I always go back to the OSHA Ergonomics guidelines (
https://www.osha.gov/SLTC/etools/sew...iondesign.html)
Have a flat surface for your quilt to rest on. I made this IKEA Hacks table (
http://frommartawithlove.com/2012/10...able-tutorial/) and I'm now working on a DIY suspension system to get the weight of the quilt up off the table completely. If I had the money, I might buy Quilt Suspenders (
http://www.jennoop.com/suspenders.html) but instead I'm making my own version that is a perfect fit for my table out of wood, a PVC pipe and a few loops of elastic with clamps somewhat similar to what Caryl Bryer Fallert-Gentry uses (
http://www.bryerpatch.com/faq/machin...mq.htm#Qcradle).
The most common reason I've found for shoulder issues is when I'm not sitting centered with the needle. Your arms should be at the same height as the machine bed & when you set them on the table with your pinkies on the table & fingers pointed at the machine, there should be equal space between your hand and the needle on each side.