The impact of shoulder pathologies on job discontinuation and return to work: a pilot ultrasonographic investigation

BACKGROUND: Ultrasound imaging has emerged as one of the most useful tools for evaluating shoulder disorders. To date, the association between shoulder ultrasonography and a patient’s work status has rarely been explored by antecedent studies. AIM: This study aimed to investigate the association between sonographically diagnosed shoulder pathologies and job discontinuation and return to work. DESIGN: A cross-sectional study. SETTING: Outpatient clinic in the university hospital. POPULATION: Fifty-nine patients who were older than 20 years of age and had worked in a full-time job within the past three years. METHODS: All participants underwent clinical evaluation using the visual analog scale (for pain), Shoulder Pain and Disability Index, Pittsburgh Sleep Quality Index, and shoulder ultrasound examination. The work-related ergonomic risks, including dealing with heavy objects, repeated use and requiring forceful motion of the affected upper extremity, were assessed. The ultrasound-identified shoulder pathologies associated with job discontinuation, that is, sick leave due to painful shoulder for more than two consecutive months, were considered as the primary outcome. In the job discontinuation subgroup, we further investigated the association between return to work and the clinical/sonographic findings. RESULTS: Univariate analysis revealed a positive association between job discontinuation and shoulder surgery or work types requiring forceful upper-limb movements. Multivariate analysis demonstrated that job discontinuation was positively associated with supraspinatus tendon full-thickness tears (risk ratio, 8.80; 95% CI, 1.77-10.56; P=0.018). Of the patients who received shoulder surgery, 46.6% had recurrent rotator cuff tears. Return to work was likely to be related to pain scores during overhead activities and shoulder function impairment but not to sonographic findings. CONCLUSIONS: Job discontinuation is associated with shoulder surgery, work that necessitates forceful upper-extremity movements and supraspinatus tendon full-thickness tears detected by ultrasound. CLINICAL REHABILITATION IMPACT: Sonographic findings should not be used as the only standard for evaluating the patient’s work capability.