Design and results of cross sectional and case-control studies on occupational risk factors for shoulder pain
| Study reference | Score (%) | Case definition | Study population | Positive findings3-150 | ||||||
|---|---|---|---|---|---|---|---|---|---|---|
| Sampling frame | Sample size | (p<0.05 or ORs >2.0 or <0.5) | ||||||||
| Design and results of cross sectional studies on occupational risk factors for shoulder pain | ||||||||||
| 17 | 82 | Shoulder pain >1/month or during >1 week in the past year (Q + Ex)3-151 | Male employees from selected job groups in aluminium smelter (USA) | 62 / 96 (R=65%) | LR (OR, adjusted for age, smoking, sport or hobbies) | |||||
| 36 / 64 (R=56%) | good health, 0.4 (0.1 to 0.9); low decision latitude, 4.0 (0.8 to 19); | |||||||||
| 9 / 21 (R=33%) | years of forearm twisting, 46 (3.8 to 550) | |||||||||
| 18 | 73 | Shoulder pain or stiffness during the past year (NQ)3-151 | Riveters and control manual workers (aircraft industry, The Netherlands) | 147 / 194 (R=76%) 125 / 194 (R=64%) | LR (OR adjusted for age) per year riveting, β=0.041, OR=1.04 (0.05 < p < 0.10) | |||||
| 19 | 73 | Shoulder symptoms during the past year (NQ) | All members dental hygienist association (DH), plus dental assistents (DA) (Canada) | DH, 1066 / 2142 (R=50%) DA, 154 / 305 (R=51%) | LR (OR adjusted for age, history of shoulder pain) no general practice, 1.8 (1.2 to 2.8), 5–6 days/weekv <3, 1.8 (1.1 to 3.2) time with rotated body; 61%–80% v 1%–20%, 2.8 (1.9 to 4.3); 81%–100%, 3.1 (1.9 to 4.9) years in practice 1–14 y, 3.9 (1.9 to 7.9); >14 y, 2.1 (0.9 to 5.1) | |||||
| 20 | 71 | Pain for at least a few hours during the past year (NQ)3-151 | All workers in a Dutch tank terminal company | 161 / 172 (R=94%) | LR (OR adjusted for age) | |||||
| heavy physical load previous jobs, 3.6 (1.3 to 9.8) | ||||||||||
| 21 | 71 | Shoulder symptoms (NQ, 0–10 scale) severe, >5 points | All female nursing personnel Swedish hospital | 821 (R=100%) | LR (OR adjusted for age), | |||||
| low fitness, 1.8 (1.3 to 2.5); low job control, 1.7 (1.1 to 2.7) | ||||||||||
| for severe symptoms, | ||||||||||
| low fitness, 2.2 (1.5 to 3.4); high work demand, 1.7 (1.1 to 2.6) | ||||||||||
| 22 | 71 | Shoulder pain >1/week or during >1 week in the past year (Q).3-151 | Random sample of active carpenters (USA) | 522 / 627 (R=83%) | LR (OR adjusted for age, smoking, previous health), | |||||
| 10–20 y employment, 2.3 (1.0 to 5.4); | ||||||||||
| >20 y employment, 3.2 (1.1 to 8.9) | ||||||||||
| minimal schedule influence, 1.9 (1.1–3.2) | ||||||||||
| 23 | 67 | Shoulder tendinitis (Ex) | Random selection of male construction industry workers (Sweden) | 54/75 Brick layers 55/75 Rock blasters 98/110 Foremen (R=80%) | LR (OR adjusted for age, dexterity, sport activities, smoking), vibration (highest v lowest category), 2.6 (0.6 to 12.5) left side rock vforemen, 3.3 (1.2 to 9.2) left; 1.7 (0.7 to 4.2) right side brick v foremen, 0.4 (0.2 to 1.3) right; insufficient cases left side | |||||
| 24 | 65 | At least moderate shoulder symptoms >1/month or during >1 week in the past year (Q)3-151 | Random selection of full time newspaper employees (USA) | 894 / 973 (R=92%) | LR (OR adjusted for sex and race) | |||||
| lack of participation in job decision making, 1.6 (1.2 to 2.1) | ||||||||||
| years employed, 1.4 (1.2 to 1.8) | ||||||||||
| increased job pressure, 1.5 (1.0 to 2.2) | ||||||||||
| 25 | 65 | Work related specific shoulder disorders (Ex) | Telecommunication company, visual display terminal users (USA) | 533 / 573 (R=93%) | LR (OR) | |||||
| fear of being replaced by computers, 2.7 (1.3 to 5.8) | ||||||||||
| arising from chair, 1.9 (1.2 to 3.2) | ||||||||||
| 26 | 65 | Work related shoulder symptoms during the past year (NQ)3-151 | All workers in one municipal district, home care wokers and other employees (Sweden) | 1020/1330 (R=77%) | LR (univariate RR adjusted for age) | |||||
