Repetitive Strain Syndrome or RSD (Reflex Sympathetic Dystrophy). The judgment prompted several headlines (some more accurate than others), which included “RSI does not exist – Judge”.

The claimant’s medical expert in Mughal emerged from the litigation with little credit and consequently in the months and years that followed, large scale litigation against many orchestras, where he was leading the expert evidence, were quietly discontinued.

In the same year, Judge Mellor sitting in Norwich County Court, heard nine representative cases against a local employer – Bernard Matthews (Mountenay and others v Bernard Matthews (1993)). Although six of the none cases were successful from the claimants’ perspective, the damages award totalled only £21,000 and importantly, only those whom the judge considered to have “clinically diagnosable upper limb disorders” were successful at trial.

Following these two important pieces of litigation the prospect of the UK being battered by the Australian experience of “Kangaroo’s Paw” and compensation totaling £500 million did not eventuate.

In our next article, we consider how psychosocial factors impact upper limb disorders.