Dyslipidaemia is associated with an increased risk of rotator cuff disease: a systematic review

Is rotator cuff related shoulder pain a multidimensional disorder? An exploratory study

Background and aims

Rotator cuff related shoulder pain has been associated with factors from multiple dimensions such as strength changes, psychosocial measures, comorbidities and level of education. However, to date little research has been undertaken to evaluate which factors explain the greatest variance in pain and disability levels in people with rotator cuff related shoulder pain. The objective of this study was therefore to evaluate which multidimensional examination findings were associated with higher pain and disability in a primary care cohort with rotator cuff related shoulder pain.

Methods

This was an exploratory cross-sectional cohort study. Sixty-seven participants with rotator cuff related shoulder pain were assessed for: pain intensity, disability; demographic, psychological, social and lifestyle characteristics, and isometric strength of shoulder internal and external rotator muscles. Univariable associations between pain intensity/disability and each variable were assessed using linear regression. Variables with univariable associations (p < 0.1) were entered into backwards stepwise multivariable regression models.

Results

The multivariable model for pain intensity included sleep and perceived persistence and explained 46.5% of the variance (37.6% uniquely by sleep, 5.4% uniquely by perceived persistence). The multivariable model for disability included sleep and sex and explained 26.8% of the variance (4.5% shared by predictors, 16.4% uniquely by sleep, 5.9% uniquely by sex).

Conclusions

Rotator cuff-related shoulder pain and disability are associated with sleep disturbance, perceived symptom persistence and sex. Rotator cuff related shoulder pain may be considered a multidimensional disorder.

Implications

Clinicians need to evaluate sleep and perceived symptom persistence in people with rotator cuff related shoulder pain. Future research may examine whether management strategies for RCRSP directed towards these factors afford improved treatment outcomes.

The Effect of Lipid Disorders on the Risk of Rotator Cuff Disease: A Systematic Review and Meta-Analysis

Background

Rotator cuff disease has a high prevalence and is associated with shoulder pain and disability. Dyslipidemia might be an intrinsic factor related to the development of the disease as it might increase tendon stiffness and result in tendon problems. The purposes of the present study were (1) to systematically review the association between lipid disorders and the risk of rotator cuff disease and (2) to provide physicians with guidance to prevent rotator cuff disease.

Methods

Six databases were searched through July 6, 2016: MEDLINE, Embase, CINAHL, Web of Science, SPORTDiscus, and the Cochrane Central Register of Controlled Trials. Eligible studies were assessed for risk of bias and strength of evidence. Meta-analysis was performed for the effect of dyslipidemia on the presence of rotator cuff disease, with the effect being expressed as an odds ratio. The overall effect was estimated, and heterogeneity across studies was expressed with the I² statistic. We used standard and contour-enhanced funnel plots as well as the Begg and Egger tests to check for publication bias.

Results

Three cross-sectional studies, 1 cohort study, and 3 case-control studies involving 505,852 participants were selected, with 6 of these studies being eligible for meta-analysis. The main-effect meta-analysis yielded a pooled odds ratio of 2.17 (95% confidence interval, 1.46 to 3.23; p < 0.001; I² = 82.4%), indicating a higher rate of rotator cuff disease in patients with dyslipidemia. The sensitivity analysis was not different from the main-effect analysis. Contour-enhanced funnel plots revealed the possibility of publication bias or other small-study effects.

Conclusions

We found that dyslipidemia was associated with high occurrence of rotator cuff disease. We recommend that physicians examine tendon conditions if their patients have severe dyslipidemia.

Level of Evidence

Prognostic Level IV. See Instructions for Authors for a complete description of levels of evidence.