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The prevalence of musculoskeletal symptoms (MSS) among U.S. dairy farmers is relatively unknown. The purpose of this study was to assess the prevalence of neck and upper extremity MSS, and to examine associations between symptoms and dairy operation activities among dairy farmers.Questionnaires were mailed to randomly selected dairy farmers in the State of Iowa, USA. Demographic, site specific MSS, and dairy operation activity information was obtained. Odds ratios and 95% confidence intervals were estimated with logistic regression adjusting for potential confounders.Among the participants (N=341), shoulder MSS were reported most frequently (54%). Neck MSS were significantly associated with manually feeding (ORadj=2.29; 95% CI= 1.09–4.80) and tractors use (ORadj = 2.17; 95% CI= 1.05–4.50). Also, wrist/hand MSS were associated with manually cleaning animal stalls (ORadj = 1.96; 95% CI= 1.06—3.63).Neck and upper extremity MSS were common and associated with common dairy farming practices. Future studies need to more accurately assess exposures to physical risk factors for MSS so ergonomic interventions can be developed. Am. J. Ind. Med. 51:443—451, 2008. © 2008 Wiley-Liss, Inc.