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J Rehabil Med 2019; 51: 627–637 REVIEW ARTICLE RISK FACTORS FOR ROTATOR CUFF TENDINOPATHY: A SYSTEMATIC REVIEW AND META-ANALYSIS Hio Teng LEONG, PT, PhD 1 , Sai Chuen FU, PhD 1 , Xin HE, MSc 1 , Joo Han OH, MD, PhD 2 , Nobuyuki YAMAMOTO, MD, PhD 3 and Shu Hang Patrick YUNG, MD 1 From the 1 Department of Orthopaedics and Traumatology, Prince of Wales Hospital, The Chinese University of Hong Kong, Hong Kong, 2 Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, South Korea and 3 Department of Orthopaedic Surgery, Tohoku University School of Medicine, Japan Objectives: To conduct a systematic review and me- ta-analysis to identify risk and associated factors for symptomatic rotator cuff tendinopathy. Data sources: PubMed, CINAHL and Scopus were searched from inception to June 2017. Study selection: Participants presented with signs and symptoms suggestive of rotator cuff tendino- pathy/tendinosis/tendinitis, shoulder impingement syndrome, or subacromial bursitis diagnosed by clinical tests and/or conventional imaging. Data extraction: Screening, quality assessment and data extraction were carried out by 2 reviewers. Data synthesis: Sixteen studies were included in this review. Overall, 22 factors were identified and 5 factors were explored using meta-analysis. Pooled analyses provided strong evidence that age above 50 years (odds ratio (OR)  = 3.31, 95% confidence in- terval (95% CI)  = 2.30–4.76, I 2   = 0%, p  < 0.001) and diabetes (OR  =  2.24, 95% CI  = 1.37–3.65, I 2   = 0%, p  = 0.001) were associated with increased risk of ro- tator cuff tendinopathy. In addition, moderate evi- dence showed that work with the shoulder above 90° was associated with increased risk of rotator cuff tendinopathy (OR  =  2.41, 95% CI  = 1.31–4.45, I 2 = 83%, p  = 0.005). Conclusion: Age above 50 years, diabetes and over- head activities were associated with increased risk of rotator cuff tendinopathy. Key words: rotator cuff tendinopathy; shoulder; overuse; risks; odd ratios; systematic review; meta-analysis. Accepted Aug 21, 2019; Epub ahead of print Sep 5, 2019 J Rehabil Med 2019; 51: 627–637 Correspondence address: Hio Teng Leong, Department of Orthopa- edics and Traumatology, Prince of Wales Hospital, The Chinese Uni- versity of Hong Kong, Hong Kong. E-mail: [email protected] S houlder disorders are common musculoskeletal pro- blems in Western society, with a 1-year prevalence of 47% and lifetime prevalence of up to 70% being re- ported (1). One of the common causes of shoulder pain is rotator cuff tendinopathy, which is characterized by pain and weakness during external rotation and eleva- tion (2). Rotator cuff tendinopathy is an umbrella term that includes different shoulder conditions affecting subacromial structures, such as rotator cuff tendinitis/ tendinosis, subacromial bursitis and shoulder impinge­ LAY ABSTRACT Rotator cuff tendinopathy is one of the common causes of shoulder pain. Successful treatment of rotator cuff tendinopathy remains challenging; thus, it is essential to identify risk and associated factors of rotator cuff tendinopathy in order to develop prevention interven- tions. The current review included 16 studies, and over- all 22 factors were identified. Pooled analyses showed age above 50 years, diabetes and performing overhead activities were associated with increased risk of rotator cuff tendinopathy. ment syndrome (2–4). Rotator cuff tendinopathy is refractory to treatments (5), results in impaired activities of daily living and has a significant socio-economic burden due to loss of work and treatment costs (6). The management of rotator cuff tendinopathy is mainly conservative. Recent systematic reviews and meta-analysis showed low or limited evidence that passive therapies, such as therapeutic ultrasound (7), extracorporeal shockwave therapy (8), low-level laser therapy, transcutaneous electrical nerve stimulation, pulsed electromagnetic field therapy (9), and other injections, such as platelet-rich plasma (10) and corti- costeroid injections (11), are effective for rotator cuff tendinopathy. These passive therapies work chiefly on symptom relief and may not alleviate the mechanical stress of tendon pathologies (12, 13). Exercise therapy has been shown to be effective in reducing pain and improving function in rotator cuff tendinopathy (3). However, approximately 40% of patients with rotator cuff tendinopathy fail to respond to conservative treat­ ment (14–16), and more than half of patients report recurrent and persistent pain over the long term (17). Successful treatment of rotator cuff tendinopathy re- mains challenging; thus, it is essential to identify risk and associated factors of rotator cuff tendinopathy for the development of prevention interventions. The cause of rotator cuff tendinopathy has been re- ported to be multifactorial. A combination of extrinsic mechanical compression (i.e. narrowing of the subacro- mial space) and tendon overuse/overload (i.e. repetitive overhead activities) have been shown to be the major mechanism of rotator cuff tendinopathy (18). Thus, the diagnosis of rotator cuff tendinopathy including rotator cuff tendinitis/tendinosis, subacromial bursitis This is an open access article under the CC BY-NC license. www.medicaljournals.se/jrm Journal Compilation © 2019 Foundation of Rehabilitation Information. ISSN 1650-1977 doi: 10.2340/16501977-2598