Clinical and Radiographic Factors Associated With Rotator Cuff Tears: A Case-Control Study

Abstract

Background Rotator cuff tears (RCTs) are considered multifactorial, arising from both intrinsic and extrinsic mechanisms. The objective of this study was to evaluate the association between 12 clinical and radiographic factors, including smoking, alcohol consumption, occupational exposure, dominant side involvement, prior shoulder trauma, dyslipidemia, diabetes, thyroid dysfunction, obesity, arterial hypertension, critical shoulder angle (CSA), and acromial index (AI), with the occurrence of RCTs and to identify which factors independently predict their development. Methodology This retrospective, case-control study included patients with RCTs confirmed intraoperatively and age and sex matched controls with ultrasound-confirmed intact rotator cuffs. Clinical variables were recorded, and radiographic parameters (CSA and AI) were measured on standardized anteroposterior shoulder radiographs. Multivariable logistic regression analysis was performed to identify independent predictors, and receiver operating characteristic (ROC) curve analysis was used to assess the diagnostic performance of radiographic parameters. Results In total, 80 participants were included: 40 cases (50%) and 40 matched controls (50%). RCTs were significantly associated with higher body mass index (BMI) (p = 0.003), dominant side involvement (p = 0.007), high-risk occupation (p = 0.001), higher AI (p = 0.003), and higher CSA (p = 0.005). Dyslipidemia, diabetes, dysthyroidism, arterial hypertension, alcohol consumption, smoking, and a history of shoulder trauma were not significantly associated with RCTs. ROC curve analysis showed CSA had superior predictive performance compared with AI. Multivariable logistic regression showed that CSA, BMI, dominant side involvement, and a high-risk occupation remained significantly and independently associated with the occurrence of an RCT. The AI was not an independent predictor. Conclusions RCTs are associated with both anatomical and clinical factors, particularly CSA, BMI, occupational exposure, and dominant side involvement. Among radiographic parameters, the CSA demonstrated the strongest predictive value. These findings may contribute to improved risk stratification and preventive strategies, particularly regarding weight management and workplace ergonomics, although prospective studies are required to confirm these associations.