| stimulus from work, 1.3 (1.0 to 1.7); flexed trunk, 1.6 (1.2 to 2.1); | ||||||||||
| work demands, 1.5 (1.2 to 2.0)‡; twisted postures, 1.6 (1.1 to 2.2); | ||||||||||
| lifting, 1.7 (1.2 to 2.4)‡; arms above shoulders, 1.5 (1.2 to 1.9); | ||||||||||
| repetitive movements, 1.5 (1.1 to 1.9)‡ | ||||||||||
| (‡ also significant in multivariate model) | ||||||||||
| 27 | 65 | Shoulder pain during the past year (NQ) | Random 8% sample of active salespeople (Denmark) | n=1306/1991 (R=66%) | LR (OR, PPR also presented, adjusted for age, sex, and smoking) ⩾30v <10 h/week in car, 1.6 (1.0 to 2.7) high work demands, 1.5 (1.1 to 2.1); uncertainty employment, 1.5 (1.0 to 2.3) | |||||
| 28 | 60 | Subacromial shoulder pain (Ex) | Survey of randomly selected 50–70 year olds (Sweden) | 445 / 552 (R=81%) +57 (selected) | LR (OR adjusted for ?), self-rated heavy workload, 5.4 (3.4 to 8.6) | |||||
| 29 | 60 | Shoulder pain or stiffness during the past month (Q) | Systematic sample of retired post office workers (UK) | 3920 / 5042 (R=78%) | LR (RR, adjusted for sex) | |||||
| working above shoulder level, 1–20 y (>1 h/day), 1.4 (1.2 to 1.6) | ||||||||||
| >20 y (>1 h/day), 1.4 (1.2 to 1.6) | ||||||||||
| 30 | 59 | Shoulder symptoms during the past year (Q + Ex). | All female employees of five assembly departments electronic factory (Sweden) | 106 / 138 (R=77%) | Multiple regression (only R2 presented) | |||||
| employment (y, p<0.05); less upper arm flexions (p<0.05); | ||||||||||
| arm abducted 0–30° over long periods (p<0.05) | ||||||||||
| 31 | 53 | Work related shoulder symptoms during the past year (NQ)3-151 | Random selection / all workers in eight metal industry companies (Sweden) | 241 blue, 209 white collar, R=± 90% | Multivariate regression (partial correlations R adjusted for age and sex), blue or white collar workers | |||||
| low job control, 0.18 / 0.17; poor supervisor climate, 0.16 / 0.20; | ||||||||||
| low stimulus from work, 0.26 / 0.22; high psychological demands, 0.27 / 0.21; | ||||||||||
| extreme work postures, 0.14 / NS; twisted postures, — / 0.16; | ||||||||||
| light materials handling, ns / 0.18; repetitive movements, 0.15/0.32; | ||||||||||
| poor relation fellow workers ns / 0.24 | ||||||||||
| 32 | 53 | Frequent shoulder pain during the past year (NQ) | All medical secretaries and office personnel in a hospital (Sweden) | 420 / 438 (R=96%) | Univariate analysis (OR) | |||||
| >5 y employed (stratified for age), 1.9 (1.1 to 3.4) | ||||||||||
| >5 h with machines, 1.9 (1.2 to 3.0) | ||||||||||
| χ2(4) test (no odds ratios presented), | ||||||||||
| unfriendly spirit of cooperation, p=0.03; given too much work | ||||||||||
| p=0.05, no influence on work conditions, p=0.003 | ||||||||||
| 33 | 53 | Shoulder discomfort or pain ever. Onset during current job (Q). | All staff of six departments in a bank, visual display unit users (Hong Kong) | 121 / 151 (R=80%) | LR (OR adjusted for age and sex) | |||||
| fixed keyboard height, 8.7 (2.4 to 32.4); bending back, 5.1 (1.5 to 7.2), frequent VDU user, 18.9 (2.2 to 164.7) | ||||||||||
| 34,35 | 47 | Shoulder pain >24 h some time during the past month (Q) | Participants Malmö longitudinal study, still residing in Malmö after 45 years (Sweden) | 575 / 830 (R=69%) | LR (adjusted for sex, intelligence) job dissatisfaction, p<0.01 (women) | |||||
| 36 | 47 | Shoulder symptoms during past ? months (NQ), specific shoulder disorders (confirmed by Ex) | All employees Volvo Flygmotor (Sweden) | 2814 / 2933 (R=96%) | Multivariate analysis (?) high physical stress, p<0.05; vibrating tools, p<0.05; mental stress at work, p<0.001 | |||||
