Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors

doi:10.1016/S0049-0172(03)00128-8

Seminars in Arthritis and Rheumatism

Volume 33, Issue 3, December 2003, Pages 185-203

https://doi.org/10.1016/S0049-0172(03)00128-8 Get rights and content

Abstract

Objectives: To review the epidemiologic literature concerning the occurrence of and the risk factors for pain and specific soft-tissue rheumatic conditions that affect the neck and upper limbs.

Methods: An extensive search of the literature, including a search of Medline and EMBASE, authoritative recent reviews, and relevant textbooks, was performed. Studies that furnished data about the occurrence of or risk factors for regional pain or specific soft-tissue entities were extracted.

Results: Numerous epidemiologic studies among different populations suggest a high prevalence of pain in the neck (10% to 19%), shoulder (18% to 26%), elbow (8% to 12%), and wrist/hand (9% to 17%) at any point in time. Less clear is the proportion of pain caused by specific upper-limb disorders as compared with nonspecific pain; however, as many as 6% of adults may have carpal tunnel syndrome. Significant risk factors for these disorders include age, female gender, obesity, and association with mechanical exposures (eg, posture, force, repetition, vibration) in the workplace. Also implicated are psychologic well-being and psychosocial workplace factors such as high levels of demand, poor control, and poor support.

Conclusion: Pain and soft-tissue rheumatic disorders of the neck and upper limb are common. It appears that individual, mechanical, and psychosocial factors all contribute to upper-limb disorders, suggesting that future strategies for prevention will need to address each of these factors if they are to be successful.

Section snippets

Methods

Epidemiologic surveys of neck or upper-limb complaints were located through EMBASE (Excerpta Medica) and Medline (National Library of Medicine) databases from 1980 to 2001, searching under the key words upper limb pain, neck pain, shoulder pain, elbow pain, wrist pain, hand pain, tendinitis, (adhesive) capsulitis, bursitis, rotator cuff syndrome (tendinitis), impingement, lateral epicondylitis, medial epicondylitis, de Quervain’s disease, tenosynovitis, carpal tunnel syndrome, trigger digit,

Results

The search identified 17 published studies on the occurrence of regional pain and 16 on the frequency of specific disorders, of which 4 were concerned with carpal tunnel syndrome (CTS) and 8 with Dupuytren’s contracture. We found 210 studies concerned with risk factors for upper-limb disorders, for which 69 incorporated an examination component, allowing inferences to be drawn about the risk factors for specific soft-tissue conditions. Before describing the findings, we draw attention to a

Pain surveys

Population-based surveys collectively show the high prevalence of neck and upper limb discomfort, including pain that is prolonged and clinically significant in impact (Table 2). For example, the lifetime prevalence of neck pain was found to be around 70% in surveys from Finland (14) and Canada (15), whereas 12% to 34% of the general population experience neck pain annually 16, 17, 18, 19, 20 and 10% to 20% on a given day (21). Similarly, around 15% to 30% of adults experience shoulder pain at

Risk factors for neck and upper-limb disorders

The evidence of association between risk factors will be considered under the rubric: individual factors (eg, age, gender, build, and genetic constitution); mechanical exposures (at work and in leisure); and psychosocial risk factors.

Causes of upper-extremity musculoskeletal disorders

Although there are methodologic shortcomings, a body of evidence suggests that upper-limb disorders are multifactorial in origin, the result of complex interplay between individual, psychosocial, and mechanical risk factors (3). Upper-limb symptoms may arise from a spectrum of conditions, ranging from specific clinical entities such as lateral epicondylitis and CTS through to diffuse regional pains with no identifiable clinical signs. The literature allows few conclusions to be drawn about the

Discussion

Although we found more than 120 epidemiologic studies of the frequency of and risk factors for upper-limb disorders, the literature is heterogeneous. Differences in methodology and assessment of outcome hamper our ability to draw conclusions about many aspects of these conditions. Notwithstanding, the evidence suggests that regional pain in the neck and upper limbs is common among adults. Less clear from the available literature is the proportion of regional neck and upper-limb pain that is

