Returning to work after a significant injury is rarely straightforward. For employers and employees alike, there are often questions around what is safe, what is possible, and how best to balance rehabilitation with meaningful work.
This case study explores how Acorn Occupational Health supported a structured return to work following a traumatic above-elbow upper limb amputation, using a Functional Capacity Assessment (FCA) to provide clear, practical guidance for both the employee and employer.
The Situation
Acorn Occupational Health was commissioned to complete a Functional Capacity Assessment for an employee returning to work following a serious road traffic accident. The employee had sustained multiple injuries, including a traumatic above-elbow amputation of their dominant arm.
The purpose of the assessment was to establish current functional ability, identify any risks associated with returning to a physically demanding warehouse role, and provide evidence-based recommendations to support a safe and sustainable return to work.
Why the Assessment Was Needed
The employer required clear, objective information to support decision-making around the employee’s return to work. In particular, they wanted to understand:
- Current physical capability following significant trauma
- Ability to safely carry out key role tasks
- Suitable adjustments to support a phased return
- Any restrictions required to reduce risk of further injury
- Longer-term role suitability and rehabilitation considerations
The Role
The employee worked as an Automation/Materials Handling Assistant within a large warehouse environment. The role included a mix of physical and operational tasks such as:
- Prolonged walking and standing across shifts
- Manual handling of parcels, totes, and light equipment
- Use of handheld scanners and communication devices
- Clearing minor conveyor blockages
- Operating control panels and automated systems
- Occasional work at height using ladders or MEWPs
At the time of assessment, the employee was undertaking amended, office-based duties as part of a phased return to work.
Health Background
Following the accident, the employee sustained multiple injuries in addition to the upper limb amputation. At the time of assessment:
- Physical recovery was progressing well
- Ongoing physiotherapy was supporting strength and adaptation
- Phantom limb pain was present but managed
- Prosthetic fitting was planned for a later stage of rehabilitation
Despite the severity of injury, the employee presented as highly motivated and engaged in their recovery and return to work planning.
How the Assessment Was Completed
The Functional Capacity Assessment combined clinical discussion with real-world task observation within the warehouse environment.
The assessment included:
- A detailed consultation covering recovery, symptoms, and confidence at work
- Observation of live workplace tasks and environmental demands
- Structured functional testing using motion-based assessment techniques
- Review of mobility, balance, and movement quality
- Analysis of specific job tasks requiring grip, reach, lifting, and coordination
This approach ensured that recommendations were based on both clinical findings and actual job demands.
Key Findings
Overall, the employee demonstrated a moderate level of functional capacity, which was considered appropriate given the stage of recovery.
Key observations included:
- Good mobility, balance, and walking tolerance within the warehouse environment
- Safe navigation of the work environment using adapted one-handed strategies
- Reduced ability to perform tasks requiring two-handed grip or stabilisation
- Limitations in maintaining three points of contact for ladder use
- Emerging fatigue during prolonged activity without structured rest breaks
Importantly, findings were consistent with both the nature of the injury and the current stage of rehabilitation.
Risks Identified
The assessment highlighted several areas of potential risk within the role:
- Manual handling tasks requiring two-handed force or stabilisation
- Work at height due to inability to safely maintain three points of contact
- Increased fatigue during extended shifts
- Overuse risk to the remaining upper limb due to compensation
- Reduced safety during certain task transitions without support or adaptation
Recommendations
A number of practical recommendations were made to support a safe and sustainable return to work:
- Temporary restriction from ladder use and work requiring three points of contact
- Consideration of MEWP (Mobile Elevating Work Platform) use where task requirements allow
- Avoidance of tasks requiring two-handed lifting or stabilisation
- Support for heavier item handling through assistance or task redesign
- Structured micro-breaks to manage fatigue during shifts
- Additional time allowance for certain tasks where required
- Ongoing welfare check-ins during the phased return period
- Review following prosthetic fitting to reassess capacity and expand duties where appropriate
A follow-up Functional Capacity Review was recommended once prosthetic rehabilitation had progressed.
The Outcome
The assessment provided the employer with clear, objective guidance to support safe decision-making during a complex return-to-work process.
It enabled:
- Safe allocation of suitable duties during phased return
- Reduced risk of re-injury or overexertion
- A structured rehabilitation-focused approach to work reintegration
- Greater confidence for both employer and employee
- A clear pathway for future role development following prosthetic fitting
Beyond This Case
While this case involved significant traumatic injury, Functional Capacity Assessments are widely applicable across a range of workplace situations, including:
- Musculoskeletal injuries and chronic pain conditions
- Fluctuating or long-term health conditions
- Fatigue-related functional decline
- Employees struggling with physical job demands
- Preventative assessment in higher-risk roles
At their core, FCA’s support a more human-centred approach to work. They help organisations understand not just what a role requires, but how an individual actually functions within it.
This allows for better-informed decisions around job design, adjustments, and long-term workforce sustainability.
Summary
This case highlights the value of Functional Capacity Assessments in supporting complex return-to-work scenarios. By combining clinical insight with real-world task analysis, Acorn Occupational Health was able to provide clear, practical recommendations that balanced safety, rehabilitation, and meaningful work participation.
Ultimately, the goal was not just return to work, but a return to work that was safe, sustainable, and supportive of long-term recovery.