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Rotator Cuff Tendinopathy Found Associated with CVD Risk

January 26, 2017
A new epidemiological study reports a possible connection between diagnosis with rotator cuff tendinopathy and an increased CVD risk.

Interview with Kurt T. Hegmann, MD, MPH

Over the years, doctors have explored the theory that inflammation could be an indirect risk factor for cardiovascular disease. Now, some new epidemiological evidence could provide credence to this theory.

In a recent cross-sectional study, a small group of researchers in Utah found a strong correlation between patients with higher cardiovascular disease (CVD) risk scores and glenohumeral joint pain. In fact, the correlation was even stronger with rotator cuff tendinopathy.

The study, which has been published in The Journal of Occupational and Environmental Medicine,1 adds yet another angle to the growing body of research exploring the possibility that common musculoskeletal disorders, such as carpal tunnel syndrome, Achilles tendinopathy, and lateral epicondylitis, are associated with CVD risk factors.2-4

Physician discusses the causes of shoulder injuries.Using baseline data originating from a previous prospective cohort that investigated distal upper extremity musculoskeletal disorders,5-6 the researchers looked at 1226 patients (average age 42.1 ±11.4 years) (65.7% female; n=105), assessing demographic characteristics, pre-existing health conditions, and CVD risk scores.

They found a sizable portion of the cohort (31.5%; n=386) reported glenohumeral joint pain in the month prior to being evaluated, whether it was in the right side, left side, or bilaterally. Presence of rotator cuff tendinopathy in the cohort also was notable (12.7%; n=156), defined by a diagnosis of both glenohumeral joint pain in the previous month and a positive supraspinatus test.

Not only were patients with rotator cuff tendinopathy older and with a higher average systolic blood pressure, but rotator cuff tendinopathy patients also reported higher average CVD risk scores compared to those without tendinopathy, at 8.9 (±5.0) versus 7.2 (±4.7), respectively.

Further specified analysis revealed other inferences, such as that both diabetes mellitus and hypercholesterolemia statistically were associated with rotator cuff tendinopathy. If a patient was diagnosed with hypertension, they too appeared to be at increased risk for glenohumeral joint pain and rotator cuff tendinopathy.

CVD Risk and Shoulder Pain: Is There a Connection?

The researchers found a significant trend, whereby CVD risk scores and glenohumeral joint pain (P = 0.003) had a peak OR of 3.75 (95% CI 1.70 to 8.29). The trend was similar between CVD risk scores and rotator cuff tendinopathy (P = 0.02) with an even higher peak OR of 4.49 (95% CI 1.66 to 12.2).

Granted, these results stemmed from an unadjusted analysis, but further efforts to factor in possible confounders (gender, BMI, job satisfaction, and family problems) only served to strengthen the associations, not weaken them.

According to Kurt T. Hegmann, MD, MPH, a coauthor of the study and a professor and director at the Rocky Mountain Center for Occupational & Environmental Health at the University of Utah in Salt Lake City, this could serve as one of the study’s primary strengths, given epidemiological connections are oftentimes questioned on the basis of possible underlying influences from related patient factors.

“That was one of the reasons why we left the (multivariate) analysis in there about shoulder pain,” Dr. Hegmann told Practical Pain Management.  “Of course, there are a few other causes of shoulder pain, although rotator cuff is by far the most common.” Other common sources of joint pain, such as arthritis, are fairly uncommon in the shoulder and are more often found in the knee, Dr. Hegmann noted, which is why the researchers focused on rotator cuff tendinopathy, specifically.

Interestingly, physical activity level at work was not associated with glenohumeral joint pain or rotator cuff tendinopathy, despite the fact the cohort consisted of a diverse range of employment types, from sedentary, office-based jobs to highly physically demanding jobs requiring frequent exertion.

“It certainly deserves further exploration. We would think that ultimately people would show that there is some risk of rotator cuff tendinitis from job factors, but the fact that this was negative was unexpected,” Dr. Hegmann remarked.

Of course, acute shoulder pain is well known to be a possible manifestation of angina. In this way, Dr. Hegmann emphasized the study’s possible inference: that rotator cuff tendinopathy could be “indirectly, not directly” influencing CVD risk.

Oftentimes, low grade inflammation is one such explanation behind this, whereby the body’s immunological response through circulating inflammatory markers could be indicative of an increased risk for compromised cardiovascular health, Dr. Hegmann explained. Indeed, in retrospect, Dr. Hegmann stated his regret in not having the funding to obtain blood samples from the cohort to further investigate this idea, although he hopes to do so in the future.

This study was funded partially through a grant from the National Institute for Occupational Safety and Health. The study authors reported no conflicts of interest.

Last updated on: February 1, 2017
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