¹Department of Occupational and Environmental Medicine, Aarhus University Hospital, Aarhus, Denmark
²Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
³Department of Clinical Medicine, Faculty of Medicine, Aalborg University, Aalborg, Denmark
⁴Department of Occupational and Environmental Medicine, University Research Clinic, Goedstrup Hospital, Herning, Denmark

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Introduction: Osteoarthritis (OA) is a degenerative joint disease that causes pain and functional impairment and may be linked to occupational mechanical exposures. The aim of this project was to investigate the association between occupational mechanical exposures and OA in the upper extremities, specifically the shoulder and elbow joints, through two systematic reviews.

Methods: Protocols for both reviews were registered in PROSPERO prior to the literature searches. The systematic literature searches were conducted across four databases and the selection of relevant articles was based on a pre-defined PECOS. Articles were screened based on title/abstract, followed by full-text reading. The exclusion, data extraction, and risk of bias assessment were independently performed by at least two review authors. The level of evidence was evaluated using the GRADE approach, and narrative syntheses were conducted to present similarities and differences between the included studies.

Results: From a total of 3,484 screened articles, 16 articles were deemed eligible for inclusion, of which 7 articles reported on shoulder OA and 10 articles reported on elbow OA (1 article provided estimates for both elbow and shoulder OA). The prevalence of OA in workers exposed to mechanical exposures varied widely, ranging from 2% to more than 60%. Higher odds ratios for developing shoulder or elbow OA were in general observed for specific exposures such as vibration and heavy manual work. For shoulder OA, regarding the acromioclavicular joint, exposure–response relationships were observed for all mechanical exposures. The level of evidence was in general considered low for shoulder OA and very low for elbow OA.

Discussion: Essentially, methodological considerations of the included literature is of importance. Much of the included literature was published several decades ago, which may limit the relevance of their findings regarding prevalence and job task descriptions in an occupational context. Moreover, the risk of bias assessment revealed major methodological weaknesses in most studies, with exposure assessments generally relying on self-reporting or job titles.

Conclusion: The findings from these two systematic reviews suggest a potential association between occupational mechanical exposures and osteoarthritis of both the shoulder and elbow joints. Despite the low level of evidence, trends across studies highlight the importance of preventive strategies targeting high-risk occupational groups. Further high-quality, longitudinal research is warranted to strengthen causal inference and support workplace interventions.