PURPOSE: To systematically identify and evaluate interventions to improve work participation for adults with upper limb musculoskeletal conditions, and explore contextual factors and mechanisms that suggest how the intervention is effective, for whom, and in what setting. METHODS: The review protocol was pre-registered with PROSPERO (CRD42023433216). Eligible studies met the following criteria. Population adults (aged >= 18 years), with musculoskeletal upper limb conditions including traumatic and non-traumatic presentations. Intervention strategies aimed at enhancing work participation. Outcomes measures including return to work, increased work duties or hours, and work functioning. STUDY DESIGN: randomised and non-randomised experimental studies, mixed methods, qualitative studies, and case series. Two reviewers independently screened, extracted data, and completed quality appraisal. Interventions were described using TIDieR and the data presented as a narrative synthesis. RESULTS: Twenty-two studies were included. Interventions were categorised into three groups: multimodal or multidisciplinary (n = 13), ergonomic (n = 4), and exercise (n = 5). Eight interventions were primarily delivered in the workplace and 14 in healthcare settings. Four outcome domains were reported: return to work (n = 18), self-reported work function (n = 4), work productivity (n = 5), and work-related costs (n = 2). Only exercise interventions showed consistent statistically significant benefits. Heterogeneity in outcomes prevented formal meta-analysis. Only five studies were rated as high quality. CONCLUSIONS: There is insufficient evidence to recommend specific work participation interventions for adults with upper limb musculoskeletal systems. No studies explored the impact of Fit Notes or other formal work guidance documentation.

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