Clinical Orthopaedics and Related Research®

, Volume 468, Issue 6, pp 1534–1541

Cigarette Smoking Increases the Risk for Rotator Cuff Tears

  • Keith M. Baumgarten
  • David Gerlach
  • Leesa M. Galatz
  • Sharlene A. Teefey
  • William D. Middleton
  • Konstantinos Ditsios
  • Ken Yamaguchi
Original Article

Abstract

There is little available evidence regarding risk factors for rotator cuff tears. Cigarette smoking may be an important risk factor for rotator cuff disease. The purpose of this study was to determine if cigarette smoking correlates with an increased risk for rotator cuff tears in patients who present with shoulder pain. A questionnaire was administered to 586 consecutive patients 18 years of age or older who had a diagnostic shoulder ultrasound for unilateral, atraumatic shoulder pain with no history of shoulder surgery. Three hundred seventy-five patients had a rotator cuff tear and 211 patients did not. Data regarding cigarette smoking were obtained for 584 of 586 patients. A history of smoking (61.9% versus 48.3%), smoking within the last 10 years (35.2% versus 30.1%), mean duration of smoking (23.4 versus 20.2 years), mean packs per day of smoking (1.25 versus 1.10 packs per day), and mean pack-years of smoking (30.1 versus 22.0) correlated with an increased risk for rotator cuff tear. We observed a dose-dependent and time-dependent relationship between smoking and rotator cuff tears. We observed a strong association between smoking and rotator cuff disease. This may indicate smoking is an important risk factor for the development of rotator cuff tears.

Level of Evidence: Level III, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

