Table 3

Summary of study characteristics and findings of included studies

Study, countryStudy design, level of evidenceCohort characteristicsNo individuals with RCRSP/study sample sizeCase definition of RCRSP, pathology reported and durationCriteria used to classify MetS or cardiometabolic risk factors includedPrevalence of MetS within population (%)Adjustments for other covariatesSummary
Findings (OR with 95% CI) or p valuePositive direction of association by UVA or MVA results
Abate et al55 ItalyCase–control study, level IIIAge: 59.2 (±7.1)
Gender: M
(n=65, 36.1%),
F (n=115, 63.9%)
180/180Unilateral shoulder pain with functional limitations, ultrasound examination
RCT (full or partial thickness)
Unknown duration
No recorded criteria but MetS risk factors meeting definition by WHO:
  • Obesity (BMI kg/m2 calculation).

  • Dyslipidaemia (diagnosis, drugs assumptions and recent blood biomarkers).

  • DM (diagnosis, drugs assumptions and recent blood biomarkers).

  • BP (diagnosis and current systolic reading).

Unable to extractAge, heavy repetitive work, diabetesMetabolic risk factors Independently associated in the presence of bilateral tears
UVA:
  • Obesity (p=0.017).

  • DM (p=0.004).


MVA:
  • BMI (p=0.047).

  • DM (p=0.029).

For RCT
  • MVA, BMI.*

  • MVA, DM.*

Applegate et al66 USACross-sectional, level IIIAge: 42.1 (±11.4)
Gender: M (n=421, 34.3%), F (n=805, 65.7%)
RC tendon pain
156/1226
GHJT pain
386/1226
Questionnaire and manikin followed by standardised physical examination (palpation, ROM and positive impingement sign)
RC tendinopathy
Any pain within last 1 month
No recorded criteria but MetS risk factors meeting definition by WHO:
  • Obesity (BMI >30 kg/m2).

  • Dyslipidaemia (>200 mg/dL).

  • DM (diagnosis).

  • BP (diagnosis and current systolic reading).

Unable to extractOnly adjusted for multiple CVD risk factors (gender, BMI, job satisfaction and family problems)Metabolic risk factors Independently associated in the presence of RC tendinopathy
UVA:
  • Higher systolic BP (OR 1.01; 95% CI 1.00 to 1.02, p<0.05).


MVA:
  • Multiple CVD risk scores (18+) for RC tendinopathy (OR 5.97; 95% CI 2.12 to 16.83, p<0.008) namely (age, gender, BP, cholesterol and DM).


Metabolic risk factors Independently associated in the presence of GHJT pain
UVA:
  • DM (OR 1.76; 95% CI 1.07 to 2.91, p<0.05).

  • Hypercholesterolemia (OR 1.45; 95% CI 1.07 to 1.96, p<0.05).

  • Higher systolic BP (OR 1.01; 95% CI 1.00 to 1.02, p<0.05).


MVA:
  • Multiple CVD risk scores (18+) for GHJT pain (OR 4.55; 95% CI 1.99 to 10.40, p<0.001) namely (age, gender, BP, cholesterol and DM).

For RC tendinopathy
  • UVA, BP.*

  • MVA, CVD risk score.*


For GHJT pain
  • UVA, DM.*

  • UVA, BP.

  • UVA, hypercholesterolemia.*

  • MVA, CVD risk score.

Djerbi et al67 FranceCase–control study, level IIIAge: 57.8
Gender: M (n=124, 60%), F (n=82, 40%)
206/306Undergoing shoulder surgery for RCRSP (preoperative clinical exam, CT arthrography and arthroscopy)
RCT
Unknown duration
No recorded criteria but MetS risk factors meeting definition by WHO:
  • BP (diagnosis or 140/90 mm Hg).

  • Obesity (BMI >30 kg/m2).

  • DM (FBG >1.26 g/L or if patient treated for type I/II DM).

  • Dyslipidaemia (LDL-C >1.60 g/L, TG >1.50 g/L, HDL-C >0.40 g/L or if taking cholesterol lowering medication).

Unable to extractNo mentionMetabolic risk factors Independently associated in the presence of RCT
SCOI 1–3
UVA:
  • Obesity (OR 2.55; 95% CI 1.4 to 4.58, p=0.0017).

  • Higher systolic BP (OR 2.04; 95% CI 1.18 to 3.52, p=0.0102).

  • Dyslipidaemia (OR 7.69; 95% CI 3.35 to 17.25, p<0.0001).


RCT SCOI 4
UVA:
  • Obesity (OR 2.105, p=0.0117)

  • Higher systolic BP (OR 4.311, p<0.0001)

  • Dyslipidaemia (OR 2.867, p=0.0004).


RCT SCOI 1–3
MVA:
  • Dyslipidaemia (OR 4.920; 95% CI 2.046 to 11.834, p=0.0004).


RCT SCOI 4
MVA:
  • Dyslipidaemia (OR 4.920; 95% CI 2.046 to 11.834, p=0.0004).

  • Higher systolic BP (OR 3.215; 95% CI 1.67 to 6.19, p=0.0005).

For RCT SCOI 1–4
  • UVA, obesity.*

  • UVA, BP.*

  • UVA and MVA, dyslipidaemia.


For RCT SCOI stage 4 (severe) only
  • UVA, dyslipidaemia.*

  • UVA, obesity.*

  • MVA, BP.