Karen E. Walker-Bone, BM, MRCP, PhD: Senior Research Fellow and Honorary Consultant Rheumatologist, Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England

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Routine utilisation of outcome measures (OMs) is an integral part of physiotherapy rehabilitation when managing non-specific neck pain (NSNP). Numerous relevant OMs exist; however, the extent to which OMs are used by physiotherapists in the UK for NSNP is unknown.
To determine current utilisation patterns of OMs in UK physiotherapy practice when managing NSNP.
An online web-based survey instrument was developed and physiotherapists were invited to participate if they were currently practicing in the UK and had some experience of managing patients with neck pain. Logistic regression analyses using the generalised linear models was carried out to identify characteristics associated with OMs utilisation.
A total of 2101 surveys were completed. One-third of the respondents reported not using OMs when managing NSNP. Lack of time and clear guidance about the suitability of available OMs were the most commonly reported reasons. A majority of the two-thirds of those who reported using OMs were consistently using pain and range of motion rating measures. Physical/functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NSNP, were rarely measured. Years of practice (p = 0.000), nation (p = 0.019) and proportion of patients with neck pain (p = 0.034) variables were found to be independently associated with frequent use of OMs.
This survey established the poor integration of OMs in the UK when managing NSNP. Further attention is required to identify or develop OMs which are feasible for use in busy clinical practice and to market them more effectively to physiotherapists.
Measuring upper limb disability for patients with neck pain: Evaluation of the feasibility of the single arm military press (SAMP) test
2020, Musculoskeletal Science and Practice
Non-specific neck pain (NSNP) is frequently associated with upper limb disability (ULD). Consequently, evaluation of ULD using an outcome measure is necessary during the management of patients with NSNP. The Single Arm Military Press (SAMP) test is a performance-based ULD measure developed for populations with neck pain. During the SAMP test, patients are asked to repeatedly lift a weight above their head for 30 s. The number of repetitions is counted. Its clinical utility in a patient group is still unknown.
This study investigates the feasibility of the SAMP test from patients and clinicians’ perspectives.
Seventy female patients with NSNP were randomly allocated into one of three groups. Participants in each group completed the SAMP test using one of three proposed weights (½kg, 1 kg or 1½kg). The feasibility of the SAMP test was established using structured qualitative exit feedback interviews for patients and administrating clinicians.
Participants using ½kg achieved the highest number of repetitions, but a high proportion reported the weight as extremely light, whereas those who tested using the 1½kg achieved the lowest number of repetitions and participants reported the weight as being heavy. Participants tested using 1 kg achieved an average number of repetitions and a high proportion reported the weight as acceptably heavy. Clinicians and patients reported that the SAMP test was efficient and convenient.
The 1 kg SAMP test is feasible for use in female patients with NSNP. The measurement properties of the SAMP test should be determined in a patient group.
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Citation Excerpt :
The primary outcome was the prevalence of diagnoses of shoulder disorders. We used a diagnostic routine modified from the Southampton examination schedule9 to identify the point prevalence (appendix 1).10,11 Most shoulder diagnoses are based on clinical tests with reported intrarater reliabilities between .63 and .94.12,13
To compare the prevalence of shoulder disorders and self-reported shoulder disability in patients with long-term type 1 diabetes mellitus and diabetes-free subjects; and to explore the association between the long-term glycemic burden and shoulder disability in the diabetes group.
Cross-sectional study of shoulder diagnoses with 30 years' historical data on glycemic burden in patients with diabetes.
Diabetics center and a university hospital.
Subjects attending the Norwegian Diabetics Center in 2015 with type 1 diabetes since 1970 or earlier were eligible (N=136). One hundred and five patients were included, and 102 (50% women; mean age, 61.9y) completed the study together with 73 diabetes-free subjects (55% women; mean age, 62.5y).
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Shoulder diagnoses decided through clinical examination according to scientific diagnostic criteria.
Frozen shoulder was diagnosed in 60 (59%) patients with diabetes and 0 diabetes-free subjects, with a lifetime prevalence of 76% in the diabetes group versus 14% in the diabetes-free subjects. Patients with diabetes had higher disability and higher mean QuickDASH scores (23.0±19.9) than diabetes-free subjects (8.9±12.0), with a mean difference of −14.2 (95% confidence interval, −19.3 to −9.0) points (P<.001). We found an association between chronic hyperglycemia and QuickDASH scores, with a 6.16-point increase in QuickDASH scores per unit increase in glycated hemoglobin A_1c (HbA_1c) (P=.014).
The point prevalence of frozen shoulder in patients with long-lasting type 1 diabetes was 59%, and the lifetime prevalence was 76%. The diabetes group had more shoulder disability than diabetes-free subjects. The historical HbA_1c level was associated with increased shoulder disability.
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Keith T. Palmer, DM, MA, FFOM: Medical Research Council Clinical Scientist and Honorary Consultant in Occupational Medicine, Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England

