Characterizing shoulder disorders in Saudi Arabia: A retrospective, single-center study of prevalence, phenotypes, and risk factors

Characterizing shoulder disorders in Saudi Arabia: A retrospective, single-center study of prevalence, phenotypes, and risk factors

Authors

  • Walaa Hamdy Elsayed Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia

Keywords:

Arthritis, Joint dislocations, Musculoskeletal Diseases, Prevalence, Risk Factors, Shoulder

Abstract

Background and aim: Shoulder disorders represent a global health issue with varying incidence. This study estimates the prevalence and predictors and identifies high-risk groups of shoulder disorders in Saudi Arabia.   Methods: A single-center retrospective study utilized the physical therapy department’s medical records in the eastern region of Saudi Arabia, including patients diagnosed with shoulder disorders from 2023 to 2025. Data analysis included descriptive statistics, classification tree, and binary logistic regression to assess the associations between shoulder disorder types and risk factors.   Results: Soft-tissue and degenerative shoulder conditions predominated, with rotator cuff syndrome comprising most cases (84.5%), followed by capsular-degenerative conditions (12.1%) and then traumatic dislocations (3.4%). Younger individuals were more likely to have traumatic dislocations, while middle-aged and older adults increasingly showed capsular-degenerative and, predominantly, rotator cuff and periarticular disorders. Females had a higher percentage of rotator cuff and soft-tissue disorders, while males exhibited more traumatic dislocations. Significant independent predictors included gender, nationality, age, body mass index, and residence.   Conclusions: Rotator cuff disorders are the most prevalent shoulder condition. Shoulder disorders are influenced by age, gender, and body mass index. Degenerative shoulder conditions progressively escalate with age, whereas traumatic disorders primarily affect younger populations. Gender-specific patterns are evident, with females being more likely to have rotator cuff and other soft-tissue disorders, while males are more prone to traumatic dislocations and non-rotator cuff conditions. Higher body mass index increases the risk of non-rotator cuff disorders, where obese females are particularly vulnerable to non-rotator cuff shoulder disorders compared to obese males.

References

1. Bakhsh HR, Bakhsh HH, Alotaibi SM, Abuzaid MA, Aloumi LA, Alorf SF. Musculoskeletal Disorder Symptoms in Saudi Allied Dental Professionals: Is there an Underestimation of Related Occupational Risk Factors? Int J Environ Res Public Health 2021;18(19). doi: 10.3390/ijerph181910167

2. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ : British Medical Journal 2005;331:1124-8. doi: 10.1136/bmj.331.7525.1124

3. Lucas J, Van Doorn P, Hegedus E, Lewis J, Van Der Windt D. A systematic review of the global prevalence and incidence of shoulder pain. BMC Musculoskeletal Disorders 2022;23. doi: 10.1186/s12891-022-05973-8

4. Oliveira VMAd, Pitangui ACR, Gomes MRA, Silva HAd, Passos MHPd, Araújo RCd. Shoulder pain in adolescent athletes: prevalence, associated factors and its influence on upper limb function. Brazilian Journal of Physical Therapy 2017;21(2):107-13. doi: 10.1016/j.bjpt.2017.03.005

5. Almalki M, Alzahrani M, Aljulaihim A, et al. Prevalence of shoulder pain and disability in young Saudi bodybuilders, Riyadh, Saudi Arabia. Saudi Journal of Sports Medicine 2022;22:38-43. doi: 10.4103/sjsm.sjsm_31_21

6. Alghamdi A, Alfaqih M, Alfaqih E, et al. The Prevalence of Shoulder Pain and Awareness of Frozen Shoulder Among the General Population in Taif City, Saudi Arabia. Cureus 2024;16. doi: 10.7759/cureus.58229

7. Iavernig T, Zanette M, Miani A, Ronchese F, Filon L. Incidence of shoulder disorders in a cohort of healthcare workers from 2009 to 2020. International Archives of Occupational and Environmental Health 2023;96:883-9. doi: 10.1007/s00420-023-01976-7

8. Althomali O. Long-Term Prevalence and Risk Factors of Musculoskeletal Disorders among the Schoolteachers in Hail, Saudi Arabia: A Cross-Sectional Study. BioMed Research International 2022;2022. doi: 10.1155/2022/3610196

9. Linaker CH, Walker-Bone K. Shoulder disorders and occupation. Best Practice & Research Clinical Rheumatology 2015;29(3):405-23. doi: 10.1016/j.berh.2015.04.001

10. Almhdawi KA, Alrabbaie H, Kanaan SF, et al. The prevalence of upper quadrants work-related musculoskeletal disorders and their predictors among registered nurses. WORK 2021;68(4):1035-47. doi: 10.3233/wor-213434

