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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 ≥45° ≥15% of time (OR 2.43) and duty cycle of forceful exertions ≥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.

Shoulder injuries are a prevalent form of musculoskeletal disorders and common reason to seek healthcare. Health system level care utilization patterns for shoulder disorders are unknown. Accordingly, we described the frequency and timing of diagnostic imaging and treatment for a new episode of shoulder pain and determine usage variations across common diagnostic subgroups, military, and private sector care clinics. A retrospective cohort of US Military Health System beneficiaries (n = 456,241) classified into 1) non-specific shoulder diagnosis only, 2) rotator cuff/sub-acromial pain, 3) acromioclavicular (AC joint) dysfunction, 4) shoulder instability/dislocation, 5) hypomobility/adhesive capsulitis, 6) osteoarthrosis, and 7) multiple diagnoses. Outcomes were healthcare use encounters within the first three months of the index visit classified into diagnostic imaging, pharmacological, and non-pharmacological treatments. The mean age of the cohort was 41 years old (SD 13). A majority of the cohort never received diagnostic imaging (76.7%). Advanced imaging was common for the multiple diagnoses group (53.6% of all advanced imaging). NSAIDS was the most common pharmacological treatment with 10.4% receiving at least one prescription, and physical therapy was the most common nonpharmacologic treatment received by 31% of the cohort. There was lower physical therapy and active treatment use and higher MRI or X-ray use for the same diagnostic group when care was initiated in a civilian clinic. Patients with rotator cuff disorders, multiple shoulder diagnoses, and hypomobility disorders were likely to have received at least one steroid joint injection if care was initiated in civilian compared to military clinics (28.1% vs 16%; 41.2% vs 32%; and 18.6% vs 13.3%, respectively). Care patterns for high volume shoulder injuries were largely congruent across military and civilian clinics. However, for specific diagnostic groups, use of imaging, steroid injections and physical therapy varied notably between military and civilian clinics.

Background Non-operatively managed shoulder conditions, including rotator cuff tendinopathy, subacromial pain syndrome, adhesive capsulitis, and non-displaced proximal humerus fractures, frequently cause pain and restricted mobility. While traditional rehabilitation is effective, access to in-person therapy can be hindered by various factors. Telerehabilitation, which leverages telecommunication technologies, is a promising alternative to traditional in-person rehabilitation. However, its overall efficacy remains uncertain due to inconsistent findings in prior studies. Methods This systematic review and meta-analysis assessed the effectiveness of telerehabilitation for non-operatively managed shoulder conditions, concentrating on randomized controlled trials (RCTs). The control group received standard in-person rehabilitation or home-based exercise programs. The primary outcomes assessed were pain (using the visual Analog Scale [VAS]), range of motion (ROM) including flexion, abduction, external rotation and internal rotation, as well as functional outcomes evaluated through the Shoulder Pain and Disability Index [SPADI], Disabilities of the Arm, Shoulder, and Hand [DASH], and Quick DASH scores. Results Eight randomized controlled trials (RCTs) were included. Data synthesis employed random-effects or fixed-effects models based on heterogeneity, with the risk of bias evaluated via the Cochrane Collaboration tool. Telerehabilitation over 12 weeks significantly reduced pain compared to in-person rehabilitation (MD = -1.06, 95% CI -1.84 to -0.29, P  = 0.007; Certainty of evidence: very low) whereas shorter durations showed limited effectiveness. Significant improvements in ROM were observed for flexion (MD = 4.01, 95% CI 2.48 to 5.54, P  < 0.001; Certainty of evidence: low), abduction (MD = 4.61, 95% CI 2.63 to 6.60, P  < 0.001; Certainty of evidence: low), and external rotation (MD = 3.69, 95% CI 0.77 to 6.62, P  = 0.01; Certainty of evidence: low). However, no significant improvement was observed for internal rotation. The functional outcomes, as measured by the SPADI, significantly improved (MD = -13.32, 95% CI -21.40 to -5.23, P  = 0.001; Certainty of evidence: low), whereas the DASH scores did not significantly differ (MD = -0.66, 95% CI -3.17 to 1.85, P  = 0.60; Certainty of evidence: low). Conclusion Telerehabilitation may reduce pain and improve range of motion in patients with non-operatively managed shoulder conditions, particularly when interventions are sustained for 12 weeks or longer. However, the certainty of evidence remains low due to methodological limitations, highlighting the need for further high-quality trials to confirm these findings.

