Cereal grinding has been practiced in Mesopotamia since the Upper Palaeolithic. While evidence of cereal grinding is clear from the archaeological and textual records, what remains unclear is whether the activity leaves signs on the skeleton in the form of markers of occupational stress (MOS). A particular constellation of MOS (e.g., osteoarthritis, traumatic injuries, and accessory articular facets) has previously been used to infer the habitual grinding of grain. These same MOS were recently observed in the skeleton of a female discovered in the Middle Bronze Age cemetery at Tell Arbid, NE Syria. Through differential diagnosis our results suggest that it remains problematic to identify grain-processing activities from the skeleton, even when a bioarchaeological approach is carried out.