Neck Solutions

Incidence of shoulder and neck pain in a working population

Incidence of shoulder and neck pain in a working population: effect modification between mechanical and psychosocial exposures at work? Results from a one year follow up of the Malmö shoulder and neck study cohort

From: J Epidemiol Community Health. 2005 Sep;59(9):721-8

Work related musculoskeletal disorders and complaints constitute an important health problem in many industrialised countries, as they account for a large number of working days lost and considerable workers compensation and disability payments. For a long time, low back pain has been the dominant problem. However, pain from the shoulder and neck region now seems to occur more frequently. The prevalence of shoulder and neck symptoms is highest in the 45–65 year age bracket, as well as among women, manual workers, and certain ethnic groups.

However, its aetiology is still incompletely understood. Mechanical exposure at work and psychosocial conditions within and without the workplace, in addition to lifestyle and individual variables (age, previous symptoms, etc) are frequently discussed as causal factors in the literature.

Shoulder and neck symptoms have been linked to jobs with highly repetitive work, static work, and work above shoulder level. However, mechanical exposure explains only part of these complaints. The role of psychosocial factors in the workplace has therefore received increasing attention. On the job pressure, monotonous work, and a high perceived workload have also been associated with musculoskeletal symptoms just as much as working situations characterised by high psychological demands, low decision latitude, and low social support.

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Musculoskeletal discomfort at work predicts low back, neck and shoulder pain

Does musculoskeletal discomfort at work predict future musculoskeletal pain?

From: Ergonomics. 2008 May;51(5):637-48

The objective of this prospective cohort study was to evaluate if peak or cumulative musculoskeletal discomfort may predict future low back, neck or shoulder pain among symptom free workers. At baseline, discomfort per body region was rated on a 10 point scale six times during a working day. Questionnaires on pain were sent out three times during follow-up. Peak discomfort was defined as a discomfort level of 2 at least once during a day; cumulative discomfort was defined as the sum of discomfort during the day. Reference workers reported a rating of zero at each measurement.

Peak discomfort was a predictor of low back pain (relative risk (RR) 1.79), neck pain (RR 2.56), right or left shoulder pain (RR 1.91 and 1.90). Cumulative discomfort predicted neck pain (RR 2.35), right or left shoulder pain (RR 2.45 and 1.64). These results suggest that both peak and cumulative discomfort could predict future musculoskeletal pain.

Shoulder pain in whiplash neck injury

Subacromial Impingement in patients with whiplash injury to the cervical spine

From: Journal of Orthopedic Surgery. 2008 Jun 27;3(1):25 [Epub ahead of print]

Impingement syndrome and shoulder pain have been reported to occur in a proportion of patients following whiplash injuries to the neck. In this study they aim to examine these findings to establish the association between subacromial impingement and whiplash injuries to the cervical spine. They examined 220 patients who had presented to the senior author for a medico-legal report following a whiplash injury to the neck. All patients were assessed for clinical evidence of subacromial impingement. 56/220 patients (26%) had developed shoulder pain following the injury; of these, 11/220 (5%) had clinical evidence of impingement syndrome. Only 3/11 patients (27%) had the diagnosis made prior to evaluation for their medico-legal report. In the majority, other clinicians had overlooked the diagnosis. The seatbelt shoulder was involved in 83% of cases.

After a neck injury a significant proportion of patients present with shoulder pain, some of whom have treatable shoulder pathology such as impingement syndrome. The diagnosis is, however, frequently overlooked and shoulder pain is attributed to pain radiating from the neck resulting in long delays before treatment. It is important that this is appreciated and patients are specifically examined for signs of subacromial impingement after whiplash injuries to the neck. Direct seatbelt trauma to the shoulder is one possible explanation for its aetiology.

Pain associated with backpacks in children

Asymmetric Loads and Pain Associated With Backpack Carrying by Children

From: J Pediatr Orthop. 2008 July/August;28(5):512-517

Shoulder and back pain in school children is associated with wearing heavy backpacks. Such pain may be attributed to the magnitude of the backpack load and the manner by which children distribute the load over their shoulders and back. The purpose of this study is to quantify the pressures under backpack straps of children while they carried a typical range of loads during varying conditions.

Ten healthy children (aged, 12-14 years) wore a backpack loaded at 10%, 20%, and 30% body weight. Backpacks were carried under 2 conditions, low on back or high on back. Pressure sensors (0.1 mm thick) measured pressures beneath the shoulder straps.

