Development of Shoulder Pain with Job-Related Repetitive Load: Mechanisms of Tendon Pathology and Anxiety

Details

• Personal Author:
  Andrade B ; Awokuse D ; Kono N ; Mack WJ ; Michener LA ; Plummer HA ; Pozzi F ; Roll SC ; Sousa CO ; Andrade B ; Awokuse D ; Kono N ; Mack WJ ; Michener LA ; Plummer HA ; Pozzi F ; Roll SC ; Sousa CO
• Description:
  Background: The paucity of longitudinal clinical studies limits our understanding of the development of shoulder pain with repetitive shoulder tasks, and its association with underlying mind and body mechanisms. Tendon thickening characterizes painful shoulder supraspinatus tendinopathy, and the perception of pain can be affected by the presence of psychological factors such as anxiety and depression. This study determined the incidence of shoulder pain in novice individuals exposed to repetitive shoulder tasks, and the associated change in outcomes of supraspinatus tendon morphology and measures of anxiety and depression. Methods: We recruited dental hygiene (DH) students (N = 45, novice and exposed to shoulder repetitive tasks) and occupational therapy (OT) students (N = 52, novice, but not exposed to shoulder repetitive tasks), following them over their first year of training. We measured shoulder pain, supraspinatus morphology via ultrasound, psychosocial distress via the Hospital Anxiety and Depression Scale. We compared the incidence of shoulder pain (defined as a change of visual analog pain scale greater than minimal clinically important difference) between DH and OT students using Fisher's exact test. We used mixed-effects models to longitudinally compare the change in outcomes between three groups: DH students that develop and did not develop shoulder pain, and OT students. Results: The incidence of shoulder pain is higher in DH students [relative risk = 4.0, 95% confidence interval (CI): 1.4, 11.4]. After one year, DH students with pain had the greatest thickening of the supraspinatus (0.7mm, 95%CI: 0.4, 0.9). The change in supraspinatus thickness of DH students with pain was greater than both DH students with no pain (0.4mm, 95%CI: 0.1, 0.8) and OT students (0.9mm, 95%CI: 0.5, 1.2). Anxiety score increased 3.8 points (95%CI: 1.6, 5.1) in DH students with pain, and 43% of DH students with pain had abnormal anxiety score at one-year (relative risk = 2.9, 95%CI: 1.0; 8.6). Conclusion: Our results provide support for the theoretical model of repetitive load as a mechanism of tendinopathy. The supraspinatus tendon thickens in the presence of repetitive tasks, and thickens the most in those who develop shoulder pain. Concurrently, anxiety develops with shoulder pain, indicating a potential maladaptive central mechanism that may impact the perception of pain. [Description provided by NIOSH]
• Subjects:
  Mental Health Musculoskeletal System Nervous System Occupational Health Safety
• Keywords:
  Author Keywords: Anxiety Mental Health Muscle Function Pain Psychological Factors Repetitive Strain Injury Repetitive Work RSI Shoulder Supraspinatus Tendinopathy Upper Extremities

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• ISSN:
  1058-2746
• Document Type:
  Text
• Funding:
  Grant
• Genre:
  Journal Article ; Journal Article
• Place as Subject:
  California ; Florida ; OSHA Region 4 ; OSHA Region 9
• CIO:
  National Institute for Occupational Safety and Health (NIOSH) ; National Institute for Occupational Safety and Health (NIOSH)
• Topic:
  Workplace Safety & Health ; Workplace Safety & Health
• Location:
  North America ; North America
• Pages in Document:
  225-234
• Volume:
  31
• Issue:
  2
• NIOSHTIC Number:
  nn:20063944
• Citation:
  J Shoulder Elbow Surg 2022 Feb; 31(2):225-234
• Contact Point Address:
  Federico Pozzi, PT, PhD, Department of Physical Therapy, University of Florida, 1225 Center Dr., Gainesville, FL 32610, USA
• Email:
  fpozzi@phhp.ufl.edu
• Federal Fiscal Year:
  2022
• Performing Organization:
  University of Southern California - Los Angeles
• Peer Reviewed:
  True
• Start Date:
  20150930
• Source Full Name:
  Journal of Shoulder and Elbow Surgery
• End Date:
  20190929
• Collection(s):
  National Institute for Occupational Safety and Health
• Main Document Checksum:
  urn:sha-512:d3c1b532e8bfb4b32b23eb1e23af3ef03998776bde45b59845393e21b58fc5679500375ad8d39eafc717d208d351a41b885aa500c9f02e10982eb0a447452052
• Download URL:
  https://stacks.cdc.gov/view/cdc/222477/cdc_222477_DS1.pdf
• File Type:
  [PDF - 785.28 KB ]