Background Individuals with multiple sclerosis (MS) frequently suffer from impaired sensory function, reduced strength and tremor in the upper limbs, which may interfere with upper limb function. However, upper limb impairment in MS is under-recognized and understudied. We aimed to evaluate the prevalence of upper limb impairment in a large sample of persons with MS; the association between upper limb function and employment status in MS; and the frequency of use of assistive devices aimed at addressing upper limb impairments. Methods We surveyed participants in the North American Research Committee on Multiple Sclerosis (NARCOMS) Registry regarding upper limb function using the ABILHAND questionnaire, and asked about use of assistive devices intended to improve the performance on upper limb activities. We evaluated the association between ABILHAND scores and current employment status using multivariable logistic regression analysis, and the association between ABILHAND scores and the use of an assistive device. Results Of 7463 eligible respondents, 5846 (78.3%) were female and mean (SD) age of 57.4 (10.2) years. The median (IQR) score on the ABILHAND was 45 (39–46). Higher levels of disability, as measured by the PDDS, correlated moderately with lower (worse) scores on the ABILHAND (r=−0.50; 95%CI: −0.48, −0.52). Over half of participants reported that they possessed an assistive device to aid upper limb function (3914, 56.0%). Older age, female sex, greater ambulatory disability, higher levels of fatigue, sensory impairment, spasticity and cognitive impairment, and visiting an occupational therapist were independently associated with increased odds of using an assistive device. After accounting for disability, perceived cognitive impairment, and fatigue, impaired upper limb function was associated with decreased odds of being employed (OR/1 point rise in ABILHAND 0.97; 95%CI: 0.96, 0.98). Conclusions Upper limb impairment is common in older MS patients, and adversely affects the ability to perform many common daily activities.