Work-related conditions

Health risks are common in the workplace and certain occupations are associated with medical conditions that can have a profound effect on individual health and work performance. Musculoskeletal conditions (e.g., tension neck syndrome, back injuries, shoulder injuries) are common among workers in the manufacturing and service industries (e.g., carpenters, factory workers, movers, office workers). Hearing conditions (e.g., noise-induced hearing loss, tinnitus) can be caused by occupational exposure to hazardous noise (e.g., construction work) and/or ototoxic chemicals (e.g., pharmaceutical manufacturing). Respiratory conditions (e.g., asthma, COPD) are associated with exposure to lung-damaging materials (e.g., silicone, asbestos, sawdust, paint) in occupations such as custodial work and construction work. Transmission of infectious diseases (e.g., tuberculosis, influenza, COVID-19) is a particular risk for health care workers. Work-related stress can have a profound negative impact on mental health and can exacerbate psychiatric conditions. Burnout syndrome, which is a reaction to chronic work-related stress, can have negative consequences for the individual worker (e.g., disability, unemployment, depression) and for the employer and economy.

A variety of occupations involve increased physical strain that can lead to damage of the musculoskeletal system. In the US, musculoskeletal conditions (MSCs) account for approximately 130 million health care visits per year. MSCs affect male workers more often than female workers.

• Tension neck syndrome: Repetitive strain injuries of the neck are typically associated with occupations that involve prolonged periods of static positioning during which the head is maintained in a forward and downward position (e.g., sitting in front of the computer or looking at a mobile device).
  • Risk factors include using office equipment and furniture that is not ergonomic and sedentary work.
  • Manifests with pain and/or discomfort in the neck and shoulder muscles
  • Preventive measures involve regular breaks, exercise, and use of ergonomic work equipment.
• Shoulder injuries: most commonly seen in occupations that require heavy overhead lifting (e.g., loading-unloading work) and in sports involving repetitive overhead activity (e.g., swimming, tennis, baseball)
  • Subacromial impingement syndrome
  • Rotator cuff tendinitis
  • Rotator cuff tear
  • Biceps tendon tear
  • Biceps tendinitis
  • Thoracic outlet syndrome
• Elbow injuries: most commonly seen in occupations that involve repetitive wrist movements and/or repetitive forearm supination-pronation
  • Lateral epicondylitis: associated with wrist extension and/or repetitive forearm supination-pronation with the elbow in near-complete extension (e.g., racket sports, gardening, sewing, office work)
  • Medial epicondylitis: associated with repetitive forearm flexion (e.g., golf, baseball, woodwork)
• Hand/wrist injuries
  • Carpal tunnel syndrome: associated with prolonged exposure to hand-transmitted vibration (e.g., construction) and awkward, repetitive wrist movements (e.g., data entry), strong handgrip (e.g., auto repair), and high pinch force (e.g., agricultural work)
  • Hand-arm vibration syndrome: a condition associated with prolonged exposure to hand-transmitted vibration (e.g., due to occupational use of vibrating power tools) ^[1]
    • Manifests with neurological symptoms (e.g., paresthesia, tingling, sensory loss), decreased grip strength due to hand muscle necrosis, and peripheral vasospasm
    • Complications: osteoporosis, joint damage
  • Hypothenar hammer syndrome: a rare condition involving ulnar artery aneurysm or thrombosis at Guyon canal
    • Manifests with pain over the hypothenar eminence, increased cold sensitivity, and ulnar nerve paresthesia
    • Associated with occupational use of vibrating tools (e.g., construction work, automotive repair) and sports involving vibration impact to the hand (e.g., baseball, mountain biking, volleyball)
• Back injuries
  • Degenerative disk disease: associated with sedentary jobs (e.g., office work, long-haul driving) and occupations that require heavy lifting, bending, and twisting ^[2]
  • Clay-shoveler's fracture ^[3]
    • Rare condition associated with work and/or activities involving rotation of the upper spine (e.g., use of wide shovels with long handles and tossing overhead)
    • Avulsion fracture of the spinous processes of the lower cervical and/or upper thoracic vertebrae (most commonly C6/C7)
  • Local cervical syndrome, cervicobrachial and cervicocephalic syndrome: associated with carrying heavy loads on the shoulder for a prolonged period of time
    • Local cervical syndrome manifests with position-dependent chronic neck pain, muscle spasms, and restriction of movement of the cervical spine.
    • Cervicobrachial syndrome is characterized by radiating pain originating in the C5- and C6-region of the cervical spine.
    • Cervicocephalic syndrome is caused by compression of the vertebral artery and irritation of the sympathetic nervous system, which leads to headaches and vertigo.
• Knee injuries: associated with work that involves kneeling for prolonged periods of time (e.g., carpentry), using ladders (e.g., roofing), and repeatedly walking up and down stairs (e.g., movers)
  • Meniscus tear
  • Anterior cruciate ligament injury
  • Posterior cruciate ligament injury
  • Osteoarthritis of the knee
• Other
  • Tendinitis: associated with repetitive movement of arms and/or legs (e.g., painters, construction workers, hairdressers)
  • Tenosynovitis: associated with repetitive bending and lifting (e.g., assembly line workers)
  • Arthritis: associated with repetitive and/or excessive strain on joints (e.g., truck drivers, textile workers)
  • Hernia: associated with heavy lifting (e.g., movers, construction workers)

