Depression increases the risk of rotator cuff tear and rotator cuff repair surgery: A nationwide population-based study

Autoři: Liang-Tseng Kuo aff001;  Hong-Ming Chen aff003;  Pei-An Yu aff001;  Chi-Lung Chen aff001;  Wei-Hsiu Hsu aff001;  Yao-Hung Tsai aff001;  Ko-Jung Chen aff004;  Vincent Chin-Hung Chen aff002
Působiště autorů: Division of Sports Medicine, Department of Orthopaedic Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan aff001;  College of Medicine, Chang Gung University, Taoyuan, Taiwan aff002;  Department of Psychiatry, Chang Gung Memorial Hospital, Chiayi, Taiwan aff003;  Health Information and Epidemiology Laboratory, Chang Gung Memorial Hospital, Chiayi, Taiwan aff004
Vyšlo v časopise: PLoS ONE 14(11)
Kategorie: Research Article
doi: 10.1371/journal.pone.0225778



Chronic inflammation is known to be associated with both rotator cuff tears (RCTs) and depression. However, no epidemiological studies with a longitudinal follow-up have been performed to prove this association. We aimed to investigate whether depressed patients had an elevated risk of RCT and subsequent repair surgery compared with those without depression.


This retrospective cohort study comprised of patients diagnosed with depression between 2000 and 2010 (depression cohort) and patients without depression (non-depression cohort, 1:2 age and sex matched). The risk of RCT and rotator cuff repair surgery were determined during a 13-year follow-up (2000–2013) between these two cohorts.


This study included 26,868 patients with depression and 53,736 patients without depression. The incidence of RCT was 648 and 438 per 100,000 person-years in the depression and non-depression cohorts, respectively. The adjusted hazard ratio (HR) was 1.46 (95% confidence interval [CI], 1.36–1.57) for depressed patients. The incidence of rotator cuff repair surgery was 28 and 18 per 100,000 person-years in the depression and non-depression cohorts, respectively. Depressed patients also had a significantly increased risk of subsequent rotator cuff repair surgery (adjusted HR = 1.46; 95% CI, 1.04–2.06).


The present study showed that depression was associated with an increased risk of rotator cuff tear and rotator cuff repair surgery.

Klíčová slova:

Coronary heart disease – Depression – Diagnostic medicine – Hyperlipidemia – Inflammatory diseases – Surgical and invasive medical procedures – Surgical repair – Tendons


1. Mikova O, Yakimova R, Rosmans E, Keins G, Maes M. Increase serum tumor necrosis factor alpha concentrations in major depression and multiple sclerosis. Eur Neuropsycopharmacol. 2001;11: 203–208.

2. Rosenblat JD, Chan DS, Mansur RB, McIntyre RS. Inflamed moods: a review of the interactions between inflammation and mood disorders. Prog Neuropsychopharmacol Biol Psychiatry. 2014;53: 23–34. doi: 10.1016/j.pnpbp.2014.01.013 24468642

3. Yoshimura R, Hori H, Ikenouchi-Sugita A, Umene-Nakano W, Ueda N, Nakamura J. High plasma interleukin-6 (IL-6) is associated with SSRI- or SNRI-refractory depression. Prog Neuropsychopharmacol Biol Psychiatry. 2009;33: 722–726. doi: 10.1016/j.pnpbp.2009.03.020 19332097

4. Zunszain PA, Hepgul N, Pariante CM. 2013 Inflammation and depression. Curr Top Behav Neurosci. 2013;14: 135–151. doi: 10.1007/7854_2012_211 22553073

5. Jordan N, Lee TA, Valenstein M, Weiss KB. Effect of care setting on evidence-based depression treatment for veterans with COPD and comorbid depression. J Gen Intern Med. 2007;22: 1447–1452. doi: 10.1007/s11606-007-0328-8 17687614

6. Martinez Rivera C, Costan Galicia J, Alcázar Navarrete B, Garcia-Polo C, Ruiz Iturriaga LA, Herrejón A, et al. Factors associated with depression in COPD: a multicenter study. Lung. 2016;194: 335–343. doi: 10.1007/s00408-016-9862-7 26932809

7. Ford DE, Mead LA, Chang PP, Cooper-Patrick L, Wang NY, Klag MJ. 1998. Depression is a risk factor for coronary artery disease in men: the precursors study. Arch Intern Med. 1998;158: 1422–1426. doi: 10.1001/archinte.158.13.1422 9665350

8. Jiang X, Asmaro R, O'Sullivan DM, Modi J, Budnik E, Schnatz PF. Depression may be a risk factor for coronary heart disease in midlife women <65 years: A 9-year prospective cohort study. Int J Cardiol. 2018;271: 8–12. doi: 10.1016/j.ijcard.2018.05.085 29880298

9. Wassertheil-Smoller S, Shumaker S, Ockene J, Talavera GA, Greenland P, Cochrane B, et al. Depression and cardiovascular sequelae in postmenopausal women. The Women's Health Initiative (WHI). Arch Intern Med 2004;164: 289–298. doi: 10.1001/archinte.164.3.289 14769624

10. Pasic J, Levy WC, Sullivan MD. Cytokines in depression and heart failure. Psychosom Med. 2003;65: 181–193. doi: 10.1097/01.psy.0000058372.50240.38 12651985

