Shoulder Dysfunction/Pain –
A Guide for Human Resources and Management
Part One: Shoulder Pain – The Facts
Shoulder pain is a common symptom and often resolves within a short period of time. Distinguishing the exact cause of long-term shoulder pain is notoriously difficult, and investigations such as x-ray and MRI scan are often required to pin down the diagnosis. As well as being due to specific lesions such as torn tendons or local arthritis, shoulder problems may be part of a general condition such as osteoarthritis or rheumatoid arthritis. Shoulder pain can also be caused by neck pain.
Shoulder problems are common in the working age population and many are amenable to simple treatments such as physiotherapy. For symptoms that are affecting work, a referral to an appropriate health professional is important and can facilitate a quicker recovery. Only a minority of individuals with shoulder pain require surgery.
Part Two: What to Look Out For – The Impact of Shoulder Disorders
The most common signs of a shoulder disorder are:
- Restricted range of movement, with particular difficulty in raising the arm above shoulder height
- Pain on movement especially on reaching forward and overhead
- Weakness in the arm and discomfort when carrying objects
The majority of individuals with shoulder pain will report the pain to their managers or colleagues. Individuals may avoid using one arm due to pain or discomfort, particularly when manual handling.
As most shoulder pain is caused by carrying heavy loads on one shoulder or by repetitive actions with the arm above shoulder height, it is uncommon for shoulder pain in health professionals to be caused by their work. It is more likely to have been caused by sporting activities such as swimming, golf or tennis. However nurses and other health professionals who regularly undertake heavy manual handling activities involving pushing and pulling are at risk of shoulder and neck pain.
A poor psychosocial work environment, including job satisfaction, may be important in the maintenance of chronic problems. A poor social work environment, together with an inadequate personal capacity to cope with these factors, may increase work related stress. The increase in stress may increase muscle tone. This in turn can result in an enhancement of the perception or reporting of symptoms, or a reduction of the capacity to cope.
Part Three – Adjustments to Facilitate Retention in the Workplace
Most shoulder problems resolve with a few weeks; however, some can take a prolonged period of rehabilitation. For example, frozen shoulder (adhesive capsulitis) can take up to 2 years to fully resolve.
In order to retain those with shoulder pain at work, the emphasis should be on adaptations to the workplace. This will particularly apply to health professionals undertaking practical procedures, likely to be located in operating theatres and diagnostic suites and in other clinical and laboratory settings. If the health professional finds that a particular procedure aggravates their shoulder pain, or restriction in shoulder movement prevents them from safely undertaking the procedure, an ergonomic assessment of the procedure should be undertaken. An occupational health nurse can do this.
General principles to prevent or minimise disability from shoulder pain include:
- avoiding reaching above shoulder height
- avoiding carrying heavy weights on one shoulder
- avoiding reaching out for instruments or tools behind the body
- avoiding heavy manual handling (including moving patients in bed or transfer of patients from a bed to a trolley or table for investigation or treatment
- maintaining a good position whilst sitting and standing.
Wardell, Burton and Kendall: Vocational Rehabilitation: What works, for whom and when, http://www.dwp.gov.uk/docs/hwwb-vocational-rehabilitation.pdf