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Open AccessReview

Dose–Response Relationship between Physical Workload and Specific Shoulder Diseases—A Systematic Review with Meta-Analysis

1
Institute and Policlinic of Occupational and Social Medicine (IPAS), Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
2
Department of Occupational Medicine, Public Health and Hazardous Substances, Statutory Accident Insurance and Prevention in the Health and Welfare Services, 22089 Hamburg, Germany
3
Competence Centre for Epidemiology and Health Services Research for Healthcare Professionals (CVcare), University Medical Centre Hamburg-Eppendorf (UKE), 20246 Hamburg, Germany
4
Division of Occupational Health, Department of Occupational Safety and Environment, Regional Government of South Hesse, 65197 Wiesbaden, Germany
5
Institute and Outpatient Clinic for Occupational and Social Medicine, University Medical Center Gießen, Justus-Liebig-University, 35392 Gießen, Germany
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2020, 17(4), 1243; https://doi.org/10.3390/ijerph17041243
Received: 22 January 2020 / Revised: 9 February 2020 / Accepted: 10 February 2020 / Published: 14 February 2020
Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived the dose-response relationship and resulting doubling dose, important for the recognition of occupational diseases. This systematic review is an update of the van der Molen et al. (2017) review. Based on its methodologies, we identified new studies published up to November 2018. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (defined as ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. No evidence for sex-specific differences in the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4–41%) per 1000 h of work with hands above shoulder level. A meta-analysis was not possible for other occupational burdens due to the low number of studies and differing exposure measurements; an estimate of the doubling dose was made based on the cohort study of Dalbøge et al. (2014). To conclude, the present systematic review with meta-analysis contributes to knowledge of the level of exposure at which specific shoulder diseases—particularly rotator cuff lesions—should be recognized as an occupational disease. View Full-Text
Keywords: rotator cuff lesions; physical workload; dose-response relationship; doubling dose; musculoskeletal diseases of the shoulder; occupational disease rotator cuff lesions; physical workload; dose-response relationship; doubling dose; musculoskeletal diseases of the shoulder; occupational disease
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Seidler, A.; Romero Starke, K.; Freiberg, A.; Hegewald, J.; Nienhaus, A.; Bolm-Audorff, U. Dose–Response Relationship between Physical Workload and Specific Shoulder Diseases—A Systematic Review with Meta-Analysis. Int. J. Environ. Res. Public Health 2020, 17, 1243.

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