When walking with the backpack straps over both shoulders, contact pressures were significantly greater in the low-back condition than in the high-back condition (P = 0.004). In addition, when children carried the backpack in the low-back condition, mean pressures (+/-SE) over the right shoulder were as follows: 98 +/- 31, 153 +/- 48, and 170 +/- 54 mm Hg at 10%, 20%, and 30% body weight, respectively, which were significantly higher than those over the left shoulder (46 +/- 14, 92 +/- 29, and 90 +/- 29 mm Hg, respectively). Perceived pain with the backpack over 1 shoulder was significantly greater than that for donning with both shoulders in the low back condition.

Pressures at 10%, 20%, and 30% body weight loads on the right or left shoulder, during low back or high back conditions, are higher than the pressure thresholds (approximately 30 mm Hg) to occlude skin blood flow. Furthermore, asymmetric and high pressures exerted for extended periods of time may help explain the shoulder and back pain attributed to backpacks. Ergonomic Backpacks are clinically proven to reduce backpack stress and are important for the prevention of back, neck and shoulder pain in children.

Prevalence and characteristics of arm, neck, and shoulder complaints

Prevalence and characteristics of complaints of the arm, neck, and/or shoulder in the open population

From: Clinical Journal of Pain. 2008 Mar-Apr;24(3):253-9.

To study the prevalence of upper extremity disorders and neck as a total and complaints of the arm, neck and/or shoulder not caused by acute trauma or any systemic disease as defined in the complaints of the arm, neck and/or shoulder model in the open population and to assess sociodemographic and health characteristics of chronic symptoms.

Data were obtained from the DMC3-study, a Dutch questionnaire survey on musculoskeletal conditions. Data on four anatomic sites were assessed: neck, shoulder, elbow, and wrist. Various health characteristics were measured including the Short Form-36. Rectangle diagrams were used to illustrate cooccurrence of pain in the four anatomic sites.

The 12-month prevalence of complaints of the arm, neck and/or shoulder was 36.8%, the point prevalence was 26.4%, and 19.0% patients reported chronic complaints of the arm, neck and/or shoulder. Women, aged 45 to 64 years, with the lowest education level and working were the most affected. Within those with upper extremity disorders, around 25% of cases were caused by an acute trauma or by some systemic disease. Of those with chronic complaints of the arm, neck and/or shoulder, 58% reported use of healthcare. Healthcare users scored worse on general health, limitations in daily living, pain, and sickness absence than nonhealthcare users; >43% reported symptoms in more than 1 anatomic site.

Upper extremity disorders and complaints of the arm, neck and/or shoulder frequently occur in the open population. Excluding acute traumas and systemic diseases reduced the prevalence of complaints of the arm, neck and/or shoulder and resulted in a relatively healthier population. A compound definition of complaints of the arm, neck and/or shoulder seems indicated because of the large overlap of affected anatomic sites.

Poor neck and shoulder postures in office workers

A field comparison of neck and shoulder postures in symptomatic and asymptomatic office workers

From: Applied Ergonomics. 2002 Jan;33(1):75-84

Poor neck and shoulder postures have been suggested to be a cause of neck and shoulder pain in computer workers. The present study aimed to evaluate and compare the head, neck and shoulder postures of office workers with and without symptoms in these regions, in their actual work environments. The two all female subject groups reported significantly different discomfort scores across five trials repeated in a single working day. The results of repeated video capture and two-dimensional motion analysis showed that there were trends for increased head tilt and neck flexion postures in the symptomatic subjects (n = 8), compared to the asymptomatic subjects (n = 8). Symptomatic subjects also tended to have more protracted acromions compared with asymptomatic subjects and showed greater movement excursions in the head segment and the acromion. All subjects demonstrated an approximately 10% increase in forward head posture from their relaxed sitting postures when working with the computer display, but there were no significant changes in posture as a result of time-at-work.

Neck and shoulder region musculoskeletal disorders questionnaire

Agreement between a self-administered questionnaire on musculoskeletal disorders of the neck and shoulder region and a physical examination

From: BMC Musculoskelet Disord. 2008 Mar 17;9:34

In epidemiological studies on neck and shoulder disorders, physical examination by health professionals, although more expensive, is usually considered a better method of data collection than self-administered questionnaires on symptoms. However, little is known on the comparison of these two methods of data collection. The agreement between self-administered questionnaires and the physical examination on the presence of neck and shoulder disorders was assessed in the present study.

These results suggest a fair to good agreement between the presence of musculoskeletal disorders ascertained by self-administered questionnaire and physical examination that may reflect differences in the constructs measured. Shorter time lags result in better agreement. Investigators should consider these results before choosing a method to measure the presence of musculoskeletal disorders in the neck and shoulder region.

