Functional Sequelae of Musculoskeletal Trauma and Return to Work: Occupational Capacity, Disability Assessment, and Medico-Legal Integration

Resumen

Musculoskeletal trauma may produce persistent functional sequelae that extend beyond anatomical healing and significantly affect occupational participation. This study analyzed the relationship between post-traumatic musculoskeletal impairment, residual functional capacity, occupational demands, work incapacity, return-to-work outcomes, and medico-legal assessment through an integrative review based on the Scientific Method. Evidence from traumatology, rehabilitation medicine, occupational medicine, functional capacity evaluation, and medico-legal literature was examined to identify the principal clinical, functional, psychosocial, and occupational factors associated with delayed or incomplete work reintegration. The findings showed that persistent pain, reduced mobility, muscle weakness, decreased endurance, functional limitations, injury severity, self-efficacy, educational level, physical workload, occupational category, and recovery expectations influence return-to-work trajectories. Functional Capacity Evaluations provide useful objective information regarding work-related performance, but their interpretation requires comparison with actual job demands and integration with clinical, psychosocial, and contextual factors. Workers whose residual functional capacities were compatible with occupational requirements demonstrated more favorable return-to-work outcomes, whereas persistent capacity-demand mismatches were associated with unsuccessful reintegration. Workplace interventions, including modified duties, ergonomic adaptations, coordinated rehabilitation, and graded return-to-work programs, were associated with improved initial and sustained occupational outcomes. From a medico-legal perspective, the evidence supports a clear distinction between anatomical impairment, functional limitation, occupational restriction, and disability. Work capacity should therefore be determined through an interdisciplinary and individualized assessment integrating objective sequelae, functional performance, job-specific requirements, prognosis, rehabilitation potential, and workplace adaptability. This multidimensional framework provides a more precise and defensible basis for disability assessment and for planning safe and sustainable occupational reintegration after musculoskeletal trauma.