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Is there an association between metabolic syndrome and rotator cuff-related shoulder pain? A systematic review
  1. Graham Burne1,2,
  2. Michael Mansfield3,
  3. Jamie E Gaida4,
  4. Jeremy S Lewis5,6,7
  1. 1Physiotherapy Department, Guy's and Saint Thomas' NHS Foundation Trust, London, UK
  2. 2Physiotherapy, University of Hertfordshire School of Health and Social Work, Hatfield, UK
  3. 3Allied Health Sciences, School of Health and Social Care, London Southbank University, London, UK
  4. 4Research Institute for Sport and Exercise (UCRISE), University of Canberra, Canberra, Australian Capital Territory, Australia
  5. 5School of Health and Social Work, University of Hertfordshire, Hatfield, UK
  6. 6Therapy Department, Central London Community Healthcare National Health Service Trust, London, UK
  7. 7Department of Physical Therapy and Rehabilitation Science, College of Health Sciences, Qatar University, Doha, Qatar
  1. Correspondence to Graham Burne; graham.burne{at}


Objectives Rotator cuff-related shoulder pain (RCRSP) is a common upper limb complaint. It has been suggested that this condition is more common among people with cardiometabolic risk factors. This systematic review has synthesised evidence from case–control, cross-sectional and cohort studies on the association between metabolic syndrome (MetS) and RCRSP.

Design and data sources Five medical databases (MEDLINE, EMBASE, SCOPUS, CINAHL and AMED) and reference checking methods were used to identify all relevant English articles that considered MetS and RCRSP. Studies were appraised using the Newcastle-Ottawa Scale (NOS). Two reviewers performed critical appraisal and data extraction. Narrative synthesis was performed via content analysis of statistically significant associations.

Results Three cross-sectional, two case–control and one cohort study met the inclusion criteria, providing a total of 1187 individuals with RCRSP. Heterogeneity in methodology and RCRSP or MetS definition precluded a meaningful meta-analysis. Four of the included studies identified associations between the prevalence of MetS and RCRSP. Studies consistently identified independent cardiometabolic risk factors associated with RCRSP. All studies were level III evidence.

Summary and conclusion The low-moderate quality evidence included in this review suggests an association between MetS and RCRSP. Most studies demonstrated moderate quality on appraisal. The direction of association and cardiometabolic factors influencing should be investigated by longitudinal and treatment studies. These preliminary conclusions and clinical utility should be treated with caution due to limitations of the evidence base.

  • metabolic syndrome
  • rotator cuff related shoulder pain
  • systematic review

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  • Twitter @GrahamBurneWHL, @@MM_Physio, @tendonresearch, @JeremyLewisPT

  • Contributors GB: protocol design, primary investigator and author. MM: inclusion/exclusion reviewer, secondary data extraction reviewer and critical appraiser (risk of bias assessment), editing of the manuscript. JEG: guidance with the original protocol, editing of the manuscript. JSL: protocol design, dissertation supervisor, editing of the manuscript.

  • Funding This study was undertaken in partial fulfilment of an MSc Advanced Physiotherapy undertaken at the Department of Allied Health Professions and Midwifery, School of Health and Social Work, University of Hertfordshire.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement All data relevant to the study are included in the article.

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