Cardiovascular Disease and Rotator Cuff Tendinopathy

Applegate KA et al. Association Between Cardiovascular Disease Risk Factors and Rotator Cuff Tendinopathy. American College of Occupational and Environmental Medicine, 2017
  • The pathophysiology of rotator cuff tendinopathy is somewhat unclear. There are two main competing theories. A biomechanical theory advanced by Neer stated that tendinopathy was based on the impact of age-related degenerative processes and impingement of the tendon. The other competing theory is based on reduced vascular supply to the rotator cuff tendons and includes the rubric of vascular compromise by atherosclerotic-related disease processes.
  • multiple individual atherosclerosis risk factors have been found to affect tendinopathies, including obesity, smoking, hypercholesterolemia, and diabetes mellitus 
  • workers were recruited from 17 diverse production facilities of 15 employers, including food processing, manufacturing, assembly lines, and office jobs from 2001 through 2007. Participants were enrolled from worksites as convenience samples based on a pre-calculated sample size that targeted workers based on the physical demands of the job: one-third from low, one-third from medium, and one-third from highly physically demanding jobs.
  • A CVD risk score was calculated for every participant on the basis of gender, age, history of high cholesterol (>200 mg/dL), BP (previous diagnosis of HTN and current systolic BP reading), a diagnosis of DM, and a history of smoking or tobacco use.
  • There were 1226 workers analyzed in this study. The average age was 42.1 (+/-11.4) years. A majority of the participants were female (65.7%). There were 66 (5.4%) participants with previously diagnosed DM, 219 (17.8%) with hypercholesterolemia, and 204 (16.6%) with HTN. Tobacco use either formerly or currently was common, being reported by 638 (52.0%) participants. Of the total population, 386 (31.5%) reported glenohumeral joint pain in the prior month in the right side, left side ,or bilaterally. The point prevalence for rotator cuff tendinopathy, a diagnosis of both glenohumeral joint pain in the prior month and a positive supraspinatus test, was 156 (12.7%)
  • CVD risk factors combined into a modified Framingham CVD risk score demonstrated a strong correlation with both glenohumeral joint pain and rotator cuff tendinopathy. This association remained strong after adjusting for potential confounders of gender, BMI, job satisfaction, and family problems
  • Take-away message: As we grow in our position as primary care musculoskeletal health care providers, we may need to play a larger role in our patients’ general health. As this and other research has shown, MSK conditions may serve as windows into helping identify more serious health problems such as cardiovascular-related disease, as illustrated here. As physical therapists, we often serve as “connectors” due to our relationships with many health care providers, so we can serve our patients well by being able to refer them to the proper provider for further diagnostic workup. What do you think? Discuss here!