title: Work-related lesions of the supraspinatus tendon: a case-control study.
abstract: OBJECTIVE
  To examine the dose-response relationship between cumulative duration of work with highly elevated arms (work above shoulder level) as well as of manual material handling and ruptures of the supraspinatus tendon in a population-based case-control study.
  
  
  METHODS
  In 14 radiologic practices, we recruited 483 male patients aged 25-65 with radiographically confirmed partial (n = 385) or total (n = 98) supraspinatus tears associated with shoulder pain. A total of 300 male control subjects were recruited. Data were gathered in a structured personal interview. To calculate cumulative exposure, the self-reported duration of lifting/carrying of heavy loads (>20 kg) as well as the duration of work with highly elevated arms was added up over the entire working life.
  
  
  RESULTS
  The results of our study support a dose-response relationship between cumulative duration of work with highly elevated arms and symptomatic supraspinatus tendon tears. For a cumulative duration of >3,195 h work above shoulder level, the risk of a supraspinatus tendon rupture is elevated to 2.0 (95% CI 1.1-3.5), adjusted for age, region, lifting/carrying of heavy loads, handheld vibration, apparatus gymnastics/shot put/javelin/hammer throwing/wrestling, and tennis. The cumulative duration of carrying/lifting of heavy loads also yields a positive dose-response relation with disease (independent from work above shoulder level and from handheld vibration), with an adjusted odds ratio of 1.8 (95% CI 1.0-3.2) in the highest exposure category (>77 h). We find an increased risk for subjects exposed to handheld vibration with an adjusted OR of 3.2 (95% CI 1.7-5.9) in the highest exposure category (16 years or more in the job with exposure), but a clear dose-response relationship is lacking.
  
  
  CONCLUSIONS
  This study points to a potential etiologic role of long-term cumulative effects of work with highly elevated arms and heavy lifting/carrying on shoulder tendon disorders.
authors.affiliation: Institute and Policlinic for Occupational and Social Medicine, TU Dresden, Fetscherstrasse 74, Dresden, Germany. Andreas.Seidler@mailbox.tu-dresden.de
authors.forename: Andreas
authors.initials: A
authors.lastname: Seidler
authors.forename: Ulrich
authors.initials: U
authors.lastname: Bolm-Audorff
authors.forename: Gabriela
authors.initials: G
authors.lastname: Petereit-Haack
authors.forename: Elke
authors.initials: E
authors.lastname: Ball
authors.forename: Magdalena
authors.initials: M
authors.lastname: Klupp
authors.forename: Noëlle
authors.initials: N
authors.lastname: Krauss
authors.forename: Gine
authors.initials: G
authors.lastname: Elsner
mesh_terms: D000328:Adult; D000368:Aged; D016022:Case-Control Studies; D006801:Humans; D017770:Lifting / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D009784:Occupational Diseases / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D016273:Occupational Exposure / Q000009:adverse effects; D009790:Occupations; D011859:Radiography; D000070636:Rotator Cuff Injuries; D012421:Rupture; D019534:Shoulder Impingement Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D012785:Shoulder Joint / Q000473:pathology; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000209:etiology* / Q000473:pathology; D013997:Time Factors; D014937:Work