OBJECTIVES: The aim of this longitudinal study was to evaluate the risk of surgery for subacromial impingement syndrome (SIS) in relation to neck-shoulder complaints and occupational biomechanical shoulder exposures. METHODS: The study was based on the Musculoskeletal Research Database at the Danish Ramazzini Centre. We linked baseline questionnaire information from 1993-2004 on neck-shoulder complaints, job titles, psychosocial work factors, body mass index, and smoking with register information on first-time surgery for SIS from 1996-2008. Biomechanical exposure measures were obtained from a job exposure matrix based on expert judgment. We applied multivariable Cox regression. RESULTS: During 280 125 person-years of follow-up among 37 402 persons, 557 first-time operations for SIS occurred. Crude surgery rates increased from 1.1 to 2.5 per 1000 person-years with increasing shoulder load. Using no neck-shoulder complaints and low shoulder load at baseline as a reference, no neck-shoulder complaints and high shoulder load showed an adjusted hazard ratio (HR adj) of 2.55 [95% confidence interval (95% CI) 1.59-4.09], while neck-shoulder complaints in combination with high shoulder load showed an HR adjof 4.52 (95% CI 2.87-7.13). Subanalyses based on 18 856 persons showed an HR adjof 5.40 (95% CI 2.88-10.11) for complaints located specifically in the shoulder in combination with high shoulder load. CONCLUSIONS: Based on these findings, persons with neck-shoulder and especially shoulder complaints in combination with high shoulder load seem an obvious target group for interventions aimed at reducing exposures to prevent surgery for SIS.
Scandinavian Journal of Work, Environment and Health, 2013, Vol 39, Issue 6, p. 568-77