Reply to: “The association between hypertension and rotator cuff disease: a spurious result?”

Thank you for giving us the opportunity to answer the Letter to the Editor. 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 are completely asymptomatic.4, 5 and 6 The population prevalence of full-thickness rotator cuff tears is 22.2% in women aged 60 to 83 years, and 47% of these tears are asymptomatic.4 The author affirms that the failure to consider the presence of asymptomatic cuff tears in the control group could fully account for the author's observation of an association between hypertension and rotator cuff tears. If we hypothetically assume that we had a plausible 22.2% prevalence of asymptomatic cuff tears in the control group,3 it would not affect the result that the prevalence of hypertension is significantly higher in the cuff tear patient group, but, on the contrary, it makes it more evident. In our article, we selected 201 patients negative for shoulder pathologies because the shoulder was painless2 and because of negative results to clinical tests for cuff tears. Of course, as the author states, there is no radiologic assessment of their rotator cuff.2 However, 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 was calculated only in the study group of patients who underwent arthroscopic cuff repair.