Work-relatedness of lateral epicondylitis: Systematic review including meta-analysis and GRADE work-relatedness of lateral epicondylitis

S Fransje Bretschneider, Felicia S Los, Denise Eygendaal, P Paul F M Kuijer, Henk F van der Molen, S Fransje Bretschneider, Felicia S Los, Denise Eygendaal, P Paul F M Kuijer, Henk F van der Molen

Abstract

Background: Lateral epicondylitis (LE) is a highly prevalent musculoskeletal disorder in workers, often associated with physically demanding work. Knowledge of work-relatedness of LE is crucial to develop appropriate preventive measures. This study investigates the prospective association between work-related physical risk factors and LE.

Methods: A systematic literature review was conducted in MedLine using PubMed from January 1, 2010 until February 16, 2021. Published reports were included if: (1) LE was clinically assessed, (2) exposure to work-related physical risk factors was assessed, and (3) associations between LE and work-related physical risk factors were reported in prospective studies. Quality of evidence was assessed using the Grading of Recommendations, Assessment, Development and Evaluation.

Results: In total, 318 workers with LE from a population of 5036 workers in five studies were included. Meta-analyses revealed high-quality evidence for associations between LE and a Strain Index (SI) score >5.1 (odds ratio [OR]: 1.75, 95% confidence interval (CI): 1.11-2.78) and moderate-quality evidence for forearm rotation >4 h/day or forearm rotation ≥45° for ≥45% time (OR: 1.85, 95% CI: 1.10-3.10). Gripping, flexion and extension of the wrist, and repetitive movements showed no significant associations with LE.

Conclusion: High-quality evidence was found indicating that a higher SI increased the risk of LE. Moderate-quality evidence was found for an association between forearm rotation and LE. No associations were found between other physical risk factors and LE. Primary preventive interventions should focus on a reduction of the SI and of high forearm rotation in work.

Keywords: elbow tendinopathy; lateral epicondylitis; occupational disease; occupational exposures; occupational physician; physical risk factors; prevention; tennis elbow; workers' health.

Conflict of interest statement

The authors declare that there are no conflicts of interest.

© 2021 The Authors. American Journal of Industrial Medicine Published by Wiley Periodicals LLC.

Figures

Figure 1
Figure 1
Flow diagram of included studies [Color figure can be viewed at wileyonlinelibrary.com]
Figure 2
Figure 2
Forest plots of the five work‐related physical risk factors for developing lateral epicondylitis [Color figure can be viewed at wileyonlinelibrary.com]

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Source: PubMed

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