Epidemiology of Shoulder Pain

Introduction

Shoulder pain is a common musculoskeletal disorder considered a disabling problem and can be associated with a substantial economic burden. Pain and disability associated with shoulder pain can have a significant impact on individuals, their families, communities and healthcare systems Affects daily function and ability to work. It is the third most common musculoskeletal disorder in physical therapy. [1][2][3]

The definition of shoulder pain is not so clear. In epidemiological studies, the definition of shoulder pain symptoms as a set of difficulties secondary to the complex interrelationships between the shoulder and adjacent regions and the frequent occurrence of referred pain has made clinical There is a problem with the case definition. The etiology of shoulder pain is varied and includes local lesions originating in the shoulder such as the glenohumeral joint, acromioclavicular joint, sternoclavicular joint, rotator cuff and other soft tissues within the shoulder complex, but can also be referred to From other structures, such as the neck or other internal organs. [4][5][6] The degree of tissue damage observed on clinical imaging does not correlate with the intensity of shoulder pain, so the relevance of diagnosing structural pathology in patients with shoulder pain has been questioned by many research and clinical practice. [7][2][8] Similarly, it has been shown that 20–40% of individuals in the general population have asymptomatic rotator cuff tears, suggesting that structural pathology may not fully account for shoulder pain sensations and highlight Potential Diagnostic labeling for misleading treatment. Consequently, “shoulder pain” has been used as a catch-all term in many available epidemiological studies. [3][9][10][11]

Here, we review some of the findings in the literature regarding the incidence and prevalence of shoulder pain in the general population, age distribution, occupational and psychosocial risk factors associated with symptom onset of shoulder-related pain. [6]

Incidence

Incidence figures ranged from 0.9-2.5%, with an average incidence rate of 29.3 cases per 1000 person-years over a 9-year period, with a specific incidence rate [12];

• 32.2 for women
• 26.2 for men

The most recent incidence data reviewed in 2021 are similar but slightly higher, with an average incidence rate of 30.3 cases per 1000 person-years over a 5-year period, with specific incidence rates [13]:

• 36.1 for women
• 28.3 for men

Average incidence rate per 1000 person-years over a 9-year period [12];

• 22.2 in 18- 44 year olds
• 40.2 in 45 – 64 year olds
• 37.1 in 65+ year olds

Incidence of Specific Conditions;

• Rotator cuff tendinopathy occurs in 0.3% to 5.5% of cases
• Traumatic dislocation of the glenohumeral joint is the most common joint dislocation, occurring between 8.2 and 23.9 per 100,000 per year [14]

Prevalence

The estimated prevalence of shoulder pain varies widely, ranging from 1% to 66% [4] [15]. This may be due in part to the complex structure of the shoulder and the close functional biomechanical association with adjacent regions including the spine. further The reason for the reported discrepancy has to do with the fact that the shoulder can be a primary or secondary source of pain, so many authors and clinicians tend to generalize this presentation simply as a shoulder pain syndrome. [4] [5]

For reference, epidemiological research reports: [6][15]

• Point prevalence between 6.9% – 26%
• 1-month prevalence between 18.6% – 31%
• Annual prevalence between 4.7% – 46.7%
• Lifetime prevalence between 6.7% – 66.7%
• The prevalence of chronic pain ranges from 15.5% to 41%, with a peak rate of 23% among those aged 18-24 and a peak of 50% among those aged 55-64 [6]

Prevalence associated with specific conditions:

• Primary coat adhesions have been reported to have a prevalence of 2% to 5.3%, mainly affecting women over the age of 40 with sedentary jobs where the shoulders are not dominant [16][17]
• The prevalence of secondary adhesive capsulitis associated with diabetes and thyroid disease was 4.3% and 38%, respectively. [17] It has been found that diabetic patients are five times more likely to suffer from joint capsulitis than the general population [18]
• The reported prevalence of rotator cuff-related abnormalities ranged from 9.7% to 62% [19]

Prevalence in women (15% – 26%) is generally higher than in men (13 – 18%) because more women present in primary care. [6]