References

  1. 1.
    Bergenudd H, Nilsson B. The prevalence of locomotor complaints in middle age and their relationship to health and socioeconomic factors. Clin Orthop Relat Res. 1994;308:264–270.PubMedGoogle Scholar
  2. 2.
    Fotiadou AN, Vlychou M, Papadopoulos P, Karataglis DS, Palladas P, Fezoulidis IV. Ultrasonography of symptomatic rotator cuff tears compared with MR imaging and surgery. Eur J Radiol. 2008;68:174–179.CrossRefPubMedGoogle Scholar
  3. 3.
    Galatz LM, Silva MJ, Rothermich SY, Zaegel MA, Havlioglu N, Thomopoulos S. Nicotine delays tendon-to-bone healing in a rat shoulder model. J Bone Joint Surg Am. 2006;88:2027–2034.CrossRefPubMedGoogle Scholar
  4. 4.
    Hellsing AL, Bryngelsson IL. Predictors of musculoskeletal pain in men: a twenty-year follow-up from examination at enlistment. Spine. 2000;25:3080–3086.CrossRefPubMedGoogle Scholar
  5. 5.
  6. 6.
    Itoi E, Minagawa H, Konno N, Kobayashi T, Sato T, Sato K, Nishi T. Relationship between smoking and rotator cuff tears. J Shoulder Elbow Surg. 1996;5(2):S124.CrossRefGoogle Scholar
  7. 7.
    Jorgensen L, Kallehave F, Christenens E, Siana J, Gottrup F. Less collagen production in smokers. Surgery. 1998;123:450–455.CrossRefPubMedGoogle Scholar
  8. 8.
    Lehman C, Cuomo F, Kummer FJ, Zuckerman JD. The incidence of full thickness rotator cuff tears in a large cadaveric population. Bull Hosp Jt Dis. 1995;54:30–31.PubMedGoogle Scholar
  9. 9.
    Leino-Arjas P. Smoking and musculoskeletal disorders in the metal industry: a prospective study. Occup Environ Med. 199;55:828–833.Google Scholar
  10. 10.
    Leow YH, Maibach MI. Cigarette smoking, cutaneous vasculature, and tissue oxygen. Clin Dermatol. 1998;16:579–584.CrossRefPubMedGoogle Scholar
  11. 11.
    Mallon WJ, Misamore G, Snead DS, Denton P. The impact of preoperative smoking habits on the results of rotator cuff repair. J Shoulder Elbow Surg. 2004;13:129–132.CrossRefPubMedGoogle Scholar
  12. 12.
    Mosley LH, Fineseth F. Cigarette smoking: impairment of digital blood flow and wound healing in the hand. Hand. 1977;9:97–101.CrossRefGoogle Scholar
  13. 13.
    Prickett WD, Teefey SA, Galatz LM, Calfee RP, Middleton WD, Yamaguchi K. Accuracy of ultrasound imaging of the rotator cuff in shoulders that are painful postoperatively. J Bone Joint Surg Am. 2003;85:1084–1089.CrossRefPubMedGoogle Scholar
  14. 14.
    Roberts CS, Walker JA 2nd, Seligson D. Diagnostic capabilities of shoulder ultrasonography in the detection of complete and partial rotator cuff tears. Am J Orthop. 200;30:159–162.Google Scholar
  15. 15.
    Sher JS, Uribe JW, Posada A, Murphy BJ, Zlatkin MB. Abnormal findings on magnetic resonance images of asymptomatic shoulders. J Bone Joint Surg Am. 1995;77:10–15.PubMedGoogle Scholar
  16. 16.
    Stenlund B, Goldie I, Hagberg M, Hogstedt C. Shoulder tendinitis and its relation to heavy manual work and exposure to vibration. Scand J Work Environ Health. 1993;19:43–49.PubMedGoogle Scholar
  17. 17.
    Teefey SA, Hasan SA, Middleton WD, Patel M, Wright RW, Yamaguchi K. Ultrasonography of the rotator cuff: a comparison of ultrasonographic and arthroscopic findings in one hundred consecutive cases. J Bone Joint Surg Am. 2000;82:498–504.PubMedGoogle Scholar
  18. 18.
    Teefey SA, Rubin DA, Middleton WD, Hildebolt CF, Leibold RA, Yamaguchi K. Detection and quantification of rotator cuff tears: comparison of ultrasonographic, magnetic resonance imaging, and arthroscopic findings in seventy-one consecutive cases. J Bone Joint Surg Am. 2004;86:708–716.PubMedGoogle Scholar
  19. 19.
    Tempelhof S, Rupp S, Seil R. Age-related prevalence of rotator cuff tears in asymptomatic shoulders. J Shoulder Elbow Surg. 1999;8:296–299.CrossRefPubMedGoogle Scholar
  20. 20.
    van Holsbeeck MT, Kolowich PA, Eyler WR, Craig JG, Shirazi KK, Habra GK, Vanderschueren GM, Bouffard JA. US depiction of partial-thickness tear of the rotator cuff. Radiology. 1995;197:443–446.PubMedGoogle Scholar
  21. 21.
    Vlychou M, Dailiana Z, Fotiadou A, Papanagiotou M, Fezoulidis IV, Malizos K. Symptomatic partial rotator cuff tears: diagnostic performance of ultrasound and magnetic resonance imaging with surgical correlation. Acta Radiol. 2009;50:101–105.CrossRefPubMedGoogle Scholar
  22. 22.
    Wendelboe AM, Hegmann KT, Gren LH, Alder SC, White GL Jr, Lyon JL. Associations between body-mass index and surgery for rotator cuff tendinitis. J Bone Joint Surg Am. 2004;86:743–747.CrossRefPubMedGoogle Scholar

Copyright information

© The Association of Bone and Joint Surgeons 2009

Authors and Affiliations

  • Keith M. Baumgarten
    • 1
  • David Gerlach
    • 2
  • Leesa M. Galatz
    • 2
  • Sharlene A. Teefey
    • 3
  • William D. Middleton
    • 3
  • Konstantinos Ditsios
    • 3
  • Ken Yamaguchi
    • 2
  1. 1.Orthopedic InstituteSioux FallsUSA
  2. 2.Department of Orthopaedic SurgeryWashington University School of MedicineSt LouisUSA
  3. 3.Department of Diagnostic RadiologyWashington University School of Medicine, MIR Institute of RadiologySt LouisUSA

Personalised recommendations