Frequency of Metabolic syndrome in Patients with Shoulder Pain

Abstract

Objectives: Shoulder pain is a common cause of disability. There are few studies in the literature linking Metabolic Syndrome (MetS) with shoulder pain and shoulder pathologies. This study aims to determine the frequency of metabolic syndrome in patients with shoulder pain; and whether there was a difference between the two groups in terms of severity and characteristics of shoulder pain. Methods: In this prospective cross-sectional study, the target population consisted of subjects aged 18 years or older applying to outpatient clinic with shoulder pain. Detailed shoulder examinations were performed. Waist-to-hip ratio and body mass index were calculated. Blood pressures were measured. Fasting blood glucose and lipids level were recorded. A Visual Analogue Scale for current pain was applied. Results: MetS was diagnosed in 44 of 104 patients. The most common shoulder problems of patients with MetS; were partial tear of rotator cuff muscles, frozen shoulder, and supraspinatus tendinitis in 5 (55.6%), 16 (32.3%), and 10 (51.6%) of the patients, respectively. ROM limitation was found to be statistically significantly higher in patients with MetS in internal and external rotation and passive abduction movements. VAS scores were higher in patients with Mets. While the difference in VAS scores with active movement and at rest was statistically significant, the difference in VAS score in night pain was not statistically significant. Conclusion: We concluded that there is a clear relationship between shoulder pain and MetS. Awareness of such association may allow early diagnosis of MS and early institution of measures to avoid its results.

Keywords

• Shoulder
• Pain
• Metabolic Syndrome
• Body Mass Index
• Hypertension

References

1. Reference1. Mitchell C, Adebajo A, Hay E, Carr A. Shoulder pain: diagnosis and management in primary care. BMJ. 2005;331(7525):1124-8.
2. Reference2. Luime JJ, Koes BW, Hendriksen IJ, Burdorf A, Verhagen AP, Miedema HS, et al. Prevalence and incidence of shoulder pain in the general population; a systematic review. Scand J Rheumatol. 2004;33(2):73-81.
3. Reference3. Van der Linden M, Westert G, De Bakker D, Schellevis F. Complaints and disorders in the population and general practice. Utrecht/Bilthoven: NIVEL/RIVM. 2005.
4. Reference4. Greving K, Dorrestijn O, Winters J, Groenhof F, Van der Meer K, Stevens M, et al. Incidence, prevalence, and consultation rates of shoulder complaints in general practice. Scandinavian journal of rheumatology. 2012;41(2):150-5.
5. Reference5. Grundy SM, Cleeman JI, Daniels SR, Donato KA, Eckel RH, Franklin BA, et al. Diagnosis and management of the metabolic syndrome: an American Heart Association/National Heart, Lung, and Blood Institute scientific statement. Curr Opin Cardiol. 2006;21(1):1-6.
6. Reference6. Galassi A, Reynolds K, He J. Metabolic syndrome and risk of cardiovascular disease: a meta-analysis. Am J Med. 2006;119(10):812-9.
7. Reference7. Ford ES. Prevalence of the metabolic syndrome defined by the International Diabetes Federation among adults in the US. Diabetes care. 2005;28(11):2745-9.
8. Reference8. Burne G, Mansfield M, Gaida JE, Lewis JS. Is there an association between metabolic syndrome and rotator cuff-related shoulder pain? A systematic review. BMJ Open Sport Exerc Med. 2019;5(1):e000544.