In epidemiological studies, data on neck-shoulder disorders are often collected by physical examination, by questionnaire or with both instruments. Physical examination by health professionals is usually recognized as more objective than questionnaires. However, questionnaires permit data collection on many participants for a fraction of the cost and time of a physical examination. Few epidemiological studies on neck and upper extremity musculoskeletal disorders have systematically compared the findings of questionnaires with those obtained by physical examination. Only four studies published in English have reported the sensitivity and specificity of a questionnaire compared to clinical examination of the neck and shoulder region to identify individuals with neck and shoulder disorders.

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Stiff neck and shoulder related to stress and gender

Association of perceived stress and stiff neck and shoulder with health status: multiple regression models by gender.

From: Hiroshima J Med Sci. 2006 Dec;55(4):101-7.

It is well known that psychological stress affects health status. Stiff neck and shoulder in a broad sense is one of the major somatic complaints among Japanese. The objective was to determine how much perceived stress and stiff neck and shoulder are associated with health-related quality of life (HRQoL) by gender. Participants (n = 512) completed the Japanese version of Perceived Stress Scale, the SF-8 Japanese version and original questions on perceived stiff neck and shoulder. Muscle hardness around the shoulder also was measured with the muscle tension meter. The multiple regression model of the men demonstrated that perceived stress was associated with not only the mental component summary (MCS) (beta: -0.494), but also the physical component summary (PCS) (beta = -0.319) of the SF-8. Although, in the model of the women, perceived stress was also associated with MCS (beta: -0.632) more than in that of the men, stiff neck and shoulder and age group (beta: -0.231; -0.268, respectively), but not stress, were related to PCS. The subjective neck and shoulder stiffness was hardly correlated with the objective shoulder muscle hardness. This study revealed the associations between perceived stress, stiff neck and shoulder and HRQoL, and their difference by gender. The hypothesis of gender differences was discussed with a focus on kind of stressors, perception of stress, admission of negative symptoms and cause of stiff neck and shoulder.

Season effects on neck and shoulder pain

Seasonal variation in neck and shoulder symptoms

From: Scandanavian Journal of Work, Environ and Health. 1992 Aug;18(4):257-61

The objective of the investigation was to study the course of neck and shoulder pain symptoms and the predictors for these symptoms among women in light sedentary work. Postal surveys were conducted among 351 tellers (age 20-50 years) of a bank company in September, December, March, and May. The response rates were 74-90%. The outcome was the frequency of the symptoms during the previous three months. In the analysis, univariate explorations and random-effects logistic binomial regression for distinguishable responses were used. A change in the frequency of neck and shoulder pain symptoms was seen in 40.5% of the subjects during the follow-up period from autumn to spring. The frequency of the symptoms decreased from autumn and winter towards spring. The stability of the frequency of the symptoms was positively associated with age.

Chronic neck pain symptoms exhibit seasonal variation, worsening in the autumn and decreasing in the spring.

Stress in neck and shoulder pain, tension headaches and fibromyalgia

Similarities in stress physiology among patients with chronic pain and headache disorders: evidence for a common pathophysiological mechanism?

From: The Journal of Headache and Pain. 2008 Apr 14 [Epub ahead of print]

One common feature of chronic musculoskeletal pain and headaches are that they are both influenced by stress. Among these, tension headache, fibromyalgia and chronic neck and shoulder pain appear to have several similarities, both with regard to pathophysiology, clinical features and demographics. The main hypothesis of the present study was that patients with chronic pain (tension headache, fibromyalgia and shoulder neck pain) had stress-induced features distinguishing them from migraine patients and healthy controls. We measured pain, blood pressure, heart rate (HR) and skin blood flow (BF) during (1 h) and after (30 min) controlled low-grade cognitive stressor in 22 migraine patients, 18 tension headache patients, 23 fibromyalgia patients, 29 shoulder neck pain patients and 44 healthy controls. fibromyalgia patients had a lower early HR response to stress than migraine patients, but no differences were found among fibromyalgia, tension headaches, shoulder and neck pain patients. Finger skin BF decreased more in fibromyalgia patients compared to migraine patients, both during and after the test. When comparing chronic pain patients (chronic tension headaches, fibromyalgia and shoulder neck pain) with those with episodic pain (episodic tension headache and migraine patients) or little or no pain (healthy controls), different adaptation profiles were found during the test for systolic and diastolic blood pressure, HR and skin BF in the chronic group. In conclusion, these results suggest that tension headache, fibromyalgia and shoulder neck pain patients may share common pathophysiological mechanisms regarding the physiological responses to and recovery from low-grade cognitive stress, differentiating them from episodic pain conditions such as migraine.