Shoulder impingement syndrome in relation to shoulder intensive work

Evaluation of antigravitational support levels provided by a passive upper-limb occupational exoskeleton in repetitive arm movements

Upper-limb occupational exoskeletons to support the workers' upper arms are typically designed to provide antigravitational support. Although typical work activities require workers to perform static and dynamic actions, the majority of the studies in literature investigated the effects of upper-limb occupational exoskeletons in static and quasi-static activities, while only a few works focused on dynamic tasks. This article presents a systematic evaluation of the effects of different levels of antigravitational support (from about 60% to 100% of the arm gravitational load) provided by a passive upper-limb occupational exoskeleton on muscles' activity during repetitive arm movements. The effect of the exoskeleton on muscle activity was evaluated by the comparison of muscle activations with and without the exoskeleton. The average muscle activation was computed considering shoulder full flexion-extension cycles, and sub-movements, namely the arm-lifting (i.e., flexion) and arm-lowering (i.e., extension) movements. Results showed a quasi-linear correlation between antigravitational support and muscle activity reductions, both when considering the full flexion-extension cycle and in the arm-lifting movement (reductions were up to 64 and 61% compared to not wearing the exoskeleton, respectively). When considering the arm-lowering movement, providing antigravitational support close to or higher than 100% of the arm gravitational load led to increased muscle activations of the extensors (up to 127%), suggesting that such an amount of antigravitational support may be not effective for a complete biomechanical load reduction on the shoulder district in dynamic tasks.

Effects of a passive shoulder exoskeleton on muscle activity among Danish slaughterhouse workers

AIM

To evaluate the effect of a shoulder exoskeleton on muscle activity and to compare the effect with a lifting glove among slaughterhouse workers in occupational settings.

MATERIALS AND METHODS

We conducted a crossover study of 26 workers measured during two work days with and without the use of a passive shoulder exoskeleton and a lifting glove at a Danish slaughterhouse. Electromyography sensors were placed bilateral on 5 shoulder muscles. The 10th, 50th, and 90th percentiles of muscle activity normalized by maximal voluntary contractions were measured and analyzed using mixed effect models.

RESULTS

For the 50th percentiles of the agonist muscles, the exoskeleton reduced muscle activity bilaterally for deltoid anterior with up to 29.47%, deltoid middle with 10.22%, and upper trapezius with 22.21%. The lifting glove only reduced muscle activity for right deltoid anterior (36.59%) and upper trapezius (7.11%), but generally increased left muscle activity with up to 15.58%.

DISCUSSION

The exoskeleton showed larger reductions in muscle activity compared to the lifting glove.

Comparison of shoulder functions between assembly workers with and without subacromial pain syndrome

BACKGROUND: The occurrence of subacromial pain syndrome (SPS) is associated with the frequent handling and lifting of heavy loads and excessive repetitive work. Thus, assembly workers have a high prevalence of SPS. OBJECTIVE: The purpose of this study was to investigate differences in shoulder ROM, muscle strength, asymmetry ratio, function, productivity, and depression between workers with and without SPS. METHODS: Sixty-seven male workers (35 workers with SPS and 32 workers without SPS) participated in this study. Shoulder internal rotation (SIR), shoulder external rotation (SER), shoulder abduction (SAB), shoulder horizontal adduction ROM and SIR, SER, elbow flexion (EF), scapular depression and adduction, scapular protraction strength were measured. The asymmetry ratio was calculated using the asymmetry ratio formula; shoulder functions were measured using the shoulder pain and disability index (SPADI), disabilities of the arm, shoulder, and hand (DASH), and visual analogue scale (VAS); and Endicott work productivity scale (EWPS). RESULTS: The SPADI (p = 0.001), DASH (p = 0.001), and VAS (p = 0.001) values of workers with SPS were higher than those of workers without SPS. Also, workers with SPS had lower SIR (p = 0.001) and SAB (p = 0.002) ROM compared to workers without SPS. In addition, workers with SPS exhibited lower SIR (p = 0.012) strength than workers without SPS. Workers with SPS had higher asymmetry ratio in SIR (p = 0.015), SER (p = 0.005), and EF (p = 0.008) strength than workers without SPS. CONCLUSIONS: The SIR, SAB ROM, SIR strength, and the asymmetry ratio of SIR, SER, EF strengths could provide an important baseline comparison for the workers with SPS.

Musculoskeletal health climate is associated with musculoskeletal pain and sickness absence among workers: a cross-sectional study

OBJECTIVES

This study aimed to investigate whether a musculoskeletal health climate, expressing the shared perceptions among workers concerning musculoskeletal health, is associated with number of musculoskeletal pain sites and sickness absence.

DESIGN

Cross-sectional study.

SETTING

Six slaughterhouses from 2 companies in Denmark and 6 home-nursing units and 12 nursing homes from 1 municipality in Jutland, Denmark.

PARTICIPANTS

A total of 1092 slaughter house workers and 410 care workers completed an online questionnaire from February to October 2019.

OUTCOME MEASURES

The exposure variable was musculoskeletal health climate assessed by two domains; (1) perceived management priority of musculoskeletal health measured by a modified subscale from the Nordic Safety Climate Questionnaire and (2) work group pain acceptance which was a modified version of the activity engagement subscale of the chronic pain acceptance scale. Outcomes variables were number of musculoskeletal pain sites (0-6) and days with sickness absence.

RESULTS

The associations between the two subscales, number of musculoskeletal pain sites and sickness absence were calculated using mixed linear and generalised estimating equation regression models. Higher perceived management priority scores were associated with a lower number of musculoskeletal pain sites across both job groups: β=-.57 (95% CI -0.91 to -0.23) and sickness absence (>5 days) due to musculoskeletal pain prevalence ratio (PR) 0.79 (95% CI 0.57 to 1.08). In contrast higher work group pain acceptance scores were associated with higher number of musculoskeletal pain sites: β=0.38 (0.11 to 0.66), whereas associations with sickness absences seemed to be modified by job groups; PR 1.59 care workers and PR 0.86 slaughterhouse workers.

CONCLUSION

The observed relationship between musculoskeletal health climate, musculoskeletal pain sites and sickness absence indicate that cultural factors should receive increased attention in work place preventive interventions.

Publication Trends and Hot Spots in Subacromial Impingement Syndrome Research: A Bibliometric Analysis of the Web of Science Core Collection

Background

In recent years, the research on subacromial impingement syndrome (SIS) has gradually increased. Although the research directions are diverse, the overall research status and trend are not clear.

Objective

The aim of our study was to use bibliometric analysis to identify the trends in SIS-related research and to analyze the most highly cited scientific publications on SIS.

