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INTRODUCTION

Successful management of work-attributed musculoskeletal conditions requires the clinician to be knowledgeable about the injury as well as the individual's occupation, essential job functions, and environment. This chapter will provide an overview of specific musculoskeletal conditions attributed to performing job-related tasks. We will also discuss the return to work process as it relates to workers’ compensation and disability determination in the setting of fitness-for-duty and own-occupational disability. Of note, many of the traditional occupations and associated job functions that have historically been associated with work-attributable musculoskeletal disorders have diminished secondary to advances in automation and engineering in the developed world and, in certain cases, this work has shifted to other workforces globally.

The US Workforce

The US civilian workforce has consisted of between 143 and 159 million persons over the past 15 years and represents roughly 60% of the total US population.1

Men and women are roughly employed at the same rate (53% vs. 47%) with women more likely to engage in part-time work (25% vs. 12%).1 Age, gender, race, occupation, and industry all influence labor force participation. In addition, the labor market and the individual's decision/ability to participate in the workforce has many other drivers beyond demographics or individual health status, such as geographic and seasonal variations in industry and the overall strength of the national and international economies. Providers should be cognizant of these complex interactions when addressing the individual's ability to enter or return to the workforce.

Workplace Injuries

Workplace exposures to chemicals, noise, dust, radiation, and certain biological exposures are subject to various regulations and standards. In the United States, the most widely known standards are provided by the Occupational Safety and Health Administration (OSHA). The scope of the OSHA standards is broad and addresses health and safety risks on a variety of topics including walking-working surfaces, ventilation, noise, nonionizing radiation, hazardous materials, personal protective equipment, electrical work, machine guarding, and fire protection.2

OSHA also requires employers with more than 10 employees to keep records of work-related injuries and illnesses, commonly referred to as an OSHA log. Employers with <10 employees and low-risk industries (e.g., most retail stores, restaurants, private offices of dentists and physicians) are exempt from general recordkeeping but must report to OSHA any workplace incident that results in a fatality, inpatient hospitalization, amputation, or loss of an eye.3 In 2015, there were approximately 2.9 million OSHA-reportable nonfatal workplace injuries and illnesses, a rate of 3 cases per 100 full-time workers. Total recordable cases (i.e., cases requiring more than first aid) and DART (days away from work, job transfer, or restriction) rates are lowest in nongovernment institutions, with rates varying by industry as well as the size of the employer. Law enforcement, nursing and residential care facilities, and construction have the highest rates of total OSHA recordable cases (Fig. 99–1).1 The private-sector occupations with the highest number of cases with days away from work include tractor-trailer drivers, general laborers, material movers and nursing assistants.1 Overexertion and bodily reaction accounted for 33% of total recordable cases (TRC) in 2015, with falls, ...

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