149 Work-related risk factors for subacromial pain syndrome: systematic review and meta-analysis

Introduction To examine the association between work-related risk factors and clinically assessed specific soft tissue shoulder disorders like rotator cuff syndrome – including tendinitis of the supraspinatus, infraspinatus and/or non-traumatic tears and ruptures –, bicipital tendinitis, calcific tendinitis, impingement and bursitis. Methods Medline and Embase were searched from 2009 until 24 March 2016 and references were added of a systematic review on this topic describing studies published before 2009. Case-control and cohort studies were included if the soft tissue shoulder disorder was clinically assessed. These shoulder disorders were grouped into subacromial pain syndrome, abbreviated to SAPS, and defined as all non-traumatic, usually unilateral, shoulder complaints that cause pain, are localised around the acromion, and often worsen during or subsequent lifting of the arm. Meta-analyses and GRADE were performed to assess evidence and quality for the studies on work-related risk factors. Result In total 16 300 patients with SAPS from a population of 2,413,722 workers from Denmark, Finland, France, Germany and Poland were included in the meta-analysis. Moderate evidence for associations were found for 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). Low to very low-quality evidence was found for hand-force exertion, hand-arm vibration and psychosocial risk factors. Discussion Arm-hand elevation, hand-force exertion and hand-arm vibration during work, increase the incidence of SAPS. Especially preventive measures to reduce arm-elevation and shoulder load, the latter involving combined physical exposures, e.g. hand-force exertion and arm-elevation, are recommended to prevent these work-related shoulder disorders. Presumably psychosocial factors play an intermediate role, and therefore, should also be targeted in occupational preventive actions.