Methods

All data were retrieved from the Web of Science Core Collection database, and the year of publications, countries, journals, institutions and total number of citations were extracted and analyzed. The results related to countries, institutions and keywords were then analyzed using VOSviewer software and bibliometrics online analysis platform. And, we also identified the 100 most cited articles on SIS.

Results

A total of 548 articles related to AIS were identified. The frequency of publication on SIS has increased substantially over time. Among all countries, Turkey has contributed the most publications on SIS (n=118). The institution with the most articles was Istanbul University (n=17). Journal of Shoulder and Elbow Surgery topped the list of journals and has published 19 SIS-related publications. The hotspot of research changed from the former arthroscopic surgery to physical therapy and rehabilitation.

Conclusion

The scientific research on SIS has rapidly expanded in recent years. This study represents the first bibliometric analysis of SIS, gives us a systematic and comprehensive summary into the development of SIS.

Comparison of the Shoulder External Rotator Strength and Asymmetry Ratio Between Workers With and Without Shoulder Impingement Syndrome

ABSTRACT

Kim, J-H, Kwon, O-Y, Hwang, U-J, Jung, S-H, Ahn, S-H, and Kim, H-A. Comparison of shoulder external rotator strength and the asymmetry ratio between workers with and without shoulder impingement syndrome. J Strength Cond Res 35(12): 3364-3369, 2021-Shoulder impingement syndrome (SIS) is the most common shoulder problem causing shoulder pain. Several studies have indicated that shoulder external rotator muscles provide dynamic stability to the shoulder joint. However, the relationship of SIS to changes in shoulder external rotator muscle strength remains controversial. The purpose of the study was to compare the shoulder external rotator strength and asymmetry ratio between workers with SIS and the normal group in a side-lying position. Twelve male industrial workers with SIS and the normal group of 12 workers participated in this study. A pulling sensor measured shoulder external rotator muscle strength in a side-lying position with the shoulder at 0° and 90° of flexion. The asymmetry ratio was calculated by a specific formula using the shoulder external rotator muscle strength of the dominant side and the unaffected side. Two-way analysis of variance was used to determine between-group differences in shoulder external rotator muscle strength and the asymmetry ratio among the 2 positions. Subjects with SIS did not exhibit significant differences in shoulder external rotator muscle strength in the side-lying position with the shoulder at 0° and 90° of flexion relative to the normal group. However, subjects with SIS had a significantly increased asymmetry ratio of shoulder external rotation strength in the side-lying position with the shoulder at 90° of flexion compared with the normal group. In conclusion, workers with SIS had an asymmetry of shoulder external rotator strength in side-lying with the shoulder at 90° of flexion.

Occupational exoskeletons: A roadmap toward large-scale adoption. Methodology and challenges of bringing exoskeletons to workplaces

The large-scale adoption of occupational exoskeletons (OEs) will only happen if clear evidence of effectiveness of the devices is available. Performing product-specific field validation studies would allow the stakeholders and decision-makers (e.g., employers, ergonomists, health, and safety departments) to assess OEs' effectiveness in their specific work contexts and with experienced workers, who could further provide useful insights on practical issues related to exoskeleton daily use. This paper reviews present-day scientific methods for assessing the effectiveness of OEs in laboratory and field studies, and presents the vision of the authors on a roadmap that could lead to large-scale adoption of this technology. The analysis of the state-of-the-art shows methodological differences between laboratory and field studies. While the former are more extensively reported in scientific papers, they exhibit limited generalizability of the findings to real-world scenarios. On the contrary, field studies are limited in sample sizes and frequently focused only on subjective metrics. We propose a roadmap to promote large-scale knowledge-based adoption of OEs. It details that the analysis of the costs and benefits of this technology should be communicated to all stakeholders to facilitate informed decision making, so that each stakeholder can develop their specific role regarding this innovation. Large-scale field studies can help identify and monitor the possible side-effects related to exoskeleton use in real work situations, as well as provide a comprehensive scientific knowledge base to support the revision of ergonomics risk-assessment methods, safety standards and regulations, and the definition of guidelines and practices for the selection and use of OEs.

Shoulder moments and angles during single and combined manual material handling tasks

Shoulder musculoskeletal disorders due to manual material handling tasks are common workplace injuries. Here we investigated the difference in shoulder biomechanics (moments and angles) between a single task of removing a box from a shelf (or depositing a box on a shelf) and the equivalent part of a combined task that consisted of removing, carrying and depositing boxes; that is, a single removing [depositing] task was compared with the removing [depositing] part of a combined task. We found that the peak and cumulative shoulder moments were larger during the single-task paradigm than during the equivalent part of the combined task by 26.3 and 25.5%, respectively. The two paradigms also differed in terms of shoulder angles. It is likely that the main contributors to this overestimation were differences between the single and combined tasks in terms of the lever arm (i.e. horizontal distance), the shoulder angle, and the task duration. Practitioners' Summary: We investigated shoulder moments during single and combined manual material handling tasks. Shoulder moments were found to be smaller during combined tasks. Practitioners should consider that analysing combined tasks using estimations based on single tasks could result in an overestimation of 26.3 and 25.5% in peak and cumulative shoulder moments, respectively.Abbrevaitions: MSDs: musculoskeletal disorders; MMH: manual material handling; LMM: linear mixed model.

Occupational differences in disability retirement due to a shoulder lesion: do work-related factors matter?

Objective

To identify occupations with a high risk of disability retirement due to a shoulder lesion and to examine the effect of physical and psychosocial work-related factors on occupational differences in disability retirement.

Methods

We followed Finnish wage earners aged 30–59 years (n = 1,135,654) from 2005 to 2014 for full disability retirement due to a shoulder lesion. The work-related exposures were assessed with job exposure matrices. We calculated age-adjusted incidence rates and hazard ratios to test for the association between occupation and disability retirement due to a shoulder lesion. We also examined the contribution of work-related exposures to the excess risk of disability retirement.

Results

As compared to professionals, the age-adjusted risk of disability retirement was increased among men in all occupational groups except managers and customer service clerks and among women in several occupational groups. Adjustment for education attenuated the occupational differences considerably, particularly among women. The physical work-related factors fully explained the excess risk of disability retirement due to a shoulder lesion among male finance and sales associate professionals and administrative secretaries as well as among agricultural and fishery workers. In women, the physical work-related factors fully explained the excess risk among construction workers, electricians and plumbers. For both genders, the contribution of psychosocial factors to excess risk of disability retirement was modest and seen for monotonous work only.

Conclusions

A reduction of the level of physical work load factors as well as monotonousness of work has a potential to prevent work disability due to a shoulder lesion.