9. Reference9. Leon-Pedroza JI, Gonzalez-Tapia LA, del Olmo-Gil E, Castellanos-Rodriguez D, Escobedo G, Gonzalez-Chavez A. [Low-grade systemic inflammation and the development of metabolic diseases: from the molecular evidence to the clinical practice]. Cir Cir. 2015;83(6):543-51.
10. Reference10. Makki K, Froguel P, Wolowczuk I. Adipose tissue in obesity-related inflammation and insulin resistance: cells, cytokines, and chemokines. ISRN Inflamm. 2013;2013:139239.
11. Reference11. Mavrikakis ME, Drimis S, Kontoyannis DA, Rasidakis A, Moulopoulou ES, Kontoyannis S. Calcific shoulder periarthritis (tendinitis) in adult onset diabetes mellitus: a controlled study. Ann Rheum Dis. 1989;48(3):211-4.
12. Reference12. Cagliero E, Apruzzese W, Perlmutter GS, Nathan DM. Musculoskeletal disorders of the hand and shoulder in patients with diabetes mellitus. Am J Med. 2002;112(6):487-90.
13. Reference13. Bridgman JF. Periarthritis of the shoulder and diabetes mellitus. Ann Rheum Dis. 1972;31(1):69-71.
14. Reference14. Lebiedz-Odrobina D, Kay J. Rheumatic manifestations of diabetes mellitus. Rheum Dis Clin North Am. 2010;36(4):681-99.
15. Reference15. Silva MB, Skare TL. Musculoskeletal disorders in diabetes mellitus. Rev Bras Reumatol. 2012;52(4):601-9.
16. Reference16. Gaida JE, Ashe MC, Bass SL, Cook JL. Is adiposity an under-recognized risk factor for tendinopathy? A systematic review. Arthritis Rheum. 2009;61(6):840-9.
17. Reference17. Donovan A, Schweitzer M, Bencardino J, Petchprapa C, Cohen J, Ciavarra G. Correlation between Rotator Cuff Tears and Systemic Atherosclerotic Disease. Radiology research and practice. 2011;2011.
18. Reference18. Abboud JA, Kim JS. The effect of hypercholesterolemia on rotator cuff disease. Clin Orthop Relat Res. 2010;468(6):1493-7.
19. Reference19. Viikari‐Juntura E, Shiri R, Solovieva S, Karppinen J, Leino‐Arjas P, Varonen H, et al. Risk factors of atherosclerosis and shoulder pain–is there an association? A systematic review. European journal of pain. 2008;12(4):412-26.
20. Reference20. Bunker TD, Esler CN. Frozen shoulder and lipids. J Bone Joint Surg Br. 1995;77(5):684-6.
21. Reference21. Rechardt M, Shiri R, Karppinen J, Jula A, Heliovaara M, Viikari-Juntura E. Lifestyle and metabolic factors in relation to shoulder pain and rotator cuff tendinitis: a population-based study. BMC Musculoskelet Disord. 2010;11:165.
22. Reference22. Contieri JP, Neves LM, Skare TL. Shoulder pain and metabolic syndrome. Acta Reumatol Port. 2015;40(2):198-9.
23. Reference23. James PT, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obes Res. 2001;9 Suppl 4:228S-33S.
24. Reference24. Li H, George DM, Jaarsma RL, Mao X. Metabolic syndrome and components exacerbate osteoarthritis symptoms of pain, depression and reduced knee function. Ann Transl Med. 2016;4(7):133.
25. Reference25. Zhuo Q, Yang W, Chen J, Wang Y. Metabolic syndrome meets osteoarthritis. Nat Rev Rheumatol. 2012;8(12):729-37.
26. Reference26. Katz JD, Agrawal S, Velasquez M. Getting to the heart of the matter: osteoarthritis takes its place as part of the metabolic syndrome. Current opinion in rheumatology. 2010;22(5):512-9.
27. Reference27. Dandona P, Aljada A, Chaudhuri A, Mohanty P, Garg R. Metabolic syndrome: a comprehensive perspective based on interactions between obesity, diabetes, and inflammation. Circulation. 2005;111(11):1448-54.
28. Reference28. Shah KM, Clark BR, McGill JB, Mueller MJ. Upper extremity impairments, pain and disability in patients with diabetes mellitus. Physiotherapy. 2015;101(2):147-54.
29. Reference29. Kim JM, Kim MW, Do HJ. Influence of Hyperlipidemia on the Treatment of Supraspinatus Tendinopathy With or Without Tear. Ann Rehabil Med. 2016;40(3):463-9.