ObjectivesThe primary aim was to examine exposureresponse relationships between cumulative occupational shoulder exposures and surgery for subacromial impingement syndrome (SIS), and to compare sexspecific exposure-response relationships. The secondary aim was to examine the time window of relevant exposures. Methods We conducted a nationwide register study of all persons born in Denmark (1933Denmark ( -1977, who had at least 5 years of full-time employment. In the follow-up period (2003)(2004)(2005)(2006)(2007)(2008), we identified first-time events of surgery for SIS. Cumulative exposure estimates for a 10-year exposure time window with a 1-year lag time were obtained by linking occupational codes with a job exposure matrix. The exposure estimates were expressed as, for example, arm-elevation-years in accordance with the pack-year concept of tobacco consumption. We used a multivariable logistic regression technique equivalent to discrete survival analysis. Results The adjusted OR (OR adj ) increased to a maximum of 2.1 for arm-elevation-years, repetition-years and force-years, and to 1.5 for hand-arm-vibration-years. Sex-specific exposure-response relationships were similar for men and women, when assessed using a relative risk scale. The OR adj increased gradually with the number of years contributing to the cumulative exposure estimates. The excess fraction was 24%. Conclusions Cumulative occupational shoulder exposures carried an increase in risk of surgery for SIS with similar exposure-response curves for men and women. The risk of surgery for SIS increased gradually, when the period of exposure assessment was extended. In the general working population, a substantial fraction of all first-time operations for SIS could be related to occupational exposures.
The impact of occupational biomechanical shoulder exposures on risk of surgery for subacromial impingement syndrome (SIS) is unknown. Shoulder load increased the risk of surgery for SIS. Neck-shoulder complaints combined with high shoulder load conveyed the highest risk.Affiliation:
We found indications of safe exposure intensities for repetition. Any intensities of force and upper arm elevation >90° above minimal implied an increased risk across 10-year exposure time windows. No independent associations were found for HAV.
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