Electronic supplementary material

The online version of this article (10.1007/s00420-020-01549-y) contains supplementary material, which is available to authorized users.

Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis

Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease.

Effect of Balance Taping Using Kinesiology Tape and Cross Taping on Shoulder Impingement Syndrome: A Case Report

Background and objectives: Shoulder impingement syndrome (SIS) is the most common disorder among people with shoulder pain. The purpose of this case report was to investigate the effect of the combined application of balance taping using kinesiology tape and cross taping on a part-time worker with SIS. Case Report: Combined balance taping and cross taping was applied for 3 weeks (average, 16 hours per day) on a part-time worker with severe pain and a limited range of motion (ROM) in the shoulder who had visual analogue scale (VAS) pain scores of 7 and 8 out of 10 for shoulder flexion and abduction, respectively, and pain and disability scores of the Shoulder Pain Disability Index (SPADI) of 37 out of 50 and 29 out of 80, respectively. After the combined application of balance taping and cross taping, the VAS pain scores for shoulder flexion and abduction decreased from 7 to 0 and from 8 to 0, respectively, and the ROM increased to a normal range. The SPADI pain score decreased from 37 to 2, and the disability score decreased from 29 to 1. Shoulder activity level also increased, and the patient was able to return to his part-time job. Conclusions: We suggest combined application of balance taping and cross taping as an effective treatment for part-time workers with SIS.

DRY NEEDLING IN THE MANAGEMENT OF PATIENTS MEETING CLINICAL DIAGNOSTIC CRITERIA FOR SUBACROMIAL PAIN SYNDROME: A CASE SERIES

BACKGROUND

Physical therapy interventions of exercise and manual therapy provide benefit in treatment of subacromial pain syndrome (SAPS). Dry needling is an emerging technique for treating musculoskeletal conditions; however, conflicting investigative evidence exists regarding the use of dry needling for SAPS.

PURPOSE

The purpose of this case series was to describe the use of dry needling, in conjunction with exercise, as a management strategy for patients meeting clinical diagnostic criteria of SAPS and to observe the short- and intermediate-term effects of dry needling with therapeutic exercise in this population. A secondary purpose was to describe a framework of clinical reasoning to guide the pragmatic application of dry needling and exercise in clinical practice.

STUDY DESIGN

Case series.

METHODS

Twenty-five patients met criteria for SAPS and provided informed consent. Patients received examination-based dry needling for the first two visits with exercises added beginning at the third treatment session to help distinguish treatment effects. The primary outcome measure used in this study was the Quick Disabilities of the Arm, Shoulder, and Hand (Q-DASH) survey assessed at their third clinical visit, at four-weeks after starting intervention and again at a three-month follow up visit.

RESULTS

On the Q-DASH survey 21 of 24 patients reported improvement at the third visit (range 4.5 to 38.6 points) and 19 of 22 reported improvement at the 3-month follow-up (range 0.1-54.5 points) relative to baseline. Sixteen of 24 patients at the third visit and 19 of 22 patients at the 3-month follow-up reported Global Rating of Changes scores of +3 or greater.

CONCLUSION

This case series provides insight to the observed short- and intermediate-term effects of dry needling combined with exercise for SAPS. Additionally, it discusses the framework of clinical reasoning when applying this intervention. The results are encouraging for dry needling as an adjunct to exercise for treating patients with SAPS.

LEVEL OF EVIDENCE

Therapy, level 4.

Could long-term overhead load in painters be associated with rotator cuff lesions? A pilot study

Background

Use of the arm above shoulder level has been described as a risk factor for developing rotator cuff tears (RCT). There is a lack of information regarding the frequency and distribution of RCT in a population using their arms above shoulder level during daily work. The aim of this study was to analyze clinical and radiographic findings in a population of painters working more than 10 years and to compare the results with a control group (CG)

Materials and methods

100 individuals working more than 10 years as a painter were compared to 100 matched controls without using their arms above shoulder level. MRI scans were performed in all participants. Clinically, the Constant score, DASH score and range of motion (ROM) of the shoulders were analyzed.

Results

In the painter group (PG) a tear of the supraspinatus tendon was detected in 45% (10%full-thickness; 35% partial) compared to 8% in the (CG) (3% full-thickness; 5%partial; p<0.001). Impingement test was painful in 52% of PG and 7% of CG (p<0.001). The Constant score in the PG was significantly lower compared to the CG (62 vs. 93 points; p<0.001). PG had significantly worse DASH scores and inferior active and passive ROM of the dominant shoulders. In the multivariable logistic regression analysis, three risk factors (smoking, sports activity, and handedness) showed no effect. However, group membership (PG/CG) and age revealed a significant effect.

Conclusion

Long-term occupational load on the shoulders in painters seems to be associated with an increased risk for developing RCT. Our findings may provide support for developing preventive strategies for this unique cohort.

Level of evidence: III

Strength Reduction in Unilateral Shoulder Pain: Is the Healthy Side Really Healthy in Rotator Cuff Disease?

OBJECTIVE

The primary aim was to ascertain whether unilateral shoulder pain is implicated in strength reduction both on the ipsilateral and contralateral side. Secondarily, we aimed to determine whether strength was affected by sonographic tendon abnormalities.

DESIGN

A total of 122 subjects were evaluated. Sixty-six female subjects with unilateral shoulder pain in the dominant arm were recruited. Abduction strength was measured in both the dominant and nondominant arm. High-resolution ultrasonography was also conducted on both shoulders. A match-paired control group (n = 66) composed of healthy volunteers underwent the same strength and sonography tests. Subjects with any radiographic anomaly were excluded from the control group. A mixed analysis of variance was performed to test the effect of unilateral shoulder pain on abduction strength. The effect of tendinopathy on shoulder strength was investigated using a mixed 2 × 2 analysis of variance.

RESULTS

Analysis of variance showed that patients with dominant shoulder pain had lower shoulder strength (11.65 ± 4.05 kg) when compared with controls (14.37 ± 4.00 kg; F = 10.454, P = 0.002). No statistically significant effects were found when comparing subjects with and without tendinopathy among the study group.

CONCLUSIONS

In patients with unilateral shoulder pain, abduction strength was found to be lower both on the ipsilateral and contralateral side. The presence of tendinopathy did not affect the reduction in strength. Future research is needed to substantiate these findings.

