Shoulder disorders in female working-age population: a cross sectional study

Roberto Meroni, Michele Scelsi, Paola Boria, Valerio Sansone, Roberto Meroni, Michele Scelsi, Paola Boria, Valerio Sansone

Abstract

Background: Musculoskeletal disorders (MSDs) are among the most common pathologies in the general population. However, research into the prevalence of upper arm MSDs is hampered by a lack of uniformity in case definition, and by the absence of a gold standard for measurement. Furthermore, some sectors of the population have benefited from extensive research whilst others have largely been ignored.

Study design: Cross-sectional study.

Objectives: to investigate the prevalence of shoulder MSDs in a working age female population not exposed to specific occupational risk factors such as heavy and/or repetitive work, assessing the differences in prevalence recorded by using three different standard measurement tools.

Methods: 302 working aged women were enrolled in this study (age 20-55 years). Each subject underwent three different assessments: standardized questionnaires for symptoms and disability and the SF36 health survey, a clinical assessment performed by a blinded orthopaedic specialist, and an imaging assessment by means of ultrasound (US) and Magnetic Resonance (MR) if indicated.

Results: According to the questionnaire 77 subjects (25.5%) complained of shoulder pain whilst 225 (74.5%) were asymptomatic. According to the clinical examination, 31 subjects (10.3%) resulted positive, whereas 271 subjects (89.7%) had normal shoulders. According to the imaging findings, 26 subjects (8.6%) had alterations to the anatomical structures of the shoulder, whilst 276 subjects (91.4%) had no detectable abnormalities in either shoulder. In all assessments, the prevalence increased with age (p = 0.001).

Conclusion: Depending on the outcome measure used, the prevalence of reported MSDs of the shoulder varies considerably. There is a striking difference between the prevalence of subjective reported symptoms and the standardized clinical/imaging examinations. However, the results of all the assessments did concur in one aspect; there was a significant trend of increased prevalence of shoulder MSDs with age. When looking at reported prevalence, this study shows the importance of noting the measurement method used before making comparisons, as it can vary considerably. The epidemic of shoulder pain reported is not indicative of an epidemic of shoulder pathology.

