Risk factors for degenerative, symptomatic rotator cuff tears: a case-control study.

ABSTRACT Background Despite the considerable public health burden of rotator cuff tears, there is no consensus on risk factors associated with symptomatic rotator cuff tears. In this study, a large data source was used to identify factors associated with symptomatic rotator cuff tears. We determined cases of rotator cuff tears as those verified by imaging or operative report and controls as symptomatic shoulders without rotator cuff tears as verified by imaging or operative report. Methods We performed a case-control study of patients with and without symptomatic rotator cuff tears from the Vanderbilt University Medical Center de-identified electronic medical record (EMR) system, the Synthetic Derivative (SD), with records on over 2.5 million patients from 1998 to 2017. Cases and controls were confirmed by individual chart review and review of imaging/operative notes. A final set of 11 variables were analyzed as potential risk factors for cuff tears. These included: age, sex, body mass index (BMI), race, smoking history, hypertension, depression/anxiety, dyslipidemia, carpal tunnel syndrome, overhead activity, and affected side. Multivariable logistic regression was used to estimate the association between predictor variables and the risk of having rotator cuff tear. Results A total of 2,738 patients were selected from SD which included 1,731 patients with rotator cuff tears and 1,007 patients without rotator cuff tears. Compared to individuals without tears, those with rotator cuff tears were more likely to be of older age (odds ratio [OR] 2.44; 95% confidence interval [CI]: 2.12 to 2.89), have higher BMI (OR 1.45; 95% CI: 1.24 to 1.69), be of male sex (OR 1.56; 95% CI: 1.32 to 1.85), and more likely to have carpal tunnel syndrome (OR 1.41; 95% CI: 1.03 to 1.93). Those with rotator cuff tears were less likely to have left shoulder symptoms (OR 0.68; 95% CI, 0.57 to 0.82) and have less likely to have depression/anxiety (OR 0.77; 95% CI, 0.62 to 0.95) compared to the control group who had symptomatic shoulder pain without rotator cuff tears. Conclusions In a large imaging/operative report verified case-control study, we identified advancing age, male sex, higher BMI, diagnosis of carpal tunnel syndrome as risk factors significantly associated with increased risk for rotator cuff tears. Left-sided shoulder symptoms and depression/anxiety were less likely to be associated for rotator cuff tears compared to symptomatic shoulders without rotator cuff tears. Contrary to some of the prior literature, smoking was not associated with rotator cuff tears.