Background: Several epidemiological studies have found an association between shoulder-loaded work activities and specific shoulder diseases. No study has derived a dose-response relationship and the resulting doubling dose. Objective(s): The aim of this systematic review is to derive the dose-response relationship between physical workload and lesions of the shoulder rotator cuff. The results of this systematic review have been published by Seidler et al. (2020). Method(s): Using methods of a previous review (van der Molen et al. 2017), we added more recent studies. The dose-response relationship between physical occupational demands (hands at/above shoulder level, repetitive movements, forceful work, hand-arm vibrations) and specific shoulder diseases (ICD-10 M 75.1-5: rotator cuff syndrome, bicipital tendinitis, calcific tendinitis, impingement, and bursitis) was derived. Finding(s): No evidence for sex-specific differences of the dose-response relationship was found. If there were at least two studies with comparable exposures, a meta-analysis was carried out. The pooled analysis resulted in a 21% risk increase (95% CI 4-41%) per 1000 hours of work with hands above shoulder level, leading to a doubling dose of 3636 hours. A meta-analysis was not possible for other diseases due to the low number of studies and differing exposure measurements. The estimate of the doubling dose was based on Dalboge et al. (2014). Conclusion(s): This systematic review with meta-analysis contributes to knowledge of the exposure level at which specific shoulder diseases, e.g., rotator cuff lesions, should be recognized as an occupational disease.Copyright © 2021