title: Associations between work-related factors and specific disorders of the shoulder--a systematic review of the literature.
abstract: OBJECTIVE
  Our aim was to provide a quantitative assessment of the exposure-response relationships between work-related physical and psychosocial factors and the occurrence of specific shoulder disorders in occupational populations.
  
  
  METHODS
  A systematic review of the literature was conducted on the associations between type of work, physical load factors, and psychosocial aspects at work, on the one hand, and the occurrence of tendinitis of the biceps tendon, rotator cuff tears, subacromial impingement syndrome (SIS), and suprascapular nerve compression, on the other hand. Associations between work factors and shoulder disorders were expressed in quantitative measures as odds ratio (OR) or relative risk (RR).
  
  
  RESULTS
  The occurrence of SIS was associated with force requirements >10% maximal voluntary contraction (MVC), lifting >20 kg >10 times/day, and high-level of hand force >1 hour/day (OR 2.8-4.2). Repetitive movements of the shoulder, repetitive motion of the hand/wrist >2 hours/day, hand-arm vibration, and working with hand above shoulder level showed an association with SIS (OR 1.04-4.7) as did upper-arm flexion > or =45 degrees > or =15% of time (OR 2.43) and duty cycle of forceful exertions > or =9% time or duty cycle of forceful pinch >0% of time (OR 2.66). High psychosocial job demand was also associated with SIS (OR 1.5-3.19). Jobs in the fish processing industry had the highest risk for both tendinitis of the biceps tendon as well as SIS (OR 2.28 and 3.38, respectively). Work in a slaughterhouse and as a betel pepper leaf culler were associated with the occurrence of SIS only (OR 5.27 and 4.68, respectively). None of the included articles described the association between job title/risk factors and the occurrence of rotator cuff tears or suprascapular nerve compression.
  
  
  CONCLUSIONS
  Highly repetitive work, forceful exertion in work, awkward postures, and high psychosocial job demand are associated with the occurrence of SIS.
authors.affiliation: Erasmus MC University Medical Center, Department of General Practice, Room Wk-109, PO Box 2040, 3000 CA Rotterdam, the Netherlands. r.vanrijn@erasmusmc.nl
authors.forename: Rogier M
authors.initials: RM
authors.lastname: van Rijn
authors.forename: Bionka Ma
authors.initials: BM
authors.lastname: Huisstede
authors.forename: Bart W
authors.initials: BW
authors.lastname: Koes
authors.forename: Alex
authors.initials: A
authors.lastname: Burdorf
mesh_terms: D000062:Accidents, Occupational; D012090:Cumulative Trauma Disorders / Q000209:etiology; D006801:Humans; D009784:Occupational Diseases / Q000209:etiology*; D016273:Occupational Exposure; D012782:Shoulder / Q000503:physiopathology; D000070599:Shoulder Injuries; D012785:Shoulder Joint / Q000503:physiopathology; D013315:Stress, Psychological / Q000150:complications / Q000209:etiology; D016474:Weight-Bearing / Q000502:physiology