Musculoskeletal health case examples

Lilli, 43, works in a big grocery store. She stocks shelves and works at the till. Lilli has developed shoulder pain and her shoulder now hurts almost all the time. She avoids using her arm and tries to avoid pain when doing her work. She has needed a few short periods of sick leave.

Don'ts

Lilli tells her supervisor about her shoulder symptoms and which tasks make them worse. The supervisor does not take Lilli’s symptoms and the resulting sick leave periods seriously. Lilli is told that every employee must be able to perform all tasks in the grocery store. When her symptoms get worse, Lilli is forced to take a long sick leave and is not able to return to her work after that.

Dos

The supervisor notices that Lilli has difficulty stocking shelves, and that Lilli avoids using her arm when working at the till. She recommends that Lilli visits the occupational health services. There, she is diagnosed with a shoulder tendon injury. Lilli takes a short sick leave and is given instructions from the occupational health professionals on how to rehabilitate her shoulder.

Lilli agrees together with her supervisor and the occupational health physician that, to support rehabilitation, a work trial by decision of occupational health services will be organised at the grocery store’s info desk where there is no work that puts strain on the shoulders. After active rehabilitation and temporary work accommodation, Lilli is able to return to her former job, filling in at the info desk from time to time.

Heikki, 50, has worked as a carpenter for several years. He has had back and knee symptoms for some years already. Heikki has tried to endure the pain and continue working. Then his shoulder starts to hurt, and he has to take sick leave. Heikki is placed on a waiting list for shoulder surgery. He undergoes shoulder surgery.

Dont's

The supervisor does not contact Heikki during his sick leave to ask how he is doing or how he has recovered from surgery. The supervisor assumes that he will return to his old job after the sick leave. Heikki cannot return to work when planned and his shoulder is recovering poorly. Furthermore, he still has knee and back problems. Heikki contacts his supervisor, who says that he cannot return to work until he has totally recovered.

After a year of sick leave, Heikki receives a negative decision on his rehabilitation application. Heikki starts collecting earnings-related unemployment allowance and then labour market subsidy. He becomes an alcoholic and is granted permanent disability pension at the age of 56. The pension liability remains with the employer, affecting the employer’s contribution category.

Dos

Before the shoulder surgery, the supervisor holds a discussion with Heikki about how he is coping at work. Heikki says that he has had difficulty working because of his back and knee pain for a long time. The occupational health physician has diagnosed him with progressive knee osteoarthritis, a disc herniation that does not require surgery, and osteoarthritis in his back. They agree together that it is important to organise an occupational health negotiation already before the shoulder surgery. After the occupational health negotiation, they come to the conclusion that it is unlikely that Heikki will be able to return to his job as a carpenter and to work for his current employer after the shoulder surgery. They discuss the possibility for Heikki to train as a foreman. Heikki has been a hard-working, highly valued, social, and well-liked employee. The supervisor thinks that Heikki would make a good foreman.

Recovering from the shoulder surgery takes longer than expected. Heikki, his supervisor and occupational health physician together come to the conclusion that there is no going back to his work as a carpenter. Heikki applies for a work trial as a foreman in the form of vocational rehabilitation. The work trial proves to be a success, and the vocational rehabilitation continues in the form of an apprenticeship to become a foreman. After graduating, Heikki finds employment as a foreman, a position where knee osteoarthrosis is not an obstacle.

Tarja is a construction cleaner aged 34. She suffers from shoulder, wrist and back pains that lead to recurrent, progressively extended periods of sick leave. Occasionally, she needs a short sick leave because of the pains. The pains also disturb her sleep.

Dont's

Tarja contacts her supervisor, telling them that construction cleaning work is too heavy for her. The pain is so bad that she is no longer able to do health-promoting exercise after the workday. The situation at home is also stressful. The supervisor tells Tarja that there is no other work available and that she should not return to her job until she has fully recovered. The sick leave continues, Tarja’s sleep is disrupted and she develops depression.

Dos

The supervisor discusses Tarja’s work ability with her. They agree that Tarja will see the occupational health physician once more, which is followed by an occupational health negotiation. The occupational health physician refers Tarja to a physiatrist, who diagnoses Tarja with joint hypermobility and recommends a Kela rehabilitation course and lighter work for her.

