Upper extremity disorders in the workplace: Costs and outcomes beyond the first return to work

Background: Cumulative trauma disorders of the upper extremities (CTD) have become increasingly important in workers' compensation caseloads over the last two decades. Relative to occupational back pain, CTD have been much less studied. Methods: We analyzed post-injury employment patterns and return-to-work probabilities for a sample of Ontario workers with CTD, for up to five years after injury. Results for workers with CTD are compared to results for workers with back injuries or fractures. Results: Most workers with CTD return to work at least once, but a first return does not necessarily mark the end of work disability. Among workers absent at least once, 26% with CTD report a second injury-related absence, compared to 18% with back pain and 12% with fractures. After five years, focusing on first returns underestimates work-loss days associated with CTD by 32%. Conclusions: A substantial proportion of workers with CTD or work-related back pain experience injury-related absences after their first return to work. Focusing on the first return to work is misleading for both injury groups, but even more so for CTD, as they appear to be even more susceptible to multiple spells of work absence.