References

    1. National Research Council (U.S.). Panel on Musculoskeletal Disorders and the Workplace, Institute of Medicine (U.S.) Musculoskeletal disorders and the workplace: low back and upper extremities. Washington, D.C: National Academy Press; 2001.
    1. Sjogaard G, Sejersted O, Winkel J, Smolander J, Jorgensen K, Westgaard R. In: In Work and Health Scientific Basis of Progress in the Working Environment. Johansen. OSaC, editor. Luxembourg: European Commission, Directorate-General V; 1995. Exposure assessment and mechanisms of pathogenesis in work-related musculoskeletal disorders: Significant aspects in the documentation of risk factors.
    1. Bernard BP. In: Musculoskeletal Disorders and Workplace Factors: A Critical Review of Epidemiologic Evidence for Work-Related Musculoskeletal Disorders of the Neck, Upper Extremity, and Low Back. Health USDOHAHSPHSCfDCaPNIfOSa, editor. 1997.
    1. Buckle P, Devereux J. Work-related neck and upper limb musculoskeletal disorders. EU-OSHA, Bilbao: European Agency for Safety and Health at Work; 1999.
    1. Punnett L, Wegman DH. Work-related musculoskeletal disorders: the epidemiologic evidence and the debate. J Electromyogr Kinesiol. 2004;14(1):13–23. doi: 10.1016/j.jelekin.2003.09.015.
    1. Bot SD, van der Waal JM, Terwee CB, van der Windt DA, Schellevis FG, Bouter LM, Dekker J. Incidence and prevalence of complaints of the neck and upper extremity in general practice. Ann Rheum Dis. 2005;64(1):118–123. doi: 10.1136/ard.2003.019349.
    1. Yassi A. Repetitive strain injuries. Lancet. 1997;349(9056):943–947. doi: 10.1016/S0140-6736(96)07221-2.
    1. Trinkoff AM, Lipscomb JA, Geiger-Brown J, Brady B. Musculoskeletal problems of the neck, shoulder, and back and functional consequences in nurses. Am J Ind Med. 2002;41(3):170–178. doi: 10.1002/ajim.10048.
    1. Verjans M, De Broeck V, Eeckelaert L, (Institute) EAfSaHaWP. OSH in figures: young workers: facts and figures/[prepared by Prevent -- Institute for Occupational Safety and Health, for the European Agency for Safety and Health at Work … Marthe Verjans, Veronique De Broeck, Lieven Eeckelaert] Luxembourg: Office for Official Publications of the European Communities, 2007; 2010.
    1. Mackinnon SE, Novak CB. Repetitive strain in the workplace. J Hand Surg [Am] 1997;22(1):2–18. doi: 10.1016/S0363-5023(05)80174-1.
    1. McNaughton H. The label ‘occupational overuse syndrome’: time to change. N Z Med J. 2000;113(1110):193–194.
    1. Helliwell PS. Diagnostic criteria for work-related upper limb disorders. Br J Rheumatol. 1996;35(12):1195–1196. doi: 10.1093/rheumatology/35.12.1195.
    1. Palmer KT, Harris EC, Linaker C, Cooper C, Coggon D. Optimising case definitions of upper limb disorder for aetiological research and prevention: a review. Occup Environ Med. 2012;69(1):71–78. doi: 10.1136/oemed-2011-100086.
    1. Ashbury FD. Occupational repetitive strain injuries and gender in Ontario, 1986 to 1991. J Occup Environ Med. 1995;37(4):479–485. doi: 10.1097/00043764-199504000-00021.
    1. Hall W, Morrow L. ‘Repetition strain injury’: an Australian epidemic of upper limb pain. Soc Sci Med. 1988;27(6):645–649. doi: 10.1016/0277-9536(88)90013-5.
    1. Greving K, Dorrestijn O, Winters JC, Groenhof F, van der Meer K, Stevens M, Diercks RL. Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scand J Rheumatol. 2012;41(2):150–155. doi: 10.3109/03009742.2011.605390.
    1. Mehlum IS, Kristensen P, Veiersted KB, Wærsted M, Punnett L. Does the threshold for reporting musculoskeletal pain or the probability of attributing work-relatedness vary by socioeconomic position or sex? J Occup Environ Med. 2013;55(8):901–909. doi: 10.1097/JOM.0b013e31828dc8ec.
    1. Strazdins L, Bammer G. Women, work and musculoskeletal health. Soc Sci Med. 2004;58:997–1005. doi: 10.1016/S0277-9536(03)00260-0.
    1. Hooftman WE, van der Beek AJ, Bongers PM, van Mechelen W. Is there a gender difference in the effect of work-related physical and psychosocial risk factors on musculoskeletal symptoms and related sickness absence? Scand J Work Environ Health. 2009;35(2):85–95. doi: 10.5271/sjweh.1316.
    1. Miranda H, Viikari-Juntura E, Heistaro S, Heliövaara M, Riihimäki H. A population study on differences in the determinants of a specific shoulder disorder versus nonspecific shoulder pain without clinical findings. Am J Epidemiol. 2005;161(9):847–855. doi: 10.1093/aje/kwi112.
    1. Ireland DC. Psychological and physical aspects of occupational arm pain. J Hand Surg. 1985;13(1):5–10.
    1. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, Thomsen JF, Frost P, Thomsen G, Overgaard E, Overgaard E, Kaergaard A. PRIM Health Study Group. Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of Danish industrial and service workers. Occup Environ Med. 2003;60(9):E8. doi: 10.1136/oem.60.9.e8.
    1. Bonde JP, Mikkelsen S, Andersen JH, Fallentin N, Baelum J, Svendsen SW, Thomsen JF, Frost P, Kaergaard A, Group PHS. Understanding work related musculoskeletal pain: does repetitive work cause stress symptoms? Occup Environ Med. 2005;62(1):41–48. doi: 10.1136/oem.2003.011296.
    1. Kuorinka I, Jonsson B, Kilbom A, Vinterberg H, Biering-Sorensen F, Andersson G, Jorgensen K. Standardised Nordic questionnaires for the analysis of musculoskeletal symptoms. Appl Ergon. 1987;18(3):233–237. doi: 10.1016/0003-6870(87)90010-X.
    1. Jobe FW, Kvitne RS, Giangarra CE. Shoulder pain in the overhand or throwing athlete. The relationship of anterior instability and rotator cuff impingement. Orthop Rev. 1989;18(9):963–975.
    1. Neer CS 2nd. Impingement lesions. Clin Orthop Relat Res. 1983;173:70–77.
    1. Hawkins RJ, Kennedy JC. Impingement syndrome in athletes. Am J Sports Med. 1980;8(3):151–158. doi: 10.1177/036354658000800302.
    1. Constant CR, Gerber C, Emery RJ, Sojbjerg JO, Gohlke F, Boileau P. A review of the Constant score: modifications and guidelines for its use. J Shoulder Elbow Surg. 2008;17(2):355–361. doi: 10.1016/j.jse.2007.06.022.
    1. Hirschmann MT, Wind B, Amsler F, Gross T. Reliability of shoulder abduction strength measure for the Constant-Murley score. Clin Orthop Relat Res. 2010;468(6):1565–1571. doi: 10.1007/s11999-009-1007-3.
    1. Rocourt MH, Radlinger L, Kalberer F, Sanavi S, Schmid NS, Leunig M, Hertel R. Evaluation of intratester and intertester reliability of the Constant-Murley shoulder assessment. J Shoulder Elbow Surg. 2008;17(2):364–369. doi: 10.1016/j.jse.2007.06.024.
    1. Hurt G, Jr Baker CL. Calcific tendinitis of the shoulder. Orthop Clin N Am. 2003;34:567–575. doi: 10.1016/S0030-5898(03)00089-0.
    1. Walker-Bone K, Palmer KT, Reading I, Coggon D, Cooper C. Prevalence and impact of musculoskeletal disorders of the upper limb in the general population. Arthritis Rheum. 2004;51(4):642–651. doi: 10.1002/art.20535.
    1. Helliwell PS, Bennett RM, Littlejohn G, Muirden KD, Wigley RD. Towards epidemiological criteria for soft-tissue disorders of the arm. Occup Med (Lond) 2003;53:313–319. doi: 10.1093/occmed/kqg034.
    1. Deyo RA, Weinstein JN. Low back pain. N Engl J Med. 2001;344(5):363–370. doi: 10.1056/NEJM200102013440508.
    1. Burbank KM, Stevenson JH, Czarnecki GR, Dorfman J. Chronic shoulder pain: part I. Evaluation and diagnosis. Am Fam Physician. 2008;77(4):453–460.
    1. Ludewig PM, Cook TM. Alterations in shoulder kinematics and associated muscle activity in people with symptoms of shoulder impingement. Phys Ther. 2000;80(3):276–291.
    1. Kannus P, Jozsa L. Histopathological changes preceding spontaneous rupture of a tendon. A controlled study of 891 patients. J Bone Joint Surg Am. 1991;73:1507–1525.
    1. Reilly P, Macleod I, Macfarlane R, Windley J, Emery RJ. Dead men and radiologists don’t lie: a review of cadaveric and radiological studies of rotator cuff tear prevalence. Ann R Coll Surg Engl. 2006;88:116–121.

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