Clinics in Shoulder and Elbow

Korean Shoulder and Elbow Society (대한견·주관절의학회)
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Risk factors of chronic subscapularis tendon tear

  • Hyung Bin Park (Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital) ;
  • Ji Yong Gwark (Department of Orthopaedic Surgery, Gyeongsang National University School of Medicine and Gyeongsang National University Changwon Hospital) ;
  • Jae-Boem Na (Department of Radiology, Gyeongsang National University School of Medicine and Gyeongsang National University Hospital)
  • Received : 2021.12.01
  • Accepted : 2022.05.12
  • Published : 2022.12.01
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Abstract

Background: Chronic subscapularis tendon tear (SBT) is a degenerative disease and a common pathologic cause of shoulder pain. Several potential risk factors for chronic SBT have been reported. Although metabolic abnormalities are common risk factors for degenerative disease, their potential etiological roles in chronic SBT remains unclear. The purpose of this study was to investigate potential risk factors for chronic SBT, with particular attention to metabolic factors. Methods: This study evaluated single shoulders of 939 rural residents. Each subject undertook a questionnaire, physical examinations, blood tests, and simple radiographs and magnetic resonance imaging (MRI) evaluations of bilateral shoulders. Subscapularis tendon integrity was determined by MRI findings based on the thickness of the involved tendons. The association strengths of demographic, physical, social, and radiologic factors, comorbidities, severity of rotator cuff tear (RCT), and serologic parameters for SBT were evaluated using logistic regression analyses. The significance of those analyses was set at p<0.05. Results: The prevalence of SBT was 32.2% (302/939). The prevalence of partial- and full-thickness tears was 23.5% (221/939) and 8.6% (81/939), respectively. The prevalence of isolated SBT was 20.2% (190/939), SBT combined with supraspinatus or infraspinatus tendon tear was 11.9% (112/939). In multivariable logistic regression analysis, dominant side involvement (p<0.001), manual labor (p=0.002), diabetes (p<0.001), metabolic syndrome (p<0.001), retraction degree of Patte tendon (p<0.001), posterosuperior RCT (p=0.010), and biceps tendon injury (p<0.001) were significantly associated with SBT. Conclusions: Metabolic syndrome is a potential risk factor for SBT, as are these factors: overuse activity, diabetes, posterosuperior RCT, increased retraction of posterosuperior rotator cuff tendon, and biceps tendon injury.

