Four hundred and twenty-four sewing machine operators from a historical cohort of garment industry workers answered questionnaires concerning musculoskeletal symptoms and job exposure. They were compared with 781 women from the general population of the region and an internal control group of 89 women from the garment industry. The risk for persistent neck and shoulder complaints increased with years of being a sewing machine operator: (up to seven years, eight to fifteen years, and more than fifteen years: prevalence proportion ratio 1.8, 3.5 and 4.4 [neck] and 1.5, 4 and 6.8 [shoulder] compared with the controls [n = 781]). The exposure-response relationships remained when adjusted for potential confounders, of which age, current shoulder-neck exposure, and child bearing were the most contributing. The study revealed that work for more than eight years as a sewing machine operator probably has a cumulative deleterious effect on the neck and shoulders.