Work above shoulder level and shoulder complaints: a systematic review

Area of Science:

• Occupational Health
• Ergonomics
• Musculoskeletal Disorders

Background:

• Workplace activities involving overhead arm movements are common.
• Shoulder pain and disorders represent a significant occupational health concern.
• Understanding the relationship between specific work exposures and shoulder conditions is crucial for prevention.

Purpose of the Study:

• To systematically review and synthesize evidence on the association between work performed above shoulder height and shoulder pain or disorders.
• To investigate the exposure-response relationship, examining how intensity and duration of arm elevation impact the risk of shoulder conditions.

Main Methods:

• A systematic literature search was conducted across major databases (Medline, Embase, Health and Safety Science Abstracts).
• Studies with prospective cohort, case-control, cross-sectional, or intervention designs were included.
• Article quality was assessed using a design-adjusted scheme, and strength of evidence was evaluated using GRADE guidelines.

Main Results:

• Thirty-four articles met the inclusion criteria.
• Higher quality studies with larger effect sizes (OR ≥ 2) focused on severe arm elevation and clinical outcomes.
• An exposure-response relationship was identified, particularly for arm elevation intensity (level and amplitude) and duration exceeding 90 degrees.

Conclusions:

• Limited evidence supports an association between general work above shoulder height and shoulder disorders.
• Moderate evidence indicates a link between severe arm elevation (elbows above shoulder level, >90°) and shoulder disorders.
• Findings highlight the importance of addressing severe arm elevation in occupational health strategies to prevent shoulder conditions.