Rechardt et al42 FinlandCross-sectional, level IIIAge: 57.8
Gender: M (n=124, 60%), F (n=82, 40%)
175/6237Physical examination, painful arc, shoulder pain provoked with resistance, manikin
GHJT pain and RC tendinopathy
>3 months
NCEP ATP III classification:
  • Central obesity (waist circumference >102 cm in males, >88 cm in females).

  • FBG (>110 mg/L).

  • LHDL-C (<40 mg/dL in men and <50 mg/dL in women).

  • BP (diagnosis, 130/85 mm Hg).

Total: 30.2%
(n=1884)
Age, sex, residential district and languageMetabolic risk factors Independently associated in the presence of GHJT pain
MVA:
  • Central obesity unilateral association in men (BMI >30 kg/m2, OR 1.6; 95% CI 1.1 to 2.3; waist circumference >102 cm OR 2.0; 95% CI 1.5 to 2.8; WHR ‘high’ OR 3.0; 95% CI 1.7 to 5.3).

  • MetS (OR 1.7; 95% CI 1.3 to 2.1).

  • Type II DM (OR 2.2; 95% CI 1.3 to 3.5) was associated with unilateral shoulder pain in men.

  • Central obesity stronger association for women with bilateral shoulder pain (BMI >30 kg/m2, OR 2.2; 95% CI 1.5 to 3.4; waist circumference >88 cm OR 4.2; 95% CI 2.8 to 6.4; WHR high OR 3.6; 95% CI 2.2 to 5.9).


Metabolic risk factors Independently associated in the presence of RCT tendinopathy
MVA:
  • Obesity (WHR high OR 3.6; 95% CI 2.2 to 5.9) and type I DM (OR 4.1; 95% CI 0.98 to 16.8) was associated with chronic RC tendinopathy in men.

  • Obesity (WHR high OR 2.3; 95% CI 1.2 to 4.3) was associated with chronic RC tendinopathy in women.

For GHJT pain
  • MVA, MetS.*

  • MVA, DM.*

  • MVA, obesity.*


For RC tendinopathy
  • MVA, obesity.*

  • MVA, DM.*

Rechardt et al43 FinlandCross-sectional, level IIIAge: 45.0 (±9.8)
Gender: M (n=23, 14%), F (n=140, 86%)
36/163Physical examination and clinical tests, pain intensity scale (0–100),
RC tendinopathy
<1 month
NCEP ATP III classification:
  • Central obesity (waist circumference >102 cm in males, >88 cm in females).

  • FBG (>110 mg/L).

  • Low HDL-C (<40 mg/dL in men and <50 mg/dL in women).

  • BP (diagnosis, 130/85 mm Hg).

Total: 18% (n=29)Age, sexMetabolic risk factors Independently associated in the presence of RC tendinopathy among UESTD
MVA:
  • Central obesity (BMI >30 kg/m2, OR 2.1; 95% CI 0.8 to 5.4; WHR >0.9, OR 3.3; 95% CI 1.3 to 8.6; waist circumference OR 3.2; 95% CI 1.4 to 7.4).

  • Dyslipidaemia (low (<1.48 mmol/L) HDL-C (OR 2.7; 95% CI 1.2 to 6.3)>1.08 mmol/L) TG (OR 2.8; 95% CI 1.2 to 6.6).

For UESTD
  • MVA, obesity.*

  • MVA, dyslipidaemia.*

Juge et al68 FranceCohort study, level IIIAge: 72.4 (±11)
Gender: M (n=17, 35.4%), F (n=31, 64.6%)
48/147Undergoing shoulder surgery for RCRSP shoulder pain, standard radiography
RCRSP
Unknown duration
No recorded criteria but MetS risk factors meeting definition by WHO:
  • Obesity (BMI kg/m2 calculation).

  • Dyslipidaemia (diagnosed/use of lipid lowering medication or abnormal dosage TG).

  • Hypertension (diagnosed or use of antihypertensive agents).

  • Type II DM (diagnosed status or use of antidiabetic medication).

Total: 12.9% (n=19)Age, CVD, hypothyroidismMetabolic risk factors Independently associated in the presence of RCRSP
MVA:
  • 4 MetS criteria (obesity, dyslipidaemia, hypertension and type II DM) than in shoulder osteoarthritis patients (p=0.03).

  • 2 or 3 criteria no association when compared with shoulder osteoarthritis (p=0.14).

For RCRSP
  • MVA, MetS criteria (4/5).*

  • *P<0.05

  • †P<0.01

  • DM diabetes mellitus; BMI, body mass index;BP, blood pressure; CVD, cardiovascular disease; FBG, fasting blood glucose; GHJT, glenohumeral joint; HDL-C, high density lipoprotein cholesterol; NCEP ATP III, National Cholesterol Education Programme (NCEP) Adult Treatment Panel III (ATP III) devised definition for the metabolic syndrome; LDL-C, low density lipoprotein cholesterol;MetS, metabolic syndrome; MVA, multivariate analysis; NOS, Newcastle-Ottawa score; RC, rotator cuff;RCRSP, rotator cuff-related shoulder pain; RCT, rotator cuff tear; ROC, receiver operating characteristic; ROM, range of motion; SCOI, Southern California Orthopaedic Institute - Rotator cuff tear classification system; TG, triglycerides; UESTD, upper extremity soft tissue disorders; UVA, univariate analysis; WHR, waist-to-hip ratio.