Int. J. Environ. Res. Public Health2021, 18, 9171 12of 15 5. Conclusions The methods used to collect, process, and interpret data on WMSDs are extremely heterogeneous, so the comparability between studies is poor. This study evaluated survey methods and assessment tools for the detection of upper extremity WMSDs and its associations in a healthy working population. While the most frequently used questionnaires focus on subjective complaints that do not seem to be related to WMSDs, the DASH questionnaire could prove to be an efficient screening method. However, the gold standard for the detection of WMSDs, and also for the derivation of prophylactic, therapeutic, and rehabilitative measures, is still the standardized physical examination, based on a predetermined set of diagnostic criteria. Our analysis has not identified any risk factors for WMSDs in the study data. Possibly, the effects of investigated risks were too small to be detected by our relatively small study sample. In order to make epidemiological research on upper extremity WMSDs more comparable, a uniform study design in regard to endpoint selection is recommended. We hope that the methodological results of our work will help other researchers to obtain more efficient and consistent tools for the research on upper extremity WMSDs. Author Contributions: Conceptualization, O.L., T.L. and V.B.; methodology, O.L. and J.M.; software, V.B.; validation, T.L. and O.L.; formal analysis, V.B.; investigation, O.L. and T.L.; resources, J.M.; data curation, J.M. and V.B.; writing—original draft preparation, O.L. and V.B.; writing—review and editing, all authors; visualization, T.L.; supervision, O.L.; project administration, J.M. All authors have read and agreed to the published version of the manuscript. Funding: This research received no external funding. Institutional Review Board Statement: The study was conducted according to the guidelines of the Declaration of Helsinki, and approved by the Ethics Committee of the Baden-Wuerttemberg Medical Association, Jahnstrasse 40, 70597 Stuttgart, Germany (project number F-2017-005, date 01/24/2017). Informed Consent Statement: Informed consent was obtained from all subjects involved in the study. Data Availability Statement: The data presented in this study are available on request from the corresponding author. Acknowledgments: The authors would like to thank all of the study participants and the staff involved in the conduct of the study, in particular Katharina Lange, Manager Medical Scientific Affairs, Aesculap AG; Stefanie Latuske, Mevluede Orhan, and Ulrike Hofer, Health Center, Aesculap AG. Conflicts of Interest: The authors declare no conflict of interest. References 1. Snashall, D. ABC of work-related disorders-hazards of work. BMJ 1996, 313, 161–164. [CrossRef] 2. Melhorn, J.M. Cumulative trauma disorders and repetitive strain injuries. Clin. Orthop. Relat. Res. 1998, 351, 107–126. [CrossRef] 3. Backhans, M.; Stjernschantz Forsberg, J.; Lager, A. (Eds.) Folkhälsorapport 2015 [Public Health Report 2015], 1st ed.; Center of Epidemiology and Community Medicine: Stockholm, Sweden, 2015; pp. 23–24. 4. Kumar, V.K.; Kumar, S.P.; Baliga, M.R. Prevalence of work-related musculoskeletal complaints among dentists in India: A national cross-sectional survey. Indian J. Dent. Res. 2013, 24, 428–438. [CrossRef] [PubMed] 5. van Eerd, D.; Beaton, D.; Cole, D.; Lucas, J.; Hogg-Johnson, S.; Bombardier, C. Classification systems for upper-limb musculoskeletal disorders in workers: A review of the literature. J. Clin. Epidemiol. 2003, 56, 925–936. [CrossRef] 6. da Costa, J.T.; Baptista, J.S.; Vaz, M. Incidence and prevalence of upper-limb work related musculoskeletal disorders: A systematic review. Work 2015, 51, 635–644. [CrossRef] [PubMed] 7. Hoy, D.G.; Smith, E.; Cross, M.; Sanchez-Riera, L.; Buchbinder, R.; Blyth, F.M. The global burden of musculoskeletal conditions for 2010: An overview of methods. ARD2014, 73, 982–989. [CrossRef] [PubMed] 8. Jensen, L.K.; Hansen, H.B. Working environment. Many work impediments among personnel in operating room. Sygeplejersken 1986, 86, 4–10. [PubMed] 9. Bernard, B.P. Musculoskeletal disorders and workplace factors: A critical review of epidemiologic evidence for work-related musculoskeletal disorders of the neck, upper extremity, and low back. US Department of Health and Human Services. NIOSH 1997, 10, 97–141.
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