Work-related hearing conditions can be caused by hazardous noise (≥ 85 dB) and/or ototoxic chemicals (e.g., solvents, metals, asphyxiants). In the US, approximately 22 million workers are exposed to hazardous noise annually, and about 10 million workers are exposed to ototoxic agents (e.g., from the manufacture of paint, pharmaceuticals, rubber, footwear). Occupational noise is a major cause of hearing loss in the US (approximately 24% of all cases). ^[4]

Noise-induced hearing loss (NIHL)

• Definition: hearing loss due to continuous exposure to sounds > 85 dB (e.g., during construction work, mining, welding) or a single exposure to sounds > 120 dB (e.g., gunshots, jet engines, fireworks)
• Pathophysiology
  • Repeated or constant exposure to noise > 85 dB → cumulative microtrauma and irreversible damage to the stereocilia of hair cells of the organ of Corti → sensorineural hearing loss
  • Sudden noise > 120 dB → tympanic membrane rupture → conductive hearing loss
• Clinical features
  • Slowly progressive hearing loss, beginning with loss of high-frequency hearing
  • Difficulty hearing in noisy, crowded environments
  • Difficulty hearing high-pitched voices (e.g., children's) occurs as the condition progresses.
• Treatment
  • There is no definitive treatment.
  • Hearing aids or cochlear implants
• Prevention: hearing protection (i.e., earplugs or earmuffs)

Tinnitus

See “Tinnitus” for more information.

Exposure to lung-damaging materials (e.g., silicone, asbestos, saw dust, paint) is a workplace hazard associated with respiratory conditions. In the US, about 2 million workers (e.g., custodial workers, construction workers, farmers) are affected by work-related asthma. Approximately 15% of all COPD cases are directly attributable to occupational hazards. Common work-related respiratory conditions include: ^[5]

