Modifying CVD Risk Factors as a Preventive Strategy for Tendinopathy
Higher CVD risk scores were associated with greater likelihood of having rotator cuff tendinopathy.
Risk factors for cardiovascular disease (CVD) are associated with rotator cuff tendinopathy and glenohumeral joint pain, according to a study published in the Journal of Occupational and Environmental Medicine.1
Musculoskeletal shoulder disorders are common, with a cumulative lifetime prevalence of up to 67%. Shoulder dysfunction and pain pose a significant personal and economic burden, accounting for $7 billion in healthcare costs in 2000.1
At this time, there are 2 competing theories that attempt to explain the pathophysiology of rotator cuff tendinopathy and glenohumeral joint pain. According to the biomechanical theory, rotator cuff tendinopathy develops as the result of degenerative processes and tendon impingement from age-related changes.1 The vascular theory proposes that atherosclerotic disease leads to compromised blood flow to the joint and resultant tendinopathy.2 Recent data suggest there is a correlation between risk factors for CVD, such as smoking and diabetes, and rotator cuff tendinopathy.3,4 However, no studies have evaluated the association between rotator cuff tendinopathy and CVD risk scores.1
In a study led by Kurt Hegmann, MD, MPH, from the Rocky Mountain Center for Occupational and Environmental Health Department of Mechanical Engineering, University of Utah, Salt Lake City, the relationship between a risk-stratified combination of CVD risk factors and rotator cuff tendinopathy and glenohumeral joint pain was examined.1
Data from 1226 workers who participated in the WISTAH hand study5 and were employed in differing environments, ranging from assembly lines to office jobs, were analyzed. Combinations of CVD risk factors were measured using a modified Framingham Heart Study risk assessment.
Higher CVD risk scores were associated with greater likelihood of having rotator cuff tendinopathy and glenohumeral joint pain. Workers with few CVD risk factors (risk score, 5) were twice as likely as workers without CVD risk factors to have glenohumeral joint pain (adjusted odds ratio, 2.06), but the risk for glenohumeral joint pain increased to more than 4-fold in workers with the highest CVD risk scores (18+; adjusted odds ratio, 4.55).
Summary and Clinical Applicability
Recent data suggest rotator cuff tendinopathy may be associated with CVD risk factors, which are potentially modifiable and may present a preventive strategy for this condition. Dr Hegmann and colleagues found that higher CVD risk scores are associated with a greater risk for rotator cuff tendinopathy and glenohumeral joint pain.
"The data suggest, but do not prove, that reducing CVD risks will help prevent further development of tendinitis in the shoulder or elsewhere in the body," Dr Hegmann said in an interview with Clinical Pain Advisor. "Whether the risk factors predict rotator cuff tears also has to be determined, and we are currently working on those analyses."
Most participants in the study worked in the manufacturing industry, so the results may not be applicable to the general population.
The data on CVD risk factors had to be modified to apply the Framingham Heart Study risk model.
- Applegate KA, Thiese MS, Merryweather AS, et al. Association between cardiovascular disease risk factors and rotator cuff tendinopathy: cross-sectional study [published online December 20 2016]. J Occup Environ Med. doi: 10.1097/JOM.0000000000000929.
- Viikari-Juntura E, Shiri R, Solovieva S, et al. Risk factors of atherosclerosis and shoulder pain--is there an association? A systematic review. Eur J Pain. 2008;12(4):412-426. doi: 10.1016/j.ejpain.2007.08.006
- Lundgreen K, Lian OB, Scott A, et al. Rotator cuff tear degeneration and cell apoptosis in smokers versus nonsmokers. Arthroscopy. 2014;30(8):936-941. doi: 10.1016/j.arthro.2014.03.027
- Cole A, Gill TK, Shanahan EM, Phillips P, Taylor AW, Hill CL. Is diabetes associated with shoulder pain or stiffness? Results from a population based study. J Rheumatol. 2009;36(2):371-377. doi: 10.3899/jrheum.080349
- Garg A, Hegmann KT, Wertsch JJ, et al. The WISTAH hand study: a prospective cohort study of distal upper extremity musculoskeletal disorders. BMC Musculoskelet Disord. 2012;13:90. doi: 10.1186/1471-2474-13-90