11. Van Der Molen H, Foresti C, Daams J, Frings-Dresen M, Kuijer P. Work-related risk factors for specific shoulder disorders: a systematic review and meta-analysis. Occupational and Environmental Medicine 2017;74:745-55. doi: 10.1136/oemed-2017-104339

12. Sabbagh HJ, Shagagi AM, Basheer HM, Mahmoud RA, Arafah AM. Effect of ergonomics awareness in controlling work-related musculoskeletal-pain among dental students: A cross-sectional study. Work 2023;76(3):1125-33. doi: 10.3233/wor-220601

13. Almogbil I, Alrashidi L, Alhajlah R, et al. Prevalence of Shoulder and Neck Pain Among Healthcare Workers in the Central Region of Saudi Arabia. Cureus 2023;15. doi: 10.7759/cureus.42286

14. Alruwaili S, Thirunavukkarasu A, Alanazi RM, et al. Prevalence, Patterns, and Associated Factors for Musculoskeletal Disorders Among the Healthcare Workers of Northern Saudi Arabia: A Multicenter Cross-Sectional Study. Journal of Pain Research 2023;16:3735-46. doi: 10.2147/JPR.S415919

15. Mohamed S, Gihan M, Ghada H, et al. A Work-Related Musculoskeletal Disorders among Physiotherapists during COVID-19 in Western Region of Saudi Arabia. Pakistan Journal of Medical and Health Sciences 2022. doi: 10.53350/pjmhs22166521

16. Alshehri S. Prevalence, characteristics, contributing factors, work sector, and impact of work-related musculoskeletal disorders among otorhinolaryngology practitioners in Saudi Arabia: A cross-sectional study. Work 2022. doi: 10.3233/wor-211054

17. Elm Ev, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. Strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ 2007;335(7624):806-8. doi: 10.1136/bmj.39335.541782.AD

18. Tofthagen C. Threats to validity in retrospective studies. J Adv Pract Oncol 2012;3(3):181-3. PMID: 25031944

19. Patanwala AE. A practical guide to conducting and writing medical record review studies. American Journal of Health-System Pharmacy 2017;74(22):1853-64. doi: 10.2146/ajhp170183

20. Stein D, Bassel M, Payne KA. Retrospective Chart Review Studies: Strategies To Ensure Robust Data Quality. Value in Health 2014;17(7):A583. doi: 10.1016/j.jval.2014.08.1979

21. Kang H. The prevention and handling of the missing data. Korean J Anesthesiol 2013;64(5):402-6. doi: 10.4097/kjae.2013.64.5.402

22. Singh M, Sanchez JC, Gulwani S, Le V, Negreanu C, Verbruggen G. Cornet: Learning Spreadsheet Formatting Rules by Example. Proc VLDB Endow 2023;16(12):4058–61. doi: 10.14778/3611540.3611620

23. Fernstad SJ. To identify what is not there: A definition of missingness patterns and evaluation of missing value visualization. Information Visualization 2019;18(2):230-50. doi: 10.1177/1473871618785387

24. Jung J, Shon MS. Epidemiology and etiology of shoulder pain based on health statistics data from Healthcare Bigdata Hub in Korea. J Korean Med Assoc 2022;65(11):687-98. doi: 10.5124/jkma.2022.65.11.687

25. Tekavec E, Jöud A, Rittner R, et al. Population-based consultation patterns in patients with shoulder pain diagnoses. BMC Musculoskelet Disord 2012;13:238. doi: 10.1186/1471-2474-13-238

26. OWEN CE, LIEW DFL, BUCHANAN RRC. Musculotendinous Inflammation: The Defining Pathology of Polymyalgia Rheumatica? The Journal of Rheumatology 2019;46(12):1552-5. doi: 10.3899/jrheum.190367

27. Manske RC, Prohaska D. Diagnosis and management of adhesive capsulitis. Curr Rev Musculoskelet Med 2008;1(3-4):180-9. doi: 10.1007/s12178-008-9031-6

28. Bakhsh W, Nicandri G. Anatomy and Physical Examination of the Shoulder. Sports Medicine and Arthroscopy Review 2018;26(3):e10-e22. doi: 10.1097/jsa.0000000000000202

29. Alqutub ST. Assessment of Beneficiaries’ Satisfaction with Access to Health Care and Barriers within the Health Delivery System in Saudi Arabia. Saudi Journal of Health Systems Research 2022;2(4):156-63. doi: 10.1159/000527562

30. Jabali AK, Hamad OF. The impact of changing eligibility policy in a teaching Saudi Government Hospital. International Journal of Healthcare Management 2016;9(1):34-9. doi: 10.1179/2047971915Y.0000000011

31. Davis DL, Sun K, Simonsick EM. Association of Shoulder Dysfunction with Mobility Limitation Among Older Adults in the Baltimore Longitudinal Study of Aging. Gerontology and Geriatric Medicine 2023;9:23337214231179843. doi: 10.1177/23337214231179843

