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In an epidemiological case-control study, exposure-response relationship between hand-arm vibration exposure and the risk of musculoskeletal disorders (MSDs) of the upper extremities were examined among 209 male cases and 614 controls in the German construction, mining, metal, and wood-working industries. To quantify individual vibration exposures, a database of industrial hygiene measurements of over 700 power tools was established. In addition, individual work histories were collected in detail. The dose-response relationships between hand-arm vibration exposure and the risk of MSDs were quantified based on multivariable logistic regression analysis. After adjusting for relevant confounders, statistically significant dose-response relationships between cumulative hand-arm vibration exposure doses and MSDs of the upper extremities could be established.