PREMUS 2025: 12th International Scientific Conference on the Prevention of Work-Related Musculoskeletal Disorders
Thresholds for musculoskeletal damage caused by hand-arm vibrations in rotator cuff structures remote from the site of impact
2Eisenach, Germany
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Introduction: In Germany, rotator cuff tears caused by hand-arm vibrations can be recognized as an occupational disease since April 2025, if they are caused by hand-arm vibrations.
Methods: Analysis of the scientific literature used in the justification and other sources.
Results: The justification for the occupational disease “rotator cuff damage” is based on epidemiological studies. The most important basis presented as “proven” is the systematic review by Seidler et al. [1]. It refers to van der Molen et al. [2]. In this respect, this work by Seidler should be understood as an update. In trauma surgery, damage to the rotator cuff during HAV impacts is only known by heavy equipment that has to be held.
Discussion: Justifikation for rotator cuff damage is based on epidemiological studies. Here the evidence up to 2020 spoke against legally significant damage to the structures of the shoulder joints caused by HAV. Little is known experimentally about the energy transfer from the point of application in the hands to the target region of the rotator cuff.
Mechanical and electromyographic measurements showed energy losses between hand, elbow and shoulder. This was confirmed by Xu et al. [3] using a design developed at NIOSH. Emerging from the hand at medium frequencies, only about a quarter of the total vibration energy reaches the shoulder.
Conclusions: Rotator cuff damage caused by hand-arm vibrations is questionable. The biological plausibility of an epidemiologically suspected cause-effect relationship must be examined in discussion according to good epidemiological practice, this includes experimental evidence.
References
[1] Seidler A, Romero Starke K, Freiberg A, Hegewald J, Nienhaus A, Bolm-Audorff U. Dose-Response Relationship between Physical Workload and Specific Shoulder Diseases-A Systematic Review with Meta-Analysis. Int J Environ Res Public Health. 2020 Feb 14;17(4):1243. DOI: 10.3390/ijerph17041243[2] van der Molen HF, Foresti C, Daams JG, Frings-Dresen MHW, Kuijer PPFM. Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis. Occup Environ Med. 2017 Oct;74(10):745-55. DOI: 10.1136/oemed-2017-10433
[3] Xu XS, Dong RG, Welcome DE, Warren C, McDowell TW, Wu JZ. Vibrations transmitted from human hands to upper arm, shoulder, back, neck, and head. Int J Ind Ergon. 2017 Dec;62:1-12. DOI: 10.1016/j.ergon.2016.07.001
