Managed Physical Medicine

Combatting Shoulder Injuries at Work

Rotator cuff and other shoulder injuries are among the most common occupational musculoskeletal problems. Why is this region so susceptible to injury, and what can employers do about it?

Low back pain may be the first injury that comes to mind when considering top work-related musculoskeletal ailments, but shoulder injuries are a close second — sometimes outpacing low back pain in some industries. Shoulder pain affects 18-26% of the general population and is one of the most common regional pain syndromes. It is also among the most common musculoskeletal problems in workers, making it difficult for patients to carry out daily tasks both at home and in the workplace. Financial burden is also a common side effect. Not only can healthcare fees be quite costly, but injury can result in time away from work, impaired work performance and even early retirement or disability.

Anatomy of a Shoulder Injury

Why is the shoulder particularly susceptible to injury? Often mistaken as a simple ball and socket joint, the shoulder is actually quite complex, has a wide range of motion and can handle impressive physical demands. However, because it consists of four articulations and a constellation of bones, muscles and ligaments in and around the joint capsule, it is vulnerable to a spectrum of articular and peri-articular pathologies. Pain can also be referred to the shoulder region while the true culprit lies elsewhere. The most common source of referred pain to the shoulder is the neck, but some viscera such as the heart, liver, or gall bladder can produce shoulder pain as well.

Risk Factors

For most shoulder pain, the true cause is unknown. There is no widely accepted classification system for reporting shoulder problems; however, recent studies have pinpointed some factors associated with shoulder pain. Perhaps the most widely studied of these is age. As we grow older, our tendons degenerate and osteoarthrosis of the joints can develop. A high body mass index has also been found to be a risk factor of incident shoulder pain.

In the workplace, physically strenuous work that loads the shoulder, include lifting, carrying, pulling or pushing, may cause pain. Working with hands above shoulder level is another strong predictor of incident shoulder pain. Some studies have also shown poor job control and work with high psychological demands to be related to shoulder pain. Mental stress is being investigated as a causal factor, but further research is needed.

Employer-Led Prevention

The good news is that, however common, shoulder injuries can be mitigated in the workplace. Employers should conduct regular worksite evaluations. When hazards are detected, they should be corrected through engineering controls such as workstation reconfiguration or tool redesign. Physical job demands should be matched to worker size and fitness level. Employee training programs should emphasize the importance of proper posture, lifting techniques, and overall fitness. Administrative controls such as adjusting procedures, rotating shifts or reconsidering break schedules may also be effective. Talk with your employees about concerns they may have, and work together to create a culture of injury awareness and prevention.


Linaker, C., & Walker-Bone, K. (2015). SHOULDER DISORDERS AND OCCUPATION. Best Practice & Research. Clinical Rheumatology29(3), 405–423. http://doi.org/10.1016/j.berh.2015.04.001

Shanahan, E. M., & Sladek, R. (2011). Shoulder pain at the workplace. Best Practice & Research Clinical Rheumatology25(1), 59-68.

Teunis, T., Lubberts, B., Reilly, B. T., & Ring, D. (2014). A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of shoulder and elbow surgery23(12), 1913-1921.

The Texas Department of Insurance, Division of Workers’ Compensation (TDI, DWC). Shoulder Injury Prevention FactSheet. HS05-033C (9-07). http://www.tdi.texas.gov/pubs/videoresource/fspreventingsho.pdf

Van Eerd, D., Beaton, D., Cole, D., Lucas, J., Hogg-Johnson, S., & Bombardier, C. (2003 epidemiology56(10), 925-936.). Classification systems for upper-limb musculoskeletal disorders in workers:: A review of the literature. Journal of clinical epidemiology56(10), 925-936.