• Allergic asthma
• COPD
• Pneumoconioses
• Hypersensitivity pneumonitis
• Bronchiolitis obliterans: a chronic disease of the small airways, usually caused by repeated cycles of inflammation and scarring
  • Chronic scarring causes obstructive lung disease.
  • Exposure to toxic fumes (e.g., nitrogen oxides) is the most common workplace-related cause; other causes include severe adenovirus pneumonia.
• Pulmonary fibrosis
• Gas toxicity
• Mesothelioma
• Lung cancer
• Inhalational anthrax
• Occupational asthma (OA) ^[6][7]
  • Definition: new-onset asthma or recurrence of quiescent asthma caused by exposure to an asthmogenic substance in the workplace
  • Epidemiology: The most commonly affected occupations include farmers, grain workers, and bakery workers.
  • Types
    • Sensitizer-induced (i.e., allergic): caused by exposure to high-molecular-weight (e.g., flour, animal proteins) and low-molecular-weight (e.g., diisocyanates) agents
    • Irritant-induced: due to acute inhalation injury or repeated exposure to the irritant agent (e.g., vapor, gas, fumes)
  • Clinical features: typical asthma symptoms that occur or worsen in a work environment with a potential for exposure to sensitizers/irritants and improve after work (see “Clinical features of asthma” for details)
  • Diagnostics: OA should be suspected in individuals with a history of symptoms that coincide with working in an environment where exposure to sensitizers/irritants may occur.
    • Perform skin prick test or allergy-specific IgE testing to identify the offending agent.
    • Confirm asthma with pulmonary function testing.
    • Serial peak expiratory flow rate (PEFR) monitoring at work and away from work: A decrease in PEFR associated with exposure to the offending agent confirms the diagnosis.
  • Treatment
    • Most important: eliminate or reduce exposure to offending agent (e.g., use of respiratory protective equipment)
    • For pharmacotherapy, see “Antiasthmatic medication.”
  • Complications: persistent bronchial hyperresponsiveness
  • Prevention
    • Primary: reducing or avoiding exposure by removing, replacing, or isolating the hazard
    • Secondary: medical surveillance programs at the workplace (e.g., regular spirometry) for early detection of OA in workers at risk

Transmission of infectious diseases occurs in occupations involving exposure to infectious patient material (e.g., in health care workers), animals and animal products (e.g., in veterinarians, poultry workers), parasitic vectors (e.g., in pest control), and environmental sources (e.g., in gardeners). Health care workers are especially at risk. Before the introduction of vaccination in 1982, the annual incidence of hepatitis B infection in US health care workers was approximately 9,000. Approximately 1% of health care workers in US hospitals have antibodies against the hepatitis C virus. ^[8]

• Definition: a reaction to chronic work-related stress that is not successfully managed and results in feelings of exhaustion, mental detachment from and cynicism or negativity toward one's job, and decreased work efficacy ^[10]
• Epidemiology: more commonly reported in female workers ^[11]
• Etiology
  • Risk factors ^[12]
    • Age < 55 years of age
    • Having a child < 21 years of age
    • Health care professions (see “Physician burnout” for details)
  • Exacerbating/precipitating factors
    • Excessive workload
    • Mismatch between work demands and resources
    • Lack of control over working circumstances and an inability to effect change
    • Inadequate organizational support structures
    • Unfavorable leadership culture
    • Moral injury
• Clinical features
  • Mild/moderate
    • Personal negativity
    • Difficulty concentrating
    • Tension headaches
    • Changes in appetite
    • Exhaustion and fatigue that do not improve with rest
    • Sleeping difficulties
  • Severe
    • Self-medication (e.g., with recreational drugs, cigarettes, alcohol)
    • Binge or comfort eating
    • Loss of interest, apathy, feelings of alienation in the workplace
    • Strong desire to leave the place of employment and/or occupation
    • Depression, suicidal ideation
• Diagnosis: evaluation to rule out underlying conditions (e.g., anxiety, depression)
• Differential diagnoses: adjustment disorder, stress-related disorders, anxiety disorders, depressive disorders
• Complications
  • For the affected individual: increased risk of unemployment, substance use, depression, disability, and suicide
  • For the employer: errors in the workplace, high employee turnover, reduced productivity
• Prevention and management ^[12][13]
  • Organization-focused strategies
    • Strategies to improve the workplace environment and directly address the causes of burnout are more effective than employee-focused strategies. ^[14]
    • Examples: reduction of workload (e.g., hiring more staff for clerical tasks), optimization of work processes and technology, employee engagement in establishing structures and targets, professional development opportunities, flexible working hours
  • Employee-focused strategies
    • Mindfulness training
    • Stress-management training
    • Communication skills training