Work-related conditions

Last updated: January 12, 2022

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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)
  • Elbow injuries: most commonly seen in occupations that involve repetitive wrist movements and/or repetitive forearm supination-pronation
  • 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]
    • Local cervical syndrome, cervicobrachial and cervicocephalic syndrome: associated with carrying heavy loads on the shoulder for a prolonged period of time
  • 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)
  • 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)

Tinnitus

See “Tinnitus” for more information.

Exposure to lung-damaging materials (e.g., silicone, asbestos, sawdust, 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 conditions include: [5]

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. [6]

Overview of occupational infections [7]
Exposure Infectious patient material Animals and animal products Parasitic vectors Environment/soil
Transmission
  • Direct contact, fomites
  • Aerosols (airborne) and droplets
  • Oral (ingestion; incl. fecal-oral)
  • Vectorborne
  • Fecal-oral (e.g., contact with infected dogs, cats, cattle)
  • Direct contact (e.g., working in contaminated water)
  • Animal bites and/or scratches
  • Inhalation of contaminated dust and aerosols
  • Inhalation and ingestion (of, e.g., contaminated dust)
  • Direct contact (from, e.g., digging in or walking barefoot over contaminated soil)
Occupations
  • Health care workers (e.g., nurses, physicians, physical therapists)
  • Laboratory technicians
  • Embalmers
  • Childcare personnel
  • Butcher, slaughterhouse workers
  • Zoo workers, animal caretakers, animal breeders
  • Farm and poultryworkers
  • Veterinarians
  • Sewage workers
  • Laboratory technicians
  • Hunters, trappers
  • Workers involved in farming, forestry, and/or pest control
  • Workers involved in construction, demolition, and/or road work
  • Gardeners
  • Farm workers
  • Roofers
  • Heating and air-conditioning workers
Pathogens and associated conditions Bacterial
Viral
  • N/A
Fungal
  • Rare
Parasitic
  • N/A
  • 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 [8]
  • Epidemiology: more commonly reported in female workers [9]
  • Etiology
    • Risk factors [10]
      • 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 [10][11]
    • Organization-focused strategies
      • Strategies to improve the workplace environment and directly address the causes of burnout are more effective than employee-focused strategies.
      • 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
  1. National Occupational Research Agenda. https://www.cdc.gov/niosh/docs/96-115/diseas.html. Updated: June 6, 2014. Accessed: November 2, 2021.
  2. Aw T-C, Blair I. Occupational infections. Elsevier ; 2012 : p. 715-726
  3. OCCUPATIONAL HEARING LOSS (OHL) SURVEILLANCE. https://www.cdc.gov/niosh/topics/ohl/default.html. . Accessed: November 2, 2021.
  4. Burn-out an "occupational phenomenon": International Classification of Diseases. https://www.who.int/news/item/28-05-2019-burn-out-an-occupational-phenomenon-international-classification-of-diseases. Updated: May 28, 2019. Accessed: September 22, 2021.
  5. Beauregard N, Marchand A, Bilodeau J, Durand P, Demers A, Haines VY. Gendered Pathways to Burnout: Results from the SALVEO Study. Annals of Work Exposures and Health. 2018; 62 (4): p.426-437. doi: 10.1093/annweh/wxx114 . | Open in Read by QxMD
  6. West CP, Dyrbye LN, Shanafelt TD. Physician burnout: contributors, consequences and solutions. J Intern Med. 2018; 283 (6): p.516-529. doi: 10.1111/joim.12752 . | Open in Read by QxMD
  7. National Academies of Sciences, Engineering, and Medicine, et al.. Taking Action Against Clinician Burnout. National Academies Press ; 2019
  8. Respiratory Health Program: Occupational Risks. https://www.cdc.gov/niosh/programs/resp/risks.html. Updated: November 13, 2019. Accessed: November 2, 2021.
  9. Heaver C, Goonetilleke KS, Ferguson H, Shiralkar S. Hand–arm vibration syndrome: a common occupational hazard in industrialized countries. Journal of Hand Surgery (European Volume). 2011; 36 (5): p.354-363. doi: 10.1177/1753193410396636 . | Open in Read by QxMD
  10. Videman T, Battié MC. Spine Update. Spine. 1999; 24 (11): p.1164-1168. doi: 10.1097/00007632-199906010-00020 . | Open in Read by QxMD
  11. Jantine Posthuma de Boer, Alexander F.Y. van Wulfften Palthe, Agnita Stadhouder, Frank W. Bloemers. The Clay Shoveler's Fracture: A Case Report and Review of the Literature. J Emerg Med. 2016; 51 (3): p.292-297. doi: 10.1016/j.jemermed.2016.03.020 . | Open in Read by QxMD

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