Development of a methodology inventory for the creation of a register of measured values for ‘tendon damage in the shoulder area’

Status:

completed 04/2024

Aims:

The medical advisory council for occupational diseases at the German Federal Ministry of Labour and Social Affairs (BMAS) has issued a scientific recommendation for formal recognition of a new occupational disease: damage to the tendon in the shoulder region caused by long-term and intensive load on the shoulder. The recommendation was published on 14 December 2021 in the Joint Ministerial Gazette (GMBl, issue 64-65/2021, p. 1411 ff.).

The cause is defined as long-term and intensive load arising during work performed above shoulder level, repetitive movements in the shoulder joint, exertion of force in the shoulder region due to the lifting of loads, or hand-arm vibration. Robust data on the forms of exposure associated with the lifting of loads and hand-arm vibration has been available for some years now from registers maintained at several statutory accident insurance institutions. However, no register data is currently available for the forms of exposure associated with work performed above shoulder level and repetitive movement in the upper arm. Knowledge of the incidence and frequency of these forms of exposure in an occupational environment is therefore very limited.

For this reason, a register of measured values is to be created over the longer term at the Institute for Occupational Safety and Health of the German Social Accident Insurance (IFA), with the cooperation of several individual statutory accident insurance institutions and with use of the CUELA measurement system (computer-assisted measurement and long-term analysis of musculoskeletal workloads). The purpose of this register is to provide valid data for quantifying the relevant loads upon the shoulder in a number of occupational groups, and thereby to create a basis for future prevention measures and workplace investigations into suspected cases of occupational disease. The sub-working group with responsibility for the shoulder region was established at the initiative of the occupational disease/exposure working group.

The sub-working group’s purpose is to develop the instruments required by the statutory accident insurance institutions for investigations of suspected cases of the occupational disease which is the subject of the new recommendation. The objectives for the short term include development of a guidance document for investigating suspected cases of this occupational disease, and a corresponding module for the IFA occupational exposure history software. Plans are also for establishment in the next four years of a measurement-based register of exposure in the form of work performed above shoulder level and repetitive movements of the upper arm.

The objective of this project was to gather existing register data and compile an inventory of methods for the possible collection of register data not yet available on shoulder load (damage to the tendon in the shoulder region).

Activities/Methods:

In the course of a literature survey, literature including that discussed in the scientific rationale was first reviewed for criteria defining work performed above shoulder level and repetitive movement of the upper arm. Furthermore, exposure data already available at the IFA was analysed to determine what activities exhibit the stated exposures. As part of the scientific discussion, a definition of the stated exposures was also formulated, in preparation for a purposeful metrological survey.

In cooperation with the statutory accident insurance institutions, relevant activities in individual occupational groups were subsequently identified and classified by priority, and corresponding activity modules defined. In conjunction with the statutory accident insurance institutions involved in the project, pilot measurements of the defined activity modules were conducted. Measurement technology of varying complexity was used for this purpose. The knowledge gained on the incidence of the defined load parameters during performance of diverse activities was incorporated directly into further development of the CUELA software application.

Results:

The project began with compilation of existing register data. Based on this compilation, an inventory of methods was drawn up for recording register data still lacking on shoulder load (damage to the tendon in the shoulder region). The method inventory is based on a user-friendly CUELA measurement system. This comprises five inertial sensors attached to the test subject’s upper arms, forearms and torso by means of Velcro straps and a back/chest strap. Use of this system requires no expert knowledge. The WIDAAN software application enables the forms of exposure associated with work performed above shoulder level and repetitive movement in the upper arm to be recorded and analysed objectively during the course of discrete activity modules and over entire work shifts. Some of the statutory accident insurance institutions have already procured the system themselves. In the follow-up project (4258) and following relevant training at the IFA, the statutory accident insurance institutions concerned are now able to perform measurements independently to create the shoulder register.

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