Background Persistent shoulder pain causes considerable disruption of the individual’s life and imposes high costs on healthcare and society. Well-informed treatment and referral pathways are crucial as unsuccessful interventions and longer duration of symptoms minimizes the likelihood of success in future interventions. Although physiotherapy is generally recommended as first line treatment, no prognostic model or clinical prediction rules exists to help guide the treatment of patients with persistent shoulder pain undergoing physiotherapy. Thus, the objective of this study was to develop a prognostic model to inform clinical decision making and predict change in symptoms and function in patients with persistent shoulder pain. Methods This was a prospective cohort study of 243 patients with persistent shoulder pain referred to outpatient physiotherapy rehabilitation centres. Data was collected at baseline and six-month follow-up. The outcome was change in shoulder symptoms and function as measured by the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) from baseline to 6 months follow up. Potential predictors were included in a multivariable linear regression model which was pruned using modified stepwise backwards elimination. Results The final model consisted of seven predictors; baseline QuickDASH score, employment status, educational level, movement impairment classification, self-rated ability to cope with the pain, health-related quality of life and pain catastrophizing. Together these variables explained 33% of the variance in QuickDASH-change scores with a model root mean squared error of 17 points. Conclusion The final prediction model explained 33% of the variance in QuickDASH change-scores at 6 months. The root mean squared error (model SD) was relatively large meaning that the prediction of individual change scores was quite imprecise. Thus, the clinical utility of the prediction model is limited in its current form. Further work needs be done in order to improve the performance and precision of the model before external validity can be examined along with the potential impact of the model in clinical practice. Two of the included predictors were novel and could be examined in future studies; movement impairment classification based on diagnosis and health-related quality of life.

Background Most existing reviews focus on evidence for the association between neck and/or shoulder complaints and physical exposures at the workplace gathered from cross-sectional studies. In comparison, this review summarizes existing evidence from longitudinal studies only. Methods A systematic literature research was conducted in Medline and EMBASE (1975–2009), and all studies were scanned by at least two researchers according to strict inclusion criteria. Levels of evidence were assigned according to the number of studies reporting similar findings, and according to the methodological quality of the included studies. Results Altogether 21 longitudinal studies (19 high-quality studies) met the inclusion criteria and were included in this review. In comparison with former reviews, we found strong evidence for an association between shoulder complaints and manual material handling (MMH) (range between Odds Ratio (OR) 1.4 and 4.9), vibration (range between OR 1.6 and OR 2.5), trunk flexion or rotation (range between OR 1.8 and OR 5.1), and working with hands above shoulder level (range between OR 1.1 and OR 1.8). Apart from that, the included studies confirmed existing knowledge on the association between physical exposures at the workplace and neck and/or shoulder complaints. Conclusions This analysis of longitudinal studies allowed for new evidence with regard to four cause-effect chains between physical exposures at work and the development of shoulder, neck and neck/shoulder complaints. As outcome variables varied greatly among the included studies, harmonization in studies on musculoskeletal research is desirable.

Literature shows an increasing interest for the development of augmented reality (AR) applications in several fields, including rehabilitation. Current studies show the need for new rehabilitation tools for upper extremity, since traditional interventions are less effective than in other body regions. This review aims at: Studying to what extent AR applications are used in shoulder rehabilitation, examining wearable/non-wearable technologies employed, and investigating the evidence supporting AR effectiveness. Nine AR systems were identified and analyzed in terms of: Tracking methods, visualization technologies, integrated feedback, rehabilitation setting, and clinical evaluation. Our findings show that all these systems utilize vision-based registration, mainly with wearable marker-based tracking, and spatial displays. No system uses head-mounted displays, and only one system (11%) integrates a wearable interface (for tactile feedback). Three systems (33%) provide only visual feedback; 66% present visual-audio feedback, and only 33% of these provide visual-audio feedback, 22% visual-audio with biofeedback, and 11% visual-audio with haptic feedback. Moreover, several systems (44%) are designed primarily for home settings. Three systems (33%) have been successfully evaluated in clinical trials with more than 10 patients, showing advantages over traditional rehabilitation methods. Further clinical studies are needed to generalize the obtained findings, supporting the effectiveness of the AR applications.