Risk of subacromial shoulder disorder in airport baggage handlers: combining duration and intensity of musculoskeletal shoulder loads

Musculoskeletal shoulder load among baggage handlers measured by combining duration and intensity based on biomechanical and epidemiological information may be a stronger predictor of subacromial shoulder disorders than baggage handler seniority. In 2012, a cohort of baggage handlers employed at Copenhagen Airport in 1990-2012, and a cohort of unskilled otherwise employed men answered a survey. Self-reported information on work tasks during employment in the airport in combination with work task specific biomechanically modelled forces in the shoulder joint was used to estimate shoulder load. Exposure measures were accumulated shoulder abduction moment, accumulated shoulder compression force, accumulated supraspinatus force and baggage handler seniority. The outcome was subacromial shoulder disorder registered in the Danish National Patient Register. When analyses were adjusted by all confounders except age, exposure variables showed close to significant associations with subacromial shoulder disorder. Results could not confirm our hypothesis that combined information on work task duration and shoulder load intensity was stronger associated with subacromial shoulder disorder than seniority. Practitioner Summary: In this study we sought to identify if the exposure to work-related musculoskeletal shoulder loading including duration and intensity among baggage handlers was associated with subacromial shoulder disorder. We found that there was an association but this was not stronger than that between baggage handler seniority and subacromial shoulder disorder.

Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis

The objective of this systematic review and meta-analysis is to examine which work-related risk factors are associated with specific soft tissue shoulder disorders. We searched the electronic databases of Medline and Embase for articles published between 2009 and 24 March 2016 and included the references of a systematic review performed for the period before 2009. Primary cross-sectional and longitudinal studies were included when outcome data were described in terms of clinically assessed soft tissue shoulder disorders and at least two levels of work-related exposure were mentioned (exposed vs less or non-exposed). Two authors independently selected studies, extracted data and assessed study quality. For longitudinal studies, we performed meta-analyses and used GRADE (Grades of Recommendations, Assessment, Development and Evaluation) to assess the evidence for the associations between risk factors and the onset of shoulder disorders. Twenty-seven studies met the inclusion criteria. In total, 16 300 patients with specific soft tissue shoulder disorders from a population of 2 413 722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis of one case-control and six prospective cohort studies. This meta-analysis revealed moderate evidence for associations between shoulder disorders and arm-hand elevation (OR=1.9, 95% CI 1.47 to 2.47) and shoulder load (OR=2.0, 95% CI 1.90 to 2.10) and low to very low evidence for hand force exertion (OR=1.5, 95% CI 1.25 to 1.87), hand-arm vibration (OR=1.3, 95% CI 1.01 to 1.77), psychosocial job demands (OR=1.1, 95% CI 1.01 to 1.25) and working together with temporary workers (OR=2.2, 95% CI 1.2 to 4.2). Low-quality evidence for no associations was found for arm repetition, social support, decision latitude, job control and job security. Moderate evidence was found that arm-hand elevation and shoulder load double the risk of specific shoulder disorders. Low to very-low-quality evidence was found for an association between hand force exertion, hand-arm vibration, psychosocial job demands and working together with temporary workers and the incidence of specific shoulder disorders.

Subacromial shoulder disorders among baggage handlers: an observational cohort study

PURPOSE

To assess the influence of cumulative employment as baggage handler on the risk of incident subacromial shoulder disorders. Baggage handling is characterized by repetitive work primarily consisting of heavy lifting in awkward positions and time pressure.

METHODS

This cohort study is based on the Copenhagen Airport Cohort consisting of unskilled men with employment at Copenhagen Airport and unskilled men with employment in other firms in the Greater Copenhagen area during the period 1990-2012. Only men were included. We followed the cohort in the National Patient Register and Civil Registration System. The primary exposure was cumulative years of employment as a baggage handler, and the primary outcome was diagnoses and surgical treatment of subacromial shoulder disorders.

RESULTS

The cohort contained 3396 baggage handlers and 63,909 workers in the reference group. Baggage handlers with longer cumulative years of employment had higher incidence compared to baggage handlers with shorter employment; for example, baggage handlers with 10-19 years of employment had incidence rate ratio of 2.07 (95 % confidence interval, 1.27-3.38) compared to baggage handlers with less than 3 years of employment. Spline regression showed an increase in incidence within the first few years after employment whereupon the increased risk remained constant for longer employment. Baggage handlers had increased incidence in younger ages than the reference population.

CONCLUSIONS

In this large cohort study, we found increased incidence of subacromial shoulder disorders for workers with longer cumulative years of employment. These results support that long-term lifting in awkward positions and time pressure influences the risk of subacromial shoulder disorders.

The Impact of Physical and Ergonomic Hazards on Poultry Abattoir Processing Workers: A Review

The poultry abattoir industry continues to grow and contribute significantly to the gross domestic product in many countries. The industry expects working shifts of eight to eleven hours, during which workers are exposed to occupational hazards which include physical hazards ranging from noise, vibration, exposure to cold and ergonomic stress from manual, repetitive tasks that require force. A PubMed, Medline and Science Direct online database search, using specific keywords was conducted and the results confirmed that physical and ergonomic hazards impact on abattoir processing workers health, with harm not only to workers’ health but also as an economic burden due to the loss of their livelihoods and the need for treatment and compensation in the industry. This review endeavours to highlight the contribution poultry processing plays in the development of physical agents and ergonomic stress related occupational diseases in poultry abattoir processing workers. The impact includes noise-induced hearing loss, increased blood pressure, menstrual and work related upper limb disorders. These are summarised as a quick reference guide for poultry abattoir owners, abattoir workers, poultry associations, occupational hygienists and medical practitioners to assist in the safer management of occupational health in poultry abattoirs.

Subacromial Space Width: Does Overuse or Genetics Play a Greater Role in Determining It? An MRI Study on Elderly Twins

BACKGROUND

Age and peripheral microcirculation disorders are the main causes of rotator cuff degeneration. Acromion variants may affect subacromial space width, causing a pathological narrowing of the space that may compromise the cuff integrity. However, it is not clear if the subacromial space width is genetically determined or if it changes according to loading conditions. To clarify this unresolved question, we performed an MRI (magnetic resonance imaging) study with the aim of evaluating the acromiohumeral distance in a group of elderly monozygotic and dizygotic twins, and we analyzed the obtained data using the twin design to separate the contributions of shared and unique environments.

METHODS

We identified twenty-nine pairs of elderly twins. On MRI scans, we evaluated the acromiohumeral distance and health status of the rotator cuff tendons. Heritability, defined as the proportion of total variance of a specific characteristic in a particular population due to a genetic cause, was estimated as twice the difference between the intraclass correlation coefficients for monozygotic and dizygotic pairs. The influence of shared environment, due to environmental factors that contribute to twin and sibling similarity, was calculated as the difference between the monozygotic correlation coefficient and the heritability index. One-way ANOVA (analysis of variance) was used to estimate the differences among job categories, both in the total cohort and within zygosity groups.