During the occupational health negotiation, it turns out that the current employer could offer Tarja lighter work as an office cleaner. During rehabilitation course Tarja gets good advice on how to take care of her health and functional capacity. She takes on office cleaning, starts sleeping better and does not need sick leave anymore. The situation at home also improves.

Seppo is a 55-year-old electrician who works on a contract basis. A shoulder disorder and knee osteoarthritis have caused him to work more slowly. Seppo has difficulty performing tasks in a crouched position or working above shoulder height.

Dont's

The supervisor notices that Seppo has difficulty performing tasks in a crouched position or working above shoulder height. They agree with the rest of the contract team that others will perform tasks that require crouching down. They also invite the whole contract team to use a lifting maintenance platform. The team finds that using a lifting maintenance platform slows down the work and instead they also start helping Seppo in his tasks that require elevated arm positions. A few other team members also start having knee and shoulder symptoms. Seppo has knee replacement surgery but, after his sick leave, there is no room for him in the contract team. He is not willing to retrain. His employment is terminated because the employer cannot offer him work that he would be able to perform.

Dos

Seppo tells his supervisor that he has difficulty keeping up with the rest of the contract team because of his shoulder and knee pain. They agree that Seppo will start working as an employee with a monthly salary in tasks where the use of a lifting maintenance platform is possible. At first, the situation eases, but then his knees also gradually start making work more difficult. Seppo takes a sick leave and knee replacement surgery is planned for him.

During his sick leave, Seppo thinks about his situation and comes to the conclusion that he cannot return to his job. He earns clearly less while being employed on a monthly salary basis and the pain in his shoulder has not eased. The occupational health physician refers him to an expert in the social services, with whom he looks into the possibility of becoming self-employed.

An occupational health negotiation is scheduled where the decision is made to apply for vocational rehabilitation. Seppo receives a preliminary decision on vocational rehabilitation and a payment commitment for the preparation of a vocational rehabilitation plan by a service provider. With the help of a career coach, he makes a business plan and a profitability calculation for establishing a company in the field of electrics. Seppo is granted support for a 6-month work trial in the new company, and he starts performing tasks suited to his health, such as preparing contract tenders. Seppo applies for a business subsidy for acquiring an assistive device that will make work easier for him. Having recovered from the joint replacement surgery, he establishes an electrical company and is able to hire three employees within a few years.

Henna is a 56-year-old specialist who mainly works remotely. As remote work increases, Henna’s neck pain worsens and she begins to feel lonely. She does not have regular meetings with her colleagues or even her supervisor. Any discussions are short, and Henna feels that nothing is ever completed.

Dont's

Hanna tries to give her supervisor a hint that she has neck pain and that her work is lonely. The supervisor does not react to Henna’s message. She contacts her less frequently to let Henna get her work done. At first, the situation irritates Henna, but she accepts her fate. Her anxiety increases and she starts drinking alcohol daily, which means she cannot recover properly and she becomes even more tired. She begins to make mistakes and often starts her workdays very late. The supervisor suspects alcohol abuse and refers Henna to the occupational health services. Unfortunately, it is too late and the referral does not lead to the desired outcome. Henna’s employment is terminated.

Dos

When Henna starts working remotely, the supervisor makes sure that Henna has a good workstation and a proper-sized screen at home. They hold regular online meetings twice a week to go over the week’s tasks and how they are progressing and to discuss general matters, so that Henna feels that she is part of the work community and that someone cares about how she is doing.

Henna says that she has experienced increasing neck pain recently. The supervisor encourages Henna to contact an occupational health physiotherapist who books an online appointment with Henna. The physiotherapist recommends small changes to Henna’s workstation at home. The physiotherapist also suggest that Henna acquire a few assistive devices and gives Henna instructions for exercise during breaks. Henna fills her supervisor in on this in their meeting. The supervisor suggests that a regular shared exercise session be organised for remote workers.

Henna’s neck symptoms decrease and she realises that she enjoys her work more now that she doesn’t feel that she is working all alone at home. This sparks the idea of a shared weekly coffee break with her closest colleagues, an idea which everyone is very happy with. Work efficiency also increases.