Smoking Predisposes to Rotator Cuff Pathology and Shoulder Dysfunction: A Systematic Review

Area of Science:

• Orthopedics
• Musculoskeletal Diseases
• Public Health

Background:

• Rotator cuff (RTC) disease and shoulder dysfunction are common causes of shoulder pain and disability.
• Smoking is a prevalent behavior with known negative health impacts, but its specific association with shoulder pathology requires further investigation.

Purpose of the Study:

• To systematically review and synthesize the existing evidence on the association between smoking and rotator cuff (RTC) disease and shoulder dysfunction.

Main Methods:

• A systematic review of English-language clinical and basic science studies was conducted.
• Search strategy included terms related to "shoulder" and "smoking" or "nicotine" or "tobacco."
• Studies were included if they examined the association of smoking with shoulder dysfunction (poor scores on rating scales) or RTC disease, excluding those focused solely on surgery outcomes, subjective symptoms, adhesive capsulitis, fractures, or tumors.

Main Results:

• Thirteen studies involving 16,172 patients (6,081 smokers) were included.
• Clinical studies consistently showed a correlation between smoking and patient-reported shoulder dysfunction and symptoms.
• Provider-reported data indicated a time- and dose-dependent relationship between smoking and RTC tears, including impingement syndrome, and larger, more degenerative tears.

Conclusions:

• Smoking is significantly associated with rotator cuff (RTC) tears, shoulder dysfunction, and symptoms.
• Smoking may accelerate RTC degeneration, leading to larger tears and potentially increasing the need for surgical intervention.