RESULTS

The intraclass correlation coefficient was substantially higher for monozygotic than for dizygotic twins, indicating a high degree of concordance of the acromiohumeral distance in pairs of individuals who shared 100% of their genes. The heritability index was 0.82, and shared and unique environmental contributions were both 0.09. There were no significant differences among subjects in different job categories, either in the total cohort (p = 0.685) or within the monozygotic (p = 0.719) and dizygotic groups (p = 0.957).

CONCLUSIONS

The acromiohumeral distance is mainly genetically determined and only marginally influenced by external factors.

Shoulder impingement in the United States military

BACKGROUND

Little is known about the incidence and characteristics of primary, or external, shoulder impingement in an occupationally and physically active population. A longitudinal, prospective epidemiologic database was used to determine the incidence and risk factors for shoulder subacromial impingement in the United States (U.S.) military. Our hypothesis was that shoulder impingement is influenced by age, sex, race, military rank, and branch of service.

METHODS

The Defense Medical Epidemiology Database was queried for all shoulder impingement injuries using International Classification of Disease, Ninth Addition, Clinical Modification code 726.10 within a 10-year period from 1999 through 2008. An overall injury incidence was calculated, and a multivariate analysis performed among demographic groups.

RESULTS

In an at-risk population of 13,768,534 person-years, we identified 106,940 cases of shoulder impingement resulting in an incidence of 7.77/1000 person-years in the U.S. military. The incidence of shoulder impingement increased with age and was highest in the group aged ≥40 years (incidence rate ratio [IRR], 4.90; 95% confidence interval [CI], 4.61-5.21), was 9.5% higher among men (IRR, 1.10, 95% CI, 1.06-1.13), and compared with service members in the Navy, those in the Air Force, Army, and Marine Corps were associated with higher rates of shoulder impingement (IRR, 1.46 [95% CI, 1.42-1.50], 1.42 [95% CI, 1.39-1.46], and 1.31 [95% CI, 1.26-1.36], respectively).

CONCLUSIONS

The incidence of shoulder impingement among U.S. military personnel is 7.77/1000 person-years. An age of ≥40 years was a significant independent risk factor for injury.

Fatigue-induced glenohumeral and scapulothoracic kinematic variability: Implications for subacromial space reduction

Superior humeral head translation and scapula reorientation can reduce the subacromial space. While these kinematic abnormalities exist in injured populations, the effect of muscle fatigue is unclear. Additionally, these mechanisms were typically studied independently, thereby neglecting potential covariance. This research evaluated the influence of upper extremity muscle fatigue on glenohumeral and scapulothoracic kinematics and defined their relationship. Radiography and motion tracking systems captured these kinematic relationships, during scapula plane elevation, both before and after fatigue. Fatigue-induced changes in humeral head position, scapular orientation and the minimum subacromial space width were measured. High inter-subject variability existed for each measure which precluded identification of mean differences at the population level. However, significant scapular upward rotation occurred following fatigue (p=0.0002). Despite similar population mean results, between 39% and 57% of participants exhibited fatigue-related changes in disadvantageous orientations. Additionally, correlations between measures were generally fair (0.21-0.40) and highly dependent on elevation, likely attributed to the variable fatigue responses. Overall, the data confirms that fatigue-induced changes in kinematics poses highly variable risk of subacromial impingement syndrome across individuals. Thus, solely considering the "average" or mean population response likely underestimates potentially injurious fatigue consequences.

Prevalence of epicondylitis, rotator cuff syndrome, and low back pain in Latino poultry workers and manual laborers

BACKGROUND

The goal of this study is to improve understanding of immigrant Latino manual workers' occupational health, focusing on upper body musculoskeletal injury.

METHODS

Physical exams were conducted with a representative sample of 516 Latino poultry workers and manual laborers in western North Carolina; outcome measures were prevalence of epicondylitis, rotator cuff syndrome, and low back pain.

RESULTS

Low back pain (n = 89; 17.2%) and rotator cuff syndrome (n = 76; 14.7%) indicated by physical exam was common. Epicondylitis was less common, but still frequent (n = 30; 5.8%). Prevalence of each outcome did not differ between poultry processing workers and other manual workers. Workers >40 years old had greater incidence of rotator cuff syndrome and epicondylitis.

CONCLUSIONS

Epicondylitis, rotator cuff syndrome, and low back pain are common in immigrant Latino workers, and may negatively impact long-term health and contribute to occupational health disparities.

Joint position sense is not altered during shoulder medial and lateral rotations in female assembly line workers with shoulder impingement syndrome

This study evaluated joint position sense (JPS) during medial and lateral rotations of the shoulder in female workers with and without shoulder impingement syndrome (SIS). Three groups were assessed. The case group consisted of 15 female assembly line workers (35.5, SD 5.8 years) with unilateral SIS. Control group 1 consisted of 15 female assembly line workers asymptomatic for SIS (34.4, SD 5.5 years) and control group 2 consisted of 15 female subjects (33.1, SD 6.2 years) asymptomatic for SIS and with no exposure to activities with the upper limbs. The JPS was evaluated bilaterally during passive (2°/sec) and active (5°/sec) repositioning tests using an isokinetic dynamometer. The target angles were 45° of lateral rotation (achieved by medially rotating the shoulder from 90° of lateral rotation) and 75° of lateral rotation (achieved by laterally rotating the shoulder from neutral rotation). There were no differences between sides for all groups (p  >  0.05). There were no differences in any of the variables between the case group and the control groups (p  >  0.05). The results of this study suggest that JPS during medial and lateral rotations of the shoulder is not altered in female assembly line workers with SIS.

Analyses of possible risk factors for subacromial impingement syndrome

AIM: To evaluate the association between various risk factors, including sleeping position, and impingement syndrome. Impingement syndrome is the most common cause of shoulder problems. The pathogenesis of this problem is still debated these days.

METHODS: This was a case control study conducted at the outpatient clinic of Songklanakarind hospital. Data regarding history, physical examination and radiographic evaluations using supraspinatous outlet views were obtained from all patients with clinically suspected impingement syndrome. The diagnoses of impingement syndrome were confirmed by a xylocaine subacromial injection test. All patients were interviewed concerning their usual sleeping position, which was categorized into supine, decubitus, prone and undetermined. Radiographs were evaluated to determine the shape of the acromion, which was divided into 3 types: flat, curved and hook. We used logistic regression analysis to determine the association between risk factors and outcome.