Isabel Reading, BSc, MSc: Medical Statistician, Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England

Cyrus Cooper, MA, DM, FRCP, F Med Sci: Professor of Rheumatology, Medical Research Council Environmental Epidemiology Unit, University of Southampton, Southampton, England.

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Soft-tissue rheumatic disorders of the neck and upper limb: prevalence and risk factors

Abstract

Section snippets

Methods

Results

Pain surveys

Risk factors for neck and upper-limb disorders

Causes of upper-extremity musculoskeletal disorders

Discussion

Semin Arthritis Rheum

Pain

J Clin Epidemiol

J Hand Surg

J Hand Surg

J Clin Epidemiol

Pain

J Clin Epidemiol

J Hand Surg

J Hand Surg

Pain

Arch Phys Med Rehabil

Am J Hum Genetics

J Hand Surg

J Clin Epidemiol

J Hand Surg

Fibromyalgia in rheumatology practicea survey of Canadian rheumatologists

J Rheumatol

Occupational injuries and illnesses in the United States by industry—1990

Self-Reported Work-Related Illness in 1995

Behavioral mechanisms of work-related upper extremity disordersA new agenda for research and practice

Am J Ind Med

Diagnostic criteria for work-related upper limb disorders

Br J Rheumatol

Occupation and upper limb disorders

Rheumatology

Workplace ergonomic factors and the development of musculoskeletal disorders of the neck and upper limb

Am J Ind Med

New avenues in research on musculoskeletal disorders

Scand J Work Environ Health

Psychosocial factors at work and musculoskeletal disease

Scand J Work Environ Health

Psychosocial stressors at work and musculoskeletal problems

Scand J Work Environ Health

Back and limb disorders

Prevalence, determinants, and consequences of chronic neck pain in Finland

Am J Epidemiol

The Saskatchewan health and back pain survey

Spine

The prevalence of and risk factors for neck pain in Hong Kong Chinese

J Public Health Med

Rheumatic symptoms in the middle-aged population in south-western Finland

Scand J Rheumatol

Neck pain in the general population

Spine

Pain from the neck-shoulder region and sick leave

Scand J Soc Med

The association of neck pain with radiological abnormalities of the cervical spine and personality traits in the general population

J Rheumatol

Prevalence, incidence and remission rates of some rheumatic diseases and syndromes

Scand J Rheumatol

Shoulder disorders in the elderlya community survey

Arthritis Rheum

Estimating the burden of musculoskeletal disorders in the communityThe comparative prevalence of symptoms at different anatomical sites

Ann Rheum Dis

Shoulder pain in middle age

Clin Orthop

The commonest rheumatic complaints of over six weeks’ duration in a twelve month period in a defined Swedish population

Scand J Rheumatol

Chronic neck pain in a geographically defined general populationStudies of differences in age, gender, social class and pain localisation

Clin J Pain

Soft tissue rheumatism

Morbidity Statistics From General Practice, 3rd National Survey, 1981–2

Shoulder disorders in general practiceincidence, patient characteristics and management

Ann Rheum Dis

Role of mechanical and psychosocial factors in the onset of forearm painProspective population based study

BMJ

The Shoulder

The frozen shoulder

Acta Orthop Scand

The shoulder