Common, and usually the rotator cuffStrong evidence
Shoulder pain is common in people who drive for a living: 39.2% over a year in 19 studies of 2,751 professional drivers, against 36.7% in the general population quoted by the same review. By job, it was 31.5% of lorry drivers, where it was the commonest painful area, 35.0% of taxi drivers and 38.7% of bus drivers. These studies looked at one point in time, and none shows that driving causes a shoulder condition; there is no figure for ordinary car drivers.
The rotator cuff is the usual source. The NHS describes impingement as pain at the top and outside of the shoulder that is worse when you lift your arm, and US orthopaedic surgeons say most rotator cuff tears come from slow wear of the tendon. Changes in the rotator cuff become common with age with or without pain, from 9.7% under 20 to 62% at 80 and over.
Sources 1, 2, 3, 4, 5, 6, 7
Why steering and the seatbelt bring it onEmerging evidence
Turning the wheel uses the front of the shoulder, the chest and the back of the shoulder, and the front of the shoulder brings the hand back round to grip again. In 8 young men in a simulator, peak shoulder joint force reached about 61% of body weight, and sudden steering loaded the supraspinatus, a rotator cuff muscle, to up to 72% of a cuff repair's failure strength; the seat position and steering with one or both hands made large differences. Driving needs only modest range, the arm raised up to about 54 degrees, but avoiding a hazard needs it fast.
In 27 students, strength was greatest with the seat at 70% of arm length from the wheel, and lower with the arms nearly straight. Holding the hands up on the wheel keeps the upper trapezius working, and power steering cut muscle work in bus drivers. US orthopaedic surgeons list pain reaching backward, such as to put on your seatbelt, among the signs of a sore biceps tendon at the front, and in 16 healthy volunteers, fastening the seatbelt worked the rotator cuff hard on both sides. These are lab and simulator studies in people without pain.
Sources 8, 9, 10, 11, 12, 13, 14, 15
Where the hands sitEmerging evidence
In one simulator study of 16 healthy volunteers, the rotator cuff worked harder with the hand at the top or side of the wheel than at the bottom. That study measured muscle activity, not pain, and no study has tested a hand position for shoulder pain. Most Swedish drivers observed had a hand near the top of the wheel, and few held it with both hands evenly. The Highway Code asks drivers to keep both hands on the wheel where possible.
Airbags: in belted drivers in frontal crashes, about 1 in 5 had an arm injury from the airbag, mostly bruises and grazes. Forearm fractures are rare and come from a forearm close to the airbag cover, and an underhand grip with the wheel turned gave the hardest impact in crash tests. So keep your hands on the rim and your forearms off the middle of the wheel.
Sources 14, 16, 17, 18, 19, 20, 21
Frozen shoulder, the neck and causes that need other careStrong evidence
A frozen shoulder causes pain that can be worse at night and stiffness in every direction, so the seatbelt, the wheel and reaching to the back seat all hurt; it is more common with diabetes, and its painful stage can last from 6 weeks to 9 months. Pain at the top of the shoulder with neck pain, or tingling down the arm, often comes from the neck, and neck pain alongside shoulder pain went with slower recovery in general practice. After a crash, collarbone fractures went with side impacts in a trauma database.
The heart: the NHS lists chest pain that spreads to your arms, neck or jaw as a 999 call. Angina is often brought on by exercise, stress, emotion or cold, and GOV.UK says if angina happens while you're resting, driving or emotional, you must stop driving until your symptoms are under control. These causes are much rarer than the rotator cuff, and the warning signs are for them.
Sources 22, 23, 24, 25, 26, 27, 28
When a scan mattersStrong evidence
Not for shoulder pain from driving. The NHS says a health professional examines you and might send you for tests such as an X-ray. Rotator cuff changes are common in people without pain, so a scan finding isn't always the cause. Imaging matters after a fall or crash, for a fracture or dislocation, and for sudden weakness lifting the arm after an injury, which needs urgent referral to a shoulder specialist.
Sources 29, 7
How it usually goesStrong evidence
In 349 people with new shoulder pain in Dutch general practice, 23% had recovered at a month and 59% at a year. The NHS says it can take 6 months or longer to recover from shoulder pain, and NHS inform expects many new shoulder problems to begin to settle within 6 weeks. Frozen shoulder can take months or years to get better; without treatment, movement improved, mostly early, but not always completely. No one can promise a date.
Sources 24, 29, 30, 22, 31