RESULTS: The study group included 111 patients with impingement syndrome and 191 healthy volunteers as a control group. The mean age was about 50 years with a body mass index (BMI) of 24 kg/m² in both groups. The most common shape of the acromion was flat (84.5%), followed by curved (10.7%) and hook (4.8%). We found the 4 independent risk factors affecting impingement syndrome were smoking status, occupation, acromion shape and sleeping position. Patients who currently smoked had a 6.8 times greater risk of impingement syndrome compared to non-smokers (OR 6.8, 95% CI: 1.2-39) and government officers had a 6.3 times increased risk compared to rubber tappers (OR 6.3, 95% CI: 1.3-30.3). Patients with a hook type acromion had 6.2 times the risk of flat type (OR 6.2, 95% CI: 1.1-35) and patients who slept in the decubitus position had 3.7 times the risk of those who slept in the supine position (OR 3.7, 95% CI: 1.2-11.6). No significant associations were found between age, sex, BMI, sports activity and impingement syndrome.

CONCLUSION: Independent risk factors affecting impingement syndrome are current smoker, government officer, a hook-type acromion and the decubitus sleeping position.

Optimising case definitions of upper limb disorder for aetiological research and prevention: a review

Experts disagree about the optimal classification of upper limb disorders (ULDs). To explore whether differences in associations with occupational risk factors offer a basis for choosing between case definitions in aetiological research and surveillance, we analysed previously published research. Eligible reports (those with estimates of relative risk (RR) for >1 case definition relative to identical exposures were identified from systematic reviews of ULD and occupation and by hand-searching five peer-review journals published between January 1990 and June 2010. We abstracted details by anatomical site of the case and exposure definitions employed and paired estimates of RR, for alternative case definitions with identical occupational exposures. Pairs of case definitions were typically nested, a stricter definition being a subset of a simpler version. Differences in RR between paired definitions were expressed as the ratio of RRs, using that for the simpler definition as the denominator. We found 21 reports, yielding 320 pairs of RRs (82, 75 and 163 respectively at the shoulder, elbow, and distal arm). Ratios of RRs were frequently ≤1 (46%), the median ratio overall and by anatomical site being close to unity. In only 2% of comparisons did ratios reach ≥4. We conclude that complex ULD case definitions (e.g. involving physical signs, more specific symptom patterns, and investigations) yield similar associations with occupational risk factors to those using simpler definitions. Thus, in population-based aetiological research and surveillance, simple case definitions should normally suffice. Data on risk factors can justifiably be pooled in meta-analyses, despite differences in case definition.

A study on health status of women engaged in a home-based "Papad-making" industry in a slum area of Kolkata

Background:

The ‘papad-making’ industries of India have provided ample opportunity of employment for the women workers of low socio-economic class although their problems are not much explored. In this study an attempt had been made for the same.

Aims:

1. To find out the health status of the women. 2. To find out the factors, in the working conditions, influencing their health status. 3. To assess their felt needs.

Settings:

A slum area of Kolkata.

Design:

A cross-sectional, descriptive type of observational study.

Methods and Materials:

The slum was chosen by random sampling method. Following this, complete enumeration method was adopted. Data were collected by interview and clinical examination of the women engaged in this occupation with a predesigned and pretested schedule.

Statistical Analysis:

Proportions and Chi-square test.

Results:

77.5% were in the reproductive age group and none were below 14 years. Most of them belonged to poor socioeconomic status. Sixty per cent were in this occupation for more than 10 years and they spent 5 hours for this work daily over and above their household job. Musculoskeletal problem was their commonest health problem. Pallor, angular stomatitis, pedal edema, chronic energy deficiency were found on examination. Personal hygienic measures taken were far from satisfactory. A focus group discussion revealed their health and family problems, dissatisfaction about their working conditions and wage. Other needs identified were home visits for their health care, free medicines and health education.

Conclusion:

Need exists for a participatory occupational health programme for this working population.

Co-occurrence of outlet impingement syndrome of the shoulder and restricted range of motion in the thoracic spine--a prospective study with ultrasound-based motion analysis

Background

Shoulder complaints, and especially the outlet-impingement syndrome, are a common condition. Among other things, poor posture has been discussed as a cause. A correlation between impingement syndrome and restricted mobility of the thoracic spine (T) has been described earlier, but there has been no motion analysis of the thoracic spine to show these correlations. In the present prospective study, we intended to find out whether there is a significant difference in the thoracic sagittal range of motion (ROM) between patients with a shoulder outlet impingement syndrome and a group of patients who had no shoulder pathology. Secondly, we wanted to clarify whether Ott's sign correlates with ultrasound topometric measurements.

Methods

Two sex- and age-matched groups (2 × n = 39) underwent a clinical and an ultrasound topometric examination. The postures examined were sitting up straight, sitting in maximal flexion and sitting in maximal extension. The disabilities of the arm, shoulder and hand (DASH) score (obtained by means of a self-assessment questionnaire) and the Constant score were calculated. Lengthening and shortening of the dorsal projections of the spine in functional positions was measured by tape with Ott's sign.

Results

On examination of the thoracic kyphosis in the erect seated posture there were no significant differences between the two groups (p = 0.66). With ultrasound topometric measurement it was possible to show a significantly restricted segmental mobility of the thoracic spine in the study group compared with the control group (p = 0.01). An in-depth look at the mobility of the subsegments T1-4, T5-8 and T9-12 revealed that differences between the groups in the mobility in the lower two sections of the thoracic spine were significant (T5-8: p = 0.03; T9-12: p = 0.02). The study group had an average Constant score of 35.1 points and the control group, 85.5 (p < 0.001). On the DASH score the patient group reached 34.2 points and the control group, 1.4 (p < 0.001). The results of Ott's sign differed significantly between the two collectives (p = 0.0018), but showed a weak correlation with the ultrasound topometric measurements (study group flexion/extension: r = 0.36/0.43, control group flexion/extension: r = 0.29/0.26).

Conclusion

The mobility of the thoracic spine should receive more attention in the diagnosis and therapy of patients with shoulder outlet impingement syndrome.

Effects of strengthening and stretching exercises applied during working hours on pain and physical impairment in workers with subacromial impingement syndrome

This study evaluated the effectiveness of a rehabilitation program performed during working hours on function and pain in workers with subacromial impingement syndrome. Fourteen male workers (31.93 +/- 5.86 years) in the school supply industry were assessed. The duration of their shoulder pain was 28.50 +/- 33.64 months, and their amount of time in this industry was 9.07 +/- 3.68 years. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire evaluated function of the upper limbs. The Mc Gill Pain Questionnaire quantified the pain by the number of words chosen and the pain rating index (PRI). Subjects completed an 8-week rehabilitation program, twice a week, consisting of cryotherapy, strengthening, and stretching exercises. Subjects' outcome data were collected pre- and post-intervention. The results showed that DASH scores improved (p<0.05) and the number of words chosen and PRI decreased (p<0.05) on the McGill Pain Questionnaire at post-intervention. Results should be interpreted cautiously, considering the lack of a control group in the investigation. In conclusion, it is suggested that an intervention program consisting of cryotherapy, strengthening, and stretching applied during working hours and twice a week may be effective to decrease pain and physical impairment in male workers with subacromial impingement syndrome.