| 37 | 47 | Shoulder symptoms in the past 12 months (NQ) | All male workers in truck assembly system (Sweden) | 28 (R=100%) | Univariate analysis repetitive movements (p<0.05); high physical load (p<0.05); trunk flexions (p<0.05); high stress (p<0.05); psychological work demands (p<0.05) | |||||
| 38 | 47 | Shoulder symptoms >1/month or during >1 week in the past year. (Q confirmed by Ex)3-151 | Selected employees pulp and paper mill (USA) | 40 / 58 (R=69%) | LR (OR adjusted for age, hobbies) | |||||
| job type, 0.0 (p=0.04); use of lance, 317.3 (p=0.05); | ||||||||||
| physical demand, 1.1 (p=0.05); use of wrench, 6.7 (p=0.28) | ||||||||||
| 39 | 47 | Shoulder pain or stiffness during the past month (Q) | All traffic police motor cyclists in one city (Japan) | 119 (R=100%) | Prevalence of symptoms: highv low vibration dose, pain, 20.6%v 2.0% (p<0.05); stiffness, 55.9%v 20.4% (p<0.05) | |||||
| 40 | 47 | Shoulder symptoms in the past 7 days (NQ) | Assembly workers in factory (Sweden). | 148/? Assembly workers (R=not reported) | LR (OR adjusted for age and duration of employment, graphical display) work pace, medium, 7 (p<0.001) | |||||
| fast, 10 (p<0.001); very fast, 1.5 | ||||||||||
| 41 | 47 | Shoulder symptoms in the past 12 months (Q) | Members of the dentists' association, Malmö (Sweden) | 359 / 395 (R=91%) | Univariate correlations (stratified by sex) years in practice, p<0.05; position relative to patient, p<0.05; use of mirror, p<0.05 | |||||
| 42 | 47 | Shoulder pain (case definition unclear) | Lorry truck drivers, partly random selection (The Netherlands) | 534 / 975 (R=55%) | LR (OR, 90% CI, adjusted for age) pallet loading, 2.1 (1.3 to 3.6); wheeled cages, 2.0 (1.1 to 3.7); packed goods, 2.3 (1.3 to 3.9) | |||||
| 43 | 43 | Shoulder pain during the past year (NQ) | All medical secretaries and office personnel in hospital (Sweden) | 420 / 438 (R=96%) | Univariate χ2analysis, OR | |||||
| poor work content, 2.5 (1.3 to 4.9) | ||||||||||
| poor social support, 1.6 (1.0 to 2.8) | ||||||||||
| Design and results of case-control studies on occupational risk factors for shoulder pain | ||||||||||
| 44 | 67 | Specific shoulder disorders (Ex) | Attenders orthopaedic clinics (UK) Controls, attenders without disease upper limb | 1564 / 1677 (R=93%) 580 cases | LR (OR adjusted for age) repeated elbow flexion, 0.4 (0.2 to 0.8) repeated shoulder rotation with elevated arm, 2.3 (p<0.05) | |||||
| 45 | 43 | Shoulder pain and disability ⩾24 h in past month (Q) | Random selection of 500 patients from a general practice (UK) | 217 / 500 (R=66%) 39 Cases | Univariate LR (RR stratified by sex), monotonous work, 2.7 (1.3 to 5.4) for men, weights on one shoulder, 5.5 (1.8 to 17.4); always damp, 5.4 (1.6 to 19); arms above shoulder level, 2.1 (0.8 to 5.8); always cold, 6.4 (1.5 to 27); always hot, 2.4 (0.7 to 7.9); always noisy, 2.2 (0.7 to 6.5); for women, always damp, 3.3 (0.4 to 27) | |||||
| 46 | 37 | Shoulder pain >3 months (Ex) | Manual workers attending healthcare centre (Sweden) Controls, manual workers (2,1) | 17/20 cases (R=85%) 34 controls | Univariate (OR based on 2×2-table), arms at or above shoulder, 10.6 (2.8 to 40.9) | |||||
↵3-150 Positive findings, the association between the risk factor at issue and the occurrence of shoulder pain is strong (OR or RR >2.0 or <0.5) or significant (p<0.05).
Risk estimates (OR/RR) are presented with corresponding 95% confidence interval (if sufficient data were available from the original publications).
↵3-151 Onset of complaints on the current job or symptoms are assumed to be related to the current job.
Additional details on the methods and results of the studies included in this review can be obtained from the corresponding author.
Ex=physical examination; Q=questionnaire; NQ=Nordic questionnaire;47 R=response rate; Obs=observation; LR=logistic regression; OR=odds ratio; RR=relative risk.