Prevalence increases with age [20], while incidence peaks around age 50 and then remains at around 2%. Most common in middle age (ages 45 – 64, from 21 – 55%), which may be due to the normal aging process of shoulder structures including the rotator cuff, but is also common in the shoulder A younger age group (12 – 57% among adolescents aged 12 – 18), which can be attributed to postural relationships associated with increased sitting time and increased technology use. [6] This is also a common complaint among older teenage athletes: the overall prevalence was 43.5 A higher proportion of adolescents participated in handball and judo. [twenty one]

In the Netherlands, the shoulder is the second most common site of musculoskeletal pain after low back pain. Some other interesting findings from the study included that 30% described persistent pain, while 55% had recurring pain, with mild pain (70%) more common than severe pain (15%). [twenty two] While Koojman et al considered shoulder pain to be the third most common musculoskeletal condition in physiotherapy [23], accounting for 14% of annual referrals to physiotherapy outpatient services in the UK. [twenty four]

Risk Factors

Risk factors for shoulder pain share many similarities with other musculoskeletal disorders such as genetics [25] hormonal influences [26] lifestyle factors such as smoking [27] alcohol consumption [28] comorbidities education level [29] and sedentary Lifestyle[6] Sleep disorders[6][15] Biochemical Pathological anatomy of peripheral and central sensitization and changes in the sensorimotor cortex [30] and a host of psychosocial factors such as somatization of depression and poor coping with anxiety [31]. In particular excessive and maladaptive loads placed on tissues appear to be a major effect Certain shoulder disorders, such as rotator cuff-related shoulder pain [32][33].

Work-related risk factors cited in the literature for episodes of shoulder pain include repetitive work, especially overhead activities or work with higher than high-intensity demands and vibration work-related posture computer work and psychosocial factors including stress work stress Social support and job satisfaction. [5][6][15][34]

When we look at specific shoulder disorders, rotator cuff disorders are associated with over-loaded glenohumeral and acromioclavicular joint instability Muscle imbalance Unfavorable anatomical features Age-related rotator cuff degeneration [35] Ischemia and musculoskeletal disorders lead to atrophy of the rotator cuff. [36][37][38][39] Risk factors for adhesive capsulitis include older female age, history of shoulder trauma surgery, diabetes mellitus, cardiopulmonary disease, cerebrovascular events, thyroid disease, and hemiplegia. [6][40][41][42]

Prognosis

About 50% of new-onset shoulder pain resolves within 8 to 12 weeks, but as many as 40% of cases persist for more than a year, and the recurrence rate and chronicity of shoulder pain are moderate to high. [15] Many people with shoulder pain do not experience full treatment Symptoms resolve, and 40% to 50% of patients with shoulder pain report a recurrence after 1 to 5 years. At the third year of follow-up, a whopping 13.6% were still receiving medical services for shoulder problems. In a 2003 study of Danish shoulder workers The average duration of symptoms of tendinopathy was 10 months or less, with 25% of workers still experiencing symptoms at 22 months. [43] Poor prognosis is associated with increasing age in females and severe or recurrent symptoms and associated neck pain. especially high baseline pain and previous episodes of shoulder pain were associated with poor outcomes. [6][44] Good prognosis is associated with early presentation of pain and mild trauma or overuse before acute onset. [5][9][43]

Studies have shown that associations between prognostic factors and outcomes are often inconsistent, possibly due to type II errors or heterogeneity at multiple levels, including adherence to treatment choice or outcome measures. Only two baseline prognostic factors consistently demonstrated Associated with two or more study outcomes; shoulder pain duration and baseline function. [45]

Economic Burden

The financial burden of shoulder disease is high, including treatment costs and lost wages. A UK study reported that around 1% of UK adults consulted their doctor within the first 6 months, at an estimated cost of £310m in additional surgery The cost of the surgery is estimated to be around £30m a year, with up to 50% of the cost related to sick leave from paid work. [46]

Relevance to Physiotherapy

Although some acute episodes of shoulder pain resolve spontaneously, up to 50% of all new-onset shoulder pain continue to be symptomatic or recur at 6 months. Up to 40% of patients remain symptomatic at 1 year. [6][47][48][49] Strongest Evidence for Treatment of Shoulder Pain Right now it’s for exercise. Physiotherapists have a detailed understanding of the pain mechanisms and exercise prescriptions associated with shoulder pain, making them experts at helping shoulder pain patients regain normal function and thereby reduce shoulder burden pain. [17][43][48]