Factors associated with self-estimated work ability and musculoskeletal symptoms among male and female workers in cooled food-processing facilities

This questionnaire study evaluates how work ability and musculoskeletal symptoms associate with physical work factors and individual characteristics of the workers in cooled food-processing facilities. A total of 1,117 workers (response rate 85%) responded to the study. Poor work ability was significantly associated with longer work duration, experience of draught at the workplace, absence from work due to health reasons, and physical inactivity during free time. The amount of local cooling experienced was significantly associated with the risk for musculoskeletal symptoms in the neck-shoulder region, shoulders, wrists and lower back. Additionally, female gender, longer work duration and poor work ability were associated with the increased prevalence of the symptoms. The prevalence of musculoskeletal symptoms was significantly higher among older employees (40 to 64 yr) than among younger employees (18 to 39 yr) for all regions except wrists. Cold discomfort and unpleasant sensations due to the physical factors of work were significantly more common among females than males. The results showed that, in addition to individual characteristics of workers, factors related to work in a cool environment (experience of draught and cooling and long exposure to cold) are associated with poor work ability and musculoskeletal symptoms.

A longitudinal analysis of the effects of a preventive exercise programme on the factors that predict shoulder pain in construction apprentices

Construction apprentices are at risk for developing shoulder pain with increasing exposure to repetitive overhead work. Risk may decrease if shoulder biomechanics are optimised and if risk factors that contribute to shoulder pain onset are identified. This prospective cohort study examined demographic and work-related factors and shoulder pain onset over 2 years in a cohort of 240 construction apprentices. Approximately 50% of the sample (n=117) performed a home exercise programme intended to have a protective effect, while the other 50% served as controls. The proportion of new-onset shoulder pain in the control group was higher than in the exercise group. Regression analysis identified four factors related to new-onset shoulder pain: previous neck pain; working in hot, cold or humid conditions; subject height; and bending and twisting the back. This information may assist employers and workers in preventing shoulder pain. By knowing factors predictive of shoulder pain development in construction workers, employers can take measures to protect workers and may secondarily decrease medical expenses and maintain productivity. Previous neck pain, working in extreme environmental conditions and being shorter all increased a worker's risk of developing shoulder pain. Exercises to optimise shoulder biomechanics have a small effect on preventing shoulder pain development.

Psychosocial factors and shoulder symptom development among workers

BACKGROUND

Shoulder injuries are a common cause of pain and discomfort. Many work-related factors have been associated with the onset of shoulder symptoms. The psychosocial concepts in the demand-control model have been studied in association with musculoskeletal symptoms but with heterogeneous findings. The purpose of this study was to assess the relationship between the psychosocial concepts of the demand-control model and the incidence of shoulder symptoms in a working population.

METHODS

After following 424 subjects for approximately 1 year, 85 incident cases were identified from self-reported data. Cox proportional hazards modeling was used to assess the associations between shoulder symptoms and demand-control model quadrants.

RESULTS

Cases were more likely to be female and report other upper extremity symptoms at baseline (P < 0.05). From the hazard models, being in either a passive or high strain job quadrant was associated with the incidence of shoulder symptoms. Hazard ratios were 2.17, 95% CI 1.02-4.66 and 2.19, 95% CI 1.08-4.42, respectively.

CONCLUSIONS

Using self-reporting to determine demand-control quadrants was successful in identifying subjects at risk of developing work-related shoulder symptoms. Research is needed to determine if this relationship holds with clinically diagnosed shoulder and other upper extremity musculoskeletal disorders. This may be part of a simple tool for assessing risk of developing these UEMSDs.

The effect of joint instability on latency and recruitment order of the shoulder muscles

Several shoulder dysfunctions are generally characterized as Shoulder Impingement Syndrome (SIS). Specifically, glenohumeral instability (GI) has been viewed as a primary cause of SIS in young individuals, mainly in overhead athletics. Past studies have associated GI with modifications in latency, recruitment order and/or EMG activity. However, it is not clear if pain and/or joint instability can account for these observed changes. The aim of this investigation was to analyze the effect of glenohumeral instability on the latencies and recruitment order of the superficial muscles of the glenohumeral and scapulothoracic joints in swimmers without pain symptom. Eight individuals with and eight without history of Shoulder Impingement Syndrome performed bilateral and simultaneous shoulder elevations at three different distances. The shoulder kinematics and EMG activities of glenohumeral and scapulothoracic muscles were registered. Results showed that subjects of both groups performed the task with similar latencies and recruitment order of the muscle activities. We conclude that shoulder instability does not necessarily affect the latencies and recruitment order of the shoulder muscles during the elevation of the shoulder in the scapular plane. Pain and other factors may be involved in the kinematics and electromyographic alterations demonstrated in other experiments.

Empowerment como forma de prevenção de problemas de saúde em trabalhadores de abatedouros

O objetivo do artigo foi ressaltar a necessidade de esforços educativos que visem ao empowerment de funcionários de abatedouros, baseado nos principais problemas de saúde por eles enfrentados. A rotina em abatedouros consiste em tarefas estressantes e cansativas. As conseqüências incluem problemas músculo-esqueléticos, transmissão de zoonoses, problemas de pele e acidentes com materiais pérfuro-cortantes e animais. Esses trabalhadores geralmente não são especializados, não têm controle sobre suas tarefas, e podem não estar conscientes dos determinantes que afetam sua saúde. Os veterinários são geralmente responsáveis pela rotina de trabalho nesses locais e conhecem os riscos à saúde que a execução dessas tarefas representam. Portanto, esses profissionais poderiam participar mais ativamente na educação para o empowerment dos trabalhadores e não se concentrarem apenas em questões referentes à segurança alimentar.