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References

  1. Keating JF, Waterworth P, Shaw-Dunn J, Crossan J. The relative strengths of the rotator cuff muscles: a cadaver study. J Bone Joint Surg Br 1993;75:137-40.
  2. Kuechle DK, Newman SR, Itoi E, Morrey BF, An KN. Shoulder muscle moment arms during horizontal flexion and elevation. J Shoulder Elbow Surg 1997;6:429-39.
  3. Lyons RP, Green A. Subscapularis tendon tears. J Am Acad Orthop Surg 2005;13:353-63.
  4. Li XX, Schweitzer ME, Bifano JA, Lerman J, Manton GL, El-Noueam KI. MR evaluation of subscapularis tears. J Comput Assist Tomogr 1999;23:713-7.
  5. Lafosse L, Jost B, Reiland Y, Audebert S, Toussaint B, Gobezie R. Structural integrity and clinical outcomes after arthroscopic repair of isolated subscapularis tears. J Bone Joint Surg Am 2007;89:1184-93.
  6. Arai R, Sugaya H, Mochizuki T, Nimura A, Moriishi J, Akita K. Subscapularis tendon tear: an anatomic and clinical investigation. Arthroscopy 2008;24:997-1004.
  7. Bennett WF. Subscapularis, medial, and lateral head coracohumeral ligament insertion anatomy: arthroscopic appearance and incidence of "hidden" rotator interval lesions. Arthroscopy 2001;17:173-80.
  8. Lo IK, Burkhart SS. The etiology and assessment of subscapularis tendon tears: a case for subcoracoid impingement, the roller-wringer effect, and TUFF lesions of the subscapularis. Arthroscopy 2003;19:1142-50.
  9. Leite MJ, Pinho AR, Sa MC, Silva MR, Sousa AN, Torres JM. Coracoid morphology and humeral version as risk factors for subscapularis tears. J Shoulder Elbow Surg 2020;29:1804-10.
  10. Leite MJ, Sa MC, Lopes MJ, Matos RM, Sousa AN, Torres JM. Coracohumeral distance and coracoid overlap as predictors of subscapularis and long head of the biceps injuries. J Shoulder Elbow Surg 2019;28:1723-7.
  11. Cetinkaya M, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U. Subscapularis tendon slip number and coracoid overlap are more related parameters for subcoracoid impingement in subscapularis tears: a magnetic resonance imaging comparison study. Arthroscopy 2017;33:734-42.
  12. Cetinkaya M, Oner AY, Ataoglu MB, Ozer M, Ayanoglu T, Kanatli U. Lesser tuberosity cysts and their relationship with subscapularis tears and subcoracoid impingement. J Orthop Sci 2017;22:63-8.
  13. Zhang H, Zhang Q, Li ZL. Coracohumeral index and coracoglenoid inclination as predictors for different types of degenerative subscapularis tendon tears. Int Orthop 2019;43:1909-16.
  14. Mohtadi NG, Vellet AD, Clark ML, et al. A prospective, double-blind comparison of magnetic resonance imaging and arthroscopy in the evaluation of patients presenting with shoulder pain. J Shoulder Elbow Surg 2004;13:258-65.
  15. Razmjou H, Fournier-Gosselin S, Christakis M, Pennings A, El-Maraghy A, Holtby R. Accuracy of magnetic resonance imaging in detecting biceps pathology in patients with rotator cuff disorders: comparison with arthroscopy. J Shoulder Elbow Surg 2016;25:38-44.
  16. International Expert Committee. International Expert Committee report on the role of the A1C assay in the diagnosis of diabetes. Diabetes Care 2009;32:1327-34.
  17. Chobanian AV, Bakris GL, Black HR, et al. Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. Hypertension 2003;42:1206-52.
  18. Alberti KG, Zimmet P, Shaw J; IDF Epidemiology Task Force Consensus Group. The metabolic syndrome: a new worldwide definition. Lancet 2005;366:1059-62.
  19. Grundy SM, Cleeman JI, Daniels SR, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute Scientific Statement. Circulation 2005;112:2735-52.
  20. Grundy SM, Cleeman JI, Merz CN, et al. Implications of recent clinical trials for the National Cholesterol Education Program Adult Treatment Panel III guidelines. Circulation 2004;110:227-39.
  21. Patte D. Classification of rotator cuff lesions. Clin Orthop Relat Res 1990;(254):81-6.
  22. Cho NS, Rhee YG. The factors affecting the clinical outcome and integrity of arthroscopically repaired rotator cuff tears of the shoulder. Clin Orthop Surg 2009;1:96-104.
  23. Goutallier D, Postel JM, Bernageau J, Lavau L, Voisin MC. Fatty muscle degeneration in cuff ruptures: pre- and postoperative evaluation by CT scan. Clin Orthop Relat Res 1994;(304):78-83.
  24. Zanetti M, Gerber C, Hodler J. Quantitative assessment of the muscles of the rotator cuff with magnetic resonance imaging. Invest Radiol 1998;33:163-70.
  25. Thomazeau H, Rolland Y, Lucas C, Duval JM, Langlais F. Atrophy of the supraspinatus belly: assessment by MRI in 55 patients with rotator cuff pathology. Acta Orthop Scand 1996;67:264-8.
  26. Deutsch A, Altchek DW, Schwartz E, Otis JC, Warren RF. Radiologic measurement of superior displacement of the humeral head in the impingement syndrome. J Shoulder Elbow Surg 1996;5:186-93.
