Response to: The association between hypertension and rotator cuff disease: a spurious result?

Response to: The association between hypertension and rotator cuff disease: a spurious result? Dear editor, Thank you for giving me the opportunity to answer to letter to the Editor JSES-D-12-00464. As mentioned by the author of this letter, it is well known that the incidence of rotator cuff tears increases with age and that a large proportion of tears is completely asymptomatic4,5,6. The population prevalence of full thickness rotator cuff tears is 22.2% in females of age 60-83 years and 47% of these tears are completely asymptomatic3. The author affirms that the failure to consider the presence of asymptomatic cuff tears in the control group could fully account for the authors observation of an association between hypertension and rotator cuff tears. If we hypothetically assume that we had a plausible prevalence in the control group of asymptomatic cuff tears of 22.2%,3 it will not not affect the result that in the cuff tear patient group the prevalence of hypertension is significantly higher, but, on the contrary, it makes it more evident. In our article, we selected 201 patients negative for shoulder pathologies because shoulder painless2 and because negative to clinical tests for cuff tears. Of course, as the author state, there is no radiological assessment of their rotator cuff.2 On the other side, a patient affected by a cuff tear (symptomatic or asymptomatic) usually does not have normal shoulder external or internal rotation strength or does have a negative external rotation lag sign.1 In addition, the main result of our study is that there is an association between size of cuff tear and hypertension and, thus, this result is not affected by eventual bias of selection of the control group, being this result calculated only in the study group (patients who underwent arthroscopic cuff repair). Best personal regards, Prof. Stefano Gumina (MD, PhD) References 1)Castoldi F, Blonna D, Hertel R. External rotation lag sign revisited: Accuracy for diagnosis of full thickness supraspinatus tear. J Shoulder Elbow Surg 2009; 18: 529-534. 2)Gumina S, Arceri V, Carbone S, Albino P, Passaretti D, Campagna V, Fagnani C, Postacchini F. The association between arterial hypertension and rotator cuff tear: the influence on rotator cuff tear sizes. J Shoulder Elbow Surg. 2012 Jun 27. doi: 10.1016/j.jse.2012.05.023 3) Oag HCL, Daines MD, Nichols AS, Arden NK, Carr AJ. The association between rotator cuff tears, shoulder pain and activities of daily living: Normal population data. Presented at BESS (British Shoulder and Elbow Society) 2012 and awaiting publication in Proceedings of BESS. 4) Yamaguchi K, Ditsios K, Middleton WD, Hildebolt CF, Galatz LM, Teefey SA. The demographic and morphological features of rotator cuff disease. A comparison of asymptomatic and symptomatic shoulders. J Bone Joint Surg Am. 2006; 88: 1699-1704. doi:10.2106/JBJS.E.00835 5) Yamamoto A, Takagishi K, Kobayashi T, Shitara H, Osawa T. Factors involved in the presence of symptoms associated with rotator cuff tears: a comparison of asymptomatic and symptomatic rotator cuff tears in the general population. J Shoulder Elbow Surg 2011; 20:1133-1137. doi:10.1016/j.jse.2011.01.011 6) Yamamoto A, Takagishi K, Osawa T, Yanagawa T, Nakajima D, Shitara H, Kobayashi T. Prevalence and risk factors of a rotator cuff tear in the general population. J Shoulder Elbow Surg 2010; 19: 116-20. doi:10.1016/j.jse.2009.04.006