Overexpression of nitric oxide synthases in tendon overuse

Tendon disorders with a chronic nature, including the rotator cuff, are extremely common, and represent a major clinical problem. Mechanical overload has been proposed as an important etiologic factor in tendinopathies. Nitric oxide (NO), a free radical produced by nitric oxide synthases (NOSs), is a potent regulator and stimulator of biological processes including tendon degeneration and healing. It is also involved in response to mechanical stimuli in different tissues. In an animal model of acutely injured tendon healing temporal and differential expression of NOS isoforms has been demonstrated, suggesting that different patterns of NOSs expression may have different biological functions. Therefore, we hypothesized that tendon overuse may result in a differential upregulation of NOSs, particularly iNOS. An animal model of supraspinatus tendon overuse was utilized, which consisted of treadmill running. A group of animals of the same strain and age subjected to normal cage activity were used as controls. Following a 4-week exercise protocol supraspinatus tendons were harvested, RNA was extracted, and subjected to competitive reverse transcription and polymerase chain reaction (RT-PCR) to determine the expression levels of inducible-, endothelial-, and neuronal-NOS isoforms (i-, e-, and nNOS). The mRNA expression of all three NOS isoforms increased in the supraspinatus tendons as a result of overuse exercise. iNOS and eNOS mRNA expression increased fourfold (p < 0.01), and there was an increase, but statistically not significant, in nNOS mRNA expression in the overused tendons when compared with the controls. This study is the first to show that NOS isoforms are upregulated in rotator cuff tendon as a result of chronic overuse, and suggests the involvement of nitric oxide in the response of tendon tissue to increased mechanical stress.

Hard work never hurt anyone: or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb

Pain in the neck and upper limb is common and contributes considerably to absence from work due to sickness. Evidence suggest that prolonged abnormal posture and repetition contribute to such conditions. Psychosocial risk factors may also play a part in the aetiology of upper limb disorders.

Associação entre distúrbios do ombro e trabalho: breve revisão da literatura

Este artigo apresenta os resultados de uma breve revisão da literatura focalizada nos distúrbios do ombro. As publicações foram pesquisadas nos sites do Medline, Ovid, Lilacs e periódicos Capes, no período de janeiro de 1993 a julho de 2004, com as seguintes palavras-chave: shoulder pain, rotator cuff, job, dor no ombro, manguito rotador, trabalho. Foram selecionados os artigos de acordo com os seguintes critérios: estudo epidemiológico publicado em inglês, português ou espanhol, com informações sobre a carga física ou sobre os fatores psicossociais do trabalho, explicitação do método de avaliação da exposição, presença de dor no ombro ou tendinopatia do manguito rotador. Vinte artigos preencheram todos os critérios de inclusão. Encontrou-se associação positiva entre os distúrbios do ombro e o trabalho praticado pelos sujeitos dos estudos revisados. Restaram como limite da revisão: a heterogeneidade dos artigos quanto à avaliação da exposição, ao tipo de diagnóstico, à metodologia utilizada na condução da pesquisa, e aos meios para avaliação da dor. Os autores discutem a necessidade de aprofundamento dos métodos de investigação de problemas musculoesqueléticos relacionados ao trabalho.

Hard work never hurt anyone--or did it? A review of occupational associations with soft tissue musculoskeletal disorders of the neck and upper limb

Pain in the neck and upper limb is common and contributes greatly to absence due to sickness. Evidence is accumulating that factors such as prolonged abnormal posture and repetition contribute to these conditions. Psychosocial factors may also play a part and the relative importance of these is not yet known. Primary and secondary prevention trials are needed.

Rotator Cuff Impingement

OBJECTIVE

To present a case of shoulder impingement syndrome managed with a conservative multimodal treatment approach.

CLINICAL FEATURES

A patient had anterior shoulder pain and a diffuse ache in the right upper arm, with tenderness in the shoulder region on palpation. Shoulder range of motion was limited with pain and catching, coupled with limited and painful cervical motion. After physical and orthopedic examination, a clinical diagnosis of shoulder impingement syndrome was made.

INTERVENTIONS AND OUTCOME

The patient underwent a multimodal treatment protocol including soft tissue therapy, phonophoresis, diversified manipulation; and rotator cuff and shoulder girdle muscle exercises. Outcomes included pain measurement; range of motion of the shoulder, and return to normal daily, work, and sporting activities. At the end of the treatment protocol the patient was symptom free with all outcome measures normal. The patient was followed up at 4 and 12 weeks and continued to be symptom free with full range of motion and complete return to normal daily and pre-treatment activities.

CONCLUSION

This case report shows the potential benefit of a multimodal chiropractic protocol in resolving symptoms associated with shoulder impingement syndrome.

Work related shoulder disorders: quantitative exposure-response relations with reference to arm posture

AIMS

To determine quantitative exposure-response relations between work with highly elevated arms and supraspinatus tendinitis, shoulder pain with disability, and shoulder pain without disability.

METHODS

A cross sectional study was conducted in a historical cohort of 1886 males from three occupational groups. Exposure measurements were performed for four consecutive working days in a random sample of 72 currently employed subjects. Individual work histories were obtained by questionnaire and register data. Health status was ascertained by physical examination blinded towards exposure and symptoms. Data were analysed by generalised estimating equation and multiple logistic regression with adjustment for potential confounders.

RESULTS

For current upper arm elevation above 90 degrees, a duration increment of 1% of the daily working hours was associated with odds ratios of 1.23 (95% CI 1.10 to 1.39) for supraspinatus tendinitis, 1.16 (95% CI 1.08 to 1.24) for shoulder pain with disability, and 1.08 (95% CI 1.04 to 1.13) for shoulder pain without disability. The outcomes were not related to duration of employment in one of the three trades.

CONCLUSIONS

Quantitative exposure-response relations were established between current work with highly elevated arms and clinically verified shoulder disorders. Substantial long term cumulative effects were not shown. A potential for primary prevention was revealed.

Clinical signs and physical function in neck and upper extremities among elderly female computer users: the NEW study

The aim of the study was to present the prevalence of clinical signs and symptoms among female computer users above 45 years, both in a group with self-reported neck/shoulder trouble (NS cases) and in a group without such trouble (NS controls). The hypothesis was that computer users with self-reported neck/shoulder trouble have more clinical findings than those not reporting trouble, and that a corresponding pattern holds true for physical function. In total 42 and 61 questionnaire-defined NS cases and NS controls participated and went through a clinical examination of the neck and upper extremities and five physical function tests: maximal voluntary contraction (MVC) of shoulder elevation, abduction, and handgrip, as well as endurance at 30% MVC shoulder elevation and a physical performance test. Based on clinical signs and symptoms, trapezius myalgia (38%), tension neck syndrome (17%) and cervicalgia (17%) were the most frequent diagnoses among NS cases, and were significantly more frequent among NS cases than NS controls. A total of 60% of the subjects with reported trouble had one or several of the diagnoses located in the neck/shoulder. Physical function of the shoulder was lower in subjects with self-reported trouble as well as in the subgroup of NS cases with clinical diagnoses. In conclusion, the present clinical diagnoses and physical function tests differed between NS cases and NS controls, and are therefore recommended to be included as quantitative objective measures in assessing musculoskeletal health. Physical function tests should be further developed in order to be able to detect pre-stages of work-related disorders for preventive strategies.