Shoulder pain is fast becoming "the new black" of workplace injury. The word is that in many organisations, work-related musculoskeletal  problems involving the arm and shoulder are rivalling lower back problems in terms of both the number of cases and case duration.

However, shoulder pain does not have to lead to work disability. With proper support and accommodation it is possible to shoulder on through shoulder pain. Learn more in the fact sheet below...

The basics of shoulder pain

Shoulder pain occurs in or around the shoulder joint, often over the front of the shoulder and / or in the upper arm and occasionally extending to the elbow. The pain might be worst when reaching overhead, or behind the back. 

The shoulder is comprised of three main bones: the humerus (upper arm), clavicle (collar bone) and scapula (shoulder blade).

The shoulder joint, a ball-and-socket joint supported by the four rotator cuff tendons, is the most mobile in the body. Most shoulder pain is related to problems with the rotator cuff tendons, or strains of the ligaments that hold the various shoulder bones together.

Shoulder pain may result from a wide variety of causes, including:

• Repetitive activities, including work activities;
• Injury, such as falling onto the shoulder or outstretched arm;
• Age;
• Arthritis; and
• Neck problems—if this is the case, the shoulder pain is known as ‘referred pain’.

Work contributions to shoulder pain

There are many workplace factors which may contribute to the development of shoulder pain. Physical, social and psychological factors may all play a role.

Physical workplace factors associated with shoulder pain include:

• Repetitive use of a tool;
• Using vibrating tools;
• Working with hands above shoulder level;
• Carrying weights on one shoulder;
• Using the wrists or arms in a repetitive way;
• Stretching down to reach below knee level; and
• Working in very damp or very cold conditions.

Social and psychological workplace factors that may contribute to shoulder pain include:

• Depression;
• Stressful work;
• Very monotonous work;
• A low level of job control; and
• Lack of encouraging organisational culture.

Preventing and coping with shoulder pain

Stretching and strengthening the muscles around the shoulder is the best way to prevent shoulder pain from developing.

If shoulder pain does occur, the best methods for dealing with it depend upon how severe the pain is. If the pain is strong, or if there is burning, numbness or deformity, it is a good idea to see a doctor as soon as possible.  Otherwise, it may be appropriate to attempt to self manage the pain for a couple of weeks and to see a doctor only if the pain continues.

The first principle for recovering from shoulder pain is to strike the right balance between activity and rest. While movements and activities that cause pain to flare up should be avoided, it is important to keep the shoulder joint mobile. Maintaining muscular strength and joint mobility promotes recovery.

Self-help treatments may also be useful, including:

• Taking anti-inflammatory pain killers such as ibuprofen. This should not be continued for more than two weeks without seeking medical advice.
• Applying an ice pack to the sore shoulder.
• Exercises, as recommended by a doctor or physiotherapist.

Common work restrictions for shoulder pain

The shoulder joint is placed under stress when the arm is moved more than 30 degrees away from the body. The muscles that work the shoulder joint have to be more active to lift the arm beyond that point.  A sensible rule of thumb is if the elbow is close to the trunk, the shoulder will not be put under load.

Common restrictions include avoiding:

• Repeated outreaching of the arm;
• Work at or above shoulder height;
• Repeated forceful activities with the arm;
• Rast and repetitive tasks with the arm; and
• Heavy lifting.

Work solutions for shoulder pain

Research has shown that the following steps are effective for managing shoulder pain in the workplace, while regular medical care is maintained:

• Early reporting of pain;
• Collaboration between the worker and supervisor to manage the problem by:
  • Making ergonomics adjustments; and
  • Changing the worker’s rotation of tasks;
• If pain continues, an occupational therapist should be brought in to review the worker and the work environment;
• The supervisor, worker and occupational therapist collaborate on a formal return to work plan, covering:
  • Return to work outcomes;
  • Modified duties, hours and rotations; and
  • Details about the “re-integration phase”, i.e. a plan for return to normal duties and hours; and
• If progress is still stalled, a re-evaluation of the approach should be undertaken, with the possibility of moving the worker to another department or section until improvement occurs.

For more information on a successful workplace intervention for shoulder pain, see this RTWMatters research article.

Sources: http://www.injurytreatment.com.au/shoulder; http://www.guardian.co.uk/lifeandstyle/besttreatments/shoulder-pain-description; http://www.arc.org.uk/arthinfo/patpubs/6039/6039.asp; Occup Environ Med. 2004 Jan;61(1):39-44. Incidence of shoulder pain in repetitive work. Leclerc A, Chastang JF, Niedhammer I, Landre MF, Roquelaure Y; Study Group on Repetitive Work; Occup Environ Med 2000;57:433-442 doi:10.1136/oem.57.7.433 Occupational risk factors for shoulder pain: a systematic review Daniëlle A W M van der Windta, Elaine Thomasb, Daniel P Popeb, Andrea F de Wintera, Gary J Macfarlanec, Lex M Boutera, Alan J Silmanb; Am J Ind Med. 2008 May;51(5):372-9.Occupational neck and shoulder pain among automobile manufacturing workers in Iran. Alipour A, Ghaffari M, Shariati B, Jensen I, Vingard E;  and  “Occupational factors related to shoulder pain and disability,” POPE D. P. (1) ; CROFT P. R. (2) ; PRITCHARD C. M. (1) ; SILMAN A. J. (1) ; MACFARLANE G. J. (1) ; Occupational and environmental medicine 1997, vol. 54, no5, pp. 316-321.