32. Djade CD, Porgo TV, Zomahoun HTV, Perrault-Sullivan G, Dionne CE. Incidence of shoulder pain in 40 years old and over and associated factors: A systematic review. Eur J Pain 2020;24(1):39-50. doi: 10.1002/ejp.1482

33. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of Shoulder and Elbow Surgery 2014;23(12):1913-21. doi: 10.1016/j.jse.2014.08.001

34. Herzberg SD, Garriga GA, Jain NB, Giri A. Elevated Body Mass Index Is Associated With Rotator Cuff Disease: A Systematic Review and Meta-analysis. Arthroscopy, Sports Medicine, and Rehabilitation 2024;6(4). doi: 10.1016/j.asmr.2024.100953

35. Özkuk K, Ateş Z. The effect of obesity on pain and disability in chronic shoulder pain patients. Journal of Back and Musculoskeletal Rehabilitation 2020;33(1):73-9. doi: 10.3233/bmr-181384

36. Khazzam M, Gee AO, Pearl M. Management of Glenohumeral Joint Osteoarthritis. JAAOS - Journal of the American Academy of Orthopaedic Surgeons 2020;28(19):781-9. doi: 10.5435/jaaos-d-20-00404

37. Liu Y, Lu J, Liu G. Differences in the clinical management of shoulder pain by physician specialty: data from the 2007–2019 National Ambulatory Medical Care Survey. Discover Health Systems 2024;3(1):47. doi: 10.1007/s44250-024-00114-5

38. Kuhn JE. Prevalence, Natural History, and Nonoperative Treatment of Rotator Cuff Disease. Operative Techniques in Sports Medicine 2023;31(1):150978. doi: 10.1016/j.otsm.2023.150978

39. Kingston K, Curry EJ, Galvin JW, Li X. Shoulder adhesive capsulitis: epidemiology and predictors of surgery. Journal of Shoulder and Elbow Surgery 2018;27(8):1437-43. doi: 10.1016/j.jse.2018.04.004

40. Sarasua SM, Floyd S, Bridges WC, Pill SG. The epidemiology and etiology of adhesive capsulitis in the U.S. Medicare population. BMC Musculoskeletal Disorders 2021;22(1):828. doi: 10.1186/s12891-021-04704-9

41. Jacob L, Gyasi RM, Koyanagi A, Haro JM, Smith L, Kostev K. Prevalence of and Risk Factors for Adhesive Capsulitis of the Shoulder in Older Adults from Germany. J Clin Med 2023;12(2). doi: 10.3390/jcm12020669

42. Chen C, Ye T, Jiang J, He W, Xia J, Yang Y. Exploring temporal trends and burden of traumatic shoulder dislocation: a global perspective. Frontiers in Public Health 2024;Volume 12 - 2024. doi: 10.3389/fpubh.2024.1346957

43. Rodriguez RR, Lam KC. Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States, 2007–2020. International Journal of Athletic Therapy and Training 2024;29(3):149-55. doi: 10.1123/ijatt.2023-0026

44. Zacchilli MA, Owens BD. Epidemiology of Shoulder Dislocations Presenting to Emergency Departments in the United States. JBJS 2010;92(3):542-9. doi: 10.2106/jbjs.I.00450

45. Enger M, Skjaker SA, Nordsletten L, et al. Sports-related acute shoulder injuries in an urban population. BMJ Open Sport & Exercise Medicine 2019;5(1):e000551. doi: 10.1136/bmjsem-2019-000551

46. Longo UG, Mazzola A, Carotti S, et al. The role of estrogen and progesterone receptors in the rotator cuff disease: a retrospective cohort study. BMC Musculoskeletal Disorders 2021;22(1):891. doi: 10.1186/s12891-021-04778-5

47. Wright CL, Patel J, Hettrich CM. Sports-Related Shoulder Injuries Among Female Athletes. Current Reviews in Musculoskeletal Medicine 2022;15(6):637-44. doi: 10.1007/s12178-022-09802-2

48. Chu P-C, Wang T-G, Guo YL. Work-related and personal factors in shoulder disorders among electronics workers: findings from an electronics enterprise in Taiwan. BMC Public Health 2021;21(1):1525. doi: 10.1186/s12889-021-11572-4

49. Du H, Li S, Tian Z, et al. Global burden of six musculoskeletal disorders in women of childbearing age from 1990 to 2021. Scientific Reports 2025;15(1):35423. doi: 10.1038/s41598-025-19382-z

Downloads

Published

07-08-2026

Issue

Section

ORIGINAL RESEARCH ARTICLE - ORTHOPAEDICS AND SURGERY

How to Cite

1.
Elsayed WH. Characterizing shoulder disorders in Saudi Arabia: A retrospective, single-center study of prevalence, phenotypes, and risk factors. Acta Biomed. 2026;97(4):18343. doi:10.23750/abm.2026.18343