  27. Belsley DA, Kuh E, Welsch RE. Regression diagnostics: identifying influential data and sources of collinearity. Hoboken, NJ: Wiley; 2005.
  28. Eckel RH, Grundy SM, Zimmet PZ. The metabolic syndrome. Lancet 2005;365:1415-28.
  29. Wang H, Cheng Y, Shao D, et al. Metabolic syndrome increases the risk for knee osteoarthritis: a meta-analysis. Evid Based Complement Alternat Med 2016;2016:7242478.
  30. Abate M, Di Carlo L, Salini V, Schiavone C. Metabolic syndrome associated to non-inflammatory Achilles enthesopathy. Clin Rheumatol 2014;33:1517-22.
  31. Park HB, Gwark JY, Im JH, Jung J, Na JB, Yoon CH. Factors associated with atraumatic posterosuperior rotator cuff tears. J Bone Joint Surg Am 2018;100:1397-405.
  32. Sakurai G, Ozaki J, Tomita Y, Kondo T, Tamai S. Incomplete tears of the subscapularis tendon associated with tears of the supraspinatus tendon: cadaveric and clinical studies. J Shoulder Elbow Surg 1998;7:510-5.
  33. Gerber C, Krushell RJ. Isolated rupture of the tendon of the subscapularis muscle: clinical features in 16 cases. J Bone Joint Surg Br 1991;73:389-94.
  34. Gerber C, Hersche O, Farron A. Isolated rupture of the subscapularis tendon. J Bone Joint Surg Am 1996;78:1015-23.
  35. Kim TK, Rauh PB, McFarland EG. Partial tears of the subscapularis tendon found during arthroscopic procedures on the shoulder: a statistical analysis of sixty cases. Am J Sports Med 2003;31:744-50.
  36. Yamamoto A, Takagishi K, Osawa T, et al. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010;19:116-20.
  37. Mehta SK, Teefey SA, Middleton W, Steger-May K, Sefko JA, Keener JD. Prevalence and risk factors for development of subscapularis and biceps pathology in shoulders with degenerative rotator cuff disease: a prospective cohort evaluation. J Shoulder Elbow Surg 2020;29:451-8.
  38. Bodin J, Ha C, Chastang JF, et al. Comparison of risk factors for shoulder pain and rotator cuff syndrome in the working population. Am J Ind Med 2012;55:605-15.
  39. Kim YK, Jung KH, Kim JW, Kim US, Hwang DH. Factors affecting rotator cuff integrity after arthroscopic repair for medium-sized or larger cuff tears: a retrospective cohort study. J Shoulder Elbow Surg 2018;27:1012-20.
  40. Cho NS, Moon SC, Jeon JW, Rhee YG. The influence of diabetes mellitus on clinical and structural outcomes after arthroscopic rotator cuff repair. Am J Sports Med 2015;43:991-7.
  41. Gaida JE, Alfredson L, Kiss ZS, Wilson AM, Alfredson H, Cook JL. Dyslipidemia in Achilles tendinopathy is characteristic of insulin resistance. Med Sci Sports Exerc 2009;41:1194-7.
  42. Longo UG, Franceschi F, Ruzzini L, Spiezia F, Maffulli N, Denaro V. Higher fasting plasma glucose levels within the normoglycaemic range and rotator cuff tears. Br J Sports Med 2009;43:284-7.
  43. Esposito K, Nappo F, Marfella R, et al. Inflammatory cytokine concentrations are acutely increased by hyperglycemia in humans: role of oxidative stress. Circulation 2002;106:2067-72.
  44. Reddy GK. Glucose-mediated in vitro glycation modulates biomechanical integrity of the soft tissues but not hard tissues. J Orthop Res 2003;21:738-43.
  45. Reddy GK, Stehno-Bittel L, Enwemeka CS. Glycation-induced matrix stability in the rabbit achilles tendon. Arch Biochem Biophys 2002;399:174-80.
  46. Bergin D, Parker L, Zoga A, Morrison W. Abnormalities on MRI of the subscapularis tendon in the presence of a full-thickness supraspinatus tendon tear. AJR Am J Roentgenol 2006;186:454-9.
  47. Erickson SJ, Fitzgerald SW, Quinn SF, Carrera GF, Black KP, Lawson TL. Long bicipital tendon of the shoulder: normal anatomy and pathologic findings on MR imaging. AJR Am J Roentgenol 1992;158:1091-6.
  48. Chen CH, Hsu KY, Chen WJ, Shih CH. Incidence and severity of biceps long head tendon lesion in patients with complete rotator cuff tears. J Trauma 2005;58:1189-93.
  49. Adams CR, Brady PC, Koo SS, et al. A systematic approach for diagnosing subscapularis tendon tears with preoperative magnetic resonance imaging scans. Arthroscopy 2012;28:1592-600.
  50. Chae SH, Jung TW, Lee SH, et al. Hidden long head of the biceps tendon instability and concealed intratendinous subscapularis tears. Orthop J Sports Med 2020;8:2325967119898123.
  51. Sahu D, Fullick R, Giannakos A, Lafosse L. Sentinel sign: a sign of biceps tendon which indicates the presence of subscapularis tendon rupture. Knee Surg Sports Traumatol Arthrosc 2016;24:3745-9.
  52. Beall DP, Williamson EE, Ly JQ, et al. Association of biceps tendon tears with rotator cuff abnormalities: degree of correlation with tears of the anterior and superior portions of the rotator cuff. AJR Am J Roentgenol 2003;180:633-9.