Rationale Firefighters (FFs) are exposed to physically demanding tasks that increase their risk of work-related shoulder disorders (WSDs). Despite the critical nature of their work, qualitative research remains limited in exploring the impact of WSDs on their well-being, as well as the challenges they encounter within the workplace and healthcare system. Objectives To explore: (1) The impact of WSDs on the well-being and job performance of FFs, (2) The occupational health challenges encountered by FFs with WSDs during recovery. Methods A total of 14 FFs (Males = 9, Females = 5) between 26 and 63 years old experiencing WSDs were purposefully sampled by sex and geographical location. Data was collected through virtual one-on-one semi-structured interviews and transcribed verbatim. Interpretive description methodology was used, and data was analyzed using thematic analysis. Findings Firefighters with WSDs indicated that pain and mobility limitations significantly impaired their ability to perform critical job tasks such as lifting, reaching, and administering life-saving interventions. In their personal lives, WSDs disrupt routine activities, fitness, and family interactions. Sleep deprivation due to pain and shift work further exacerbates physical and cognitive strain, impacting their job performance. Occupationally, FFs reported lost work time, financial strain, and career setbacks due to modified duties, often leading to feelings of guilt, isolation, and diminished professional identity. Additionally, operational challenges related to poorly designed firefighting equipment and protective gear were reported to increase the risk of re-injury, particularly for female FFs and those with smaller statures. Lastly, healthcare challenges such as lack of tailored health care protocols and suboptimal intervention programs were reported. Conclusion This study underscores the complex interplay of physical, occupational, and psychosocial factors in shaping firefighters’ experiences with WSDs. This emphasizes the need for ergonomic improvements, better healthcare protocols, and psychosocial support to improve the well-being of FFs with WSDs.

ObjectivesShoulder disorders are common in the working population. This longitudinal study aimed to explore the relationships between personal factors and occupational organisational, psychosocial, and biomechanical factors and the incidence of shoulder disorders.MethodsA total of 3710 workers in the Pays de la Loire region (Loire Valley area, France) were randomly included by their occupational physician in the Cosali cohort between 2002 and 2005. All workers completed a self-administered questionnaire about personal factors and work exposure, and using a standardised physical examination, occupational physicians diagnosed shoulder disorders. Between 2007 and 2010, 1611 workers were re-examined by their occupational physician. The 1,320 workers free of shoulder disorders at baseline were studied. A conceptual model was developed in which relationships between organisational, psychosocial, biomechanical, and personal factors at baseline and the incidence of shoulder disorders were assumed. Structural equation modelling was used to test the model.ResultsShoulder disorders were directly associated with biomechanical factors and age but not with psychosocial factors. However, skill discretion and psychological demand influenced shoulder disorders indirectly through biomechanical factors. Exposure to a work pace dependent on an automatic rate and to a work pace dependent on customers’ demands were associated with biomechanical and psychosocial factors, but not directly to shoulder disorders.ConclusionsThis study identified the complex direct and indirect relationships between occupational factors and shoulder disorders. Our data confirmed our conceptual causation model: organisational and psychosocial factors were associated with biomechanical factors, while biomechanical factors were associated with the incidence of shoulder disorders.

PurposeThis study aimed to describe the internal structure of the infraspinatus muscle. A secondary aim was to explore differences in internal structure between genders, sides, and correlations to demographic data.MethodsIn total, 106 shoulder MRI examinations of patients between 18 and 30 years of age seeking care in 2012–2020 at The Sahlgrenska University Hospital in Gothenburg, Sweden were re-reviewed.ResultsThe number of intramuscular tendons centrally in the infraspinatus muscle varied between 3 and 8 (median = 5). Laterally, the number of intramuscular tendons varied between 1 and 5 (median = 2). There was no difference in the median between the genders or sides. No correlations between the number of intramuscular tendons and demographic data were found. The muscle volume varied between 63 and 249 ml with a median of 188 ml for males and 122 ml for females. There was no significant difference in volume between the sides. The muscle volume correlated with body weight (Pearson’s correlation coefficient, r = 0.72, p < 0.001) and height (r = 0.61, p < 0.001).ConclusionThe anatomical variations of the infraspinatus muscle are widespread. In the medial part of the muscle belly, the number of intramuscular tendons varied between 3 and 8, while the number of intramuscular tendons laterally varied between 1 and 5. Results of our study may help to understand the internal structure of the infraspinatus muscle and its function in shoulder stabilization.