Work-related lesions of the supraspinatus tendon: a case-control study

Int Arch Occup Environ Health. 2011 Apr;84(4):425-33. doi: 10.1007/s00420-010-0567-6. Epub 2010 Aug 25.


Objectives: 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.

MeSH terms

  • Adult
  • Aged
  • Case-Control Studies
  • Humans
  • Lifting / adverse effects*
  • Male
  • Middle Aged
  • Occupational Diseases / diagnostic imaging
  • Occupational Diseases / etiology*
  • Occupational Diseases / pathology
  • Occupational Exposure / adverse effects
  • Occupations
  • Radiography
  • Rotator Cuff Injuries
  • Rupture
  • Shoulder Impingement Syndrome / diagnostic imaging
  • Shoulder Impingement Syndrome / etiology*
  • Shoulder Impingement Syndrome / pathology
  • Shoulder Joint / pathology
  • Tendon Injuries / diagnostic imaging
  • Tendon Injuries / etiology*
  • Tendon Injuries / pathology
  • Time Factors
  • Work*