Institute and Policlinic for Occupational and Social Medicine, TU Dresden, Fetscherstrasse 74, Dresden, Germany.
Int Arch Occup Environ Health. 2011 Apr;84(4):425-33. doi: 10.1007/s00420-010-0567-6. Epub 2010 Aug 25.
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.
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.
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.
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.
在一项基于人群的病例对照研究中，研究工作时手臂高举（肩部以上）和手工搬运的累积时间与冈上肌腱撕裂之间的剂量-反应关系。
在 14 家放射科诊所，我们招募了 483 名年龄在 25-65 岁之间、有放射学证实的部分（n=385）或全部（n=98）冈上肌腱撕裂伴肩部疼痛的男性患者。共招募了 300 名男性对照受试者。数据通过结构化个人访谈收集。为了计算累积暴露量，将自我报告的搬运重物（>20 公斤）的时间和长时间手臂高举的工作时间相加，得出整个工作生涯中的累积暴露量。
我们的研究结果支持手臂高举工作时间与症状性冈上肌腱撕裂之间存在剂量-反应关系。对于手臂高举工作时间超过 3195 小时，冈上肌腱撕裂的风险升高至 2.0（95%CI 1.1-3.5），调整年龄、地区、搬运重物、手持振动、体操/铅球/标枪/链球/摔跤和网球等因素后。搬运/举起重物的累积时间也与疾病呈正相关（独立于手臂高举和手持振动），在最高暴露组（>77 小时）中，调整后的比值比为 1.8（95%CI 1.0-3.2）。我们发现，暴露于手持振动的受试者风险增加，调整后的比值比为 3.2（95%CI 1.7-5.9），在最高暴露组（有暴露的工作中 16 年或更长时间），但缺乏明确的剂量-反应关系。
本研究表明，手臂长期高举和搬运重物可能对肩部肌腱疾病有潜在的病因作用。