11. Bennett S, Thomas AJ, 2014. Depression and dementia: cause, consequence or coincidence? Maturitas. 2014;79: 184–190. doi: 10.1016/j.maturitas.2014.05.009 24931304

12. Lewinson RT, Vallerand IA, Lowerison MW, Parsons LM, Frolkis AD, Kaplan GG, et al. Depression Is Associated with an Increased Risk of Psoriatic Arthritis among Patients with Psoriasis: A Population-Based Study. J Invest Dermatol. 2017;137: 828–835. doi: 10.1016/j.jid.2016.11.032 28237512

13. Chung SW, Park JS, Kim SH, Shin SH, Oh JH. Quality of life after arthroscopic rotator cuff repair: evaluation using SF-36 and an analysis of affecting clinical factors. Am J Sports Med. 2012;40: 631–639. doi: 10.1177/0363546511430309 22190415

14. Abraham AC, Shah SA, Thomopoulos S. Targeting inflammation in rotator cuff tendon degeneration and repair. Tech Shoulder Elb Surg. 2017;18: 84–90. doi: 10.1097/BTE.0000000000000124 28947893

15. Nho SJ, Yadav H, Shindle MK, Macgillivray JD. Rotator cuff degeneration: etiology and pathogenesis. Am J Sports Med. 2008;36: 987–993. doi: 10.1177/0363546508317344 18413681

16. Wani Z, Abdulla M, Habeebullah A, Kalogriantis S. Rotator cuff tears: review of epidemiology, clinical assessment and operative treatment. Trauma. 2016;18: 190–204.

17. Franceschi C, Campisi J. Chronic inflammation (inflammaging) and its potential contribution to age-associated diseases. J Gerontol A Biol Sci Med Sci. 2014;69 Suppl 1: S4–S9.

18. Hashimoto T, Nobuhara K, Hamada T. Pathologic evidence of degeneration as a primary cause of rotator cuff tear. Clin Orthop Relat Res. 2003;415: 111–120.

19. Rees JD, Stride M, Scott A. Tendons—time to revisit inflammation. Br J Sports Med. 2013;48: 1553–1557. doi: 10.1136/bjsports-2012-091957 23476034

20. Schubert T, Weidler C, Lerch K, Hofstädter F, Straub RH. Achilles tendinosis is associated with sprouting of substance P positive nerve fibres. Ann Rheum Dis. 2005;64: 1083–1086. doi: 10.1136/ard.2004.029876 15958764

21. Lin TT, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WH. The Effect of Diabetes, Hyperlipidemia, and Statins on the Development of Rotator Cuff Disease, A Nationwide, 11-Year, Longitudinal, Population-Based Follow-up Study. Am J Sports Med 2015;43: 2126–2132. doi: 10.1177/0363546515588173 26085191

22. Wu CY, Chen YJ, Ho HJ, Hsu YC, Kuo KN, Wu MS, et al. Association between nucleoside analogues and risk of hepatitis B virus-related hepatocellular carcinoma recurrence following liver resection. JAMA. 2012;308: 1906–1914. doi: 10.1001/2012.jama.11975 23162861

23. Leonard BE. Pain, Depression and Inflammation: Are Interconnected Causative Factors Involved? Mod Trends Pharmacopsychiatry. 2015;30: 22–35. doi: 10.1159/000435930 26437055

24. Frazão P, Costa CM, de Almeida MF. Risks associated with tendinitis: effects from demographic, socioeconomic, and psychological status among Brazilian workers. Am J Ind Med. 2010;53: 72–79. doi: 10.1002/ajim.20782 19943317

25. Boettger MK, Hensellek S, Richter F, Gajda M, Stöckigt R, von Banchet GS, et al. Antinociceptive effects of tumour necrosis factor alpha neutralisation in a rat model of antigen-induced arthritis: evidence of a neuronal target. Arthritis Rheum. 2008;58: 2368–2378. doi: 10.1002/art.23608 18668541

26. Lipscomb H, Kucera K, Epling C, Dement J. Upper extremity musculoskeletal symptoms and disorders among a cohort of women employed in poultry processing. Am J Ind Med. 2008;51: 24–36. doi: 10.1002/ajim.20527 18000834

27. Zakaria MH, Davis WA, Davis TM. Incidence and predictors of hospitalization for tendon rupture in type 2 diabetes: the Fremantle diabetes study. Diabet Med 2014;31: 425–430. doi: 10.1111/dme.12344 24151882

28. Ranger TA, Wong AM, Cook JL, Gaida JE. Is there an association between tendinopathy and diabetes mellitus? A systematic review with meta-analysis. Br J Sports Med. 2016;50: 982–989. doi: 10.1136/bjsports-2015-094735 26598716

29. Chhana A, Callon KE, Dray M, Pool B, Naot D, Gamble GD, et al. Interactions between tenocytes and monosodium urate monohydrate crystals: implications for tendon involvement in gout. Ann Rheum Dis. 2014;73: 1737–1741. doi: 10.1136/annrheumdis-2013-204657 24709860

30. Schweyer S, Hemmerlein B, Radzun HJ, Fayyazi A. Continuous recruitment, coexpression of tumour necrosis factor-alpha and matrix metalloproteinases, and apoptosis of macrophages in gout tophi. Virchows Arch. 2000;437: 534–539. doi: 10.1007/s004280000282 11147175

31. Sasaki K, Yamamoto N, Kiyosawa T, Sekido M. The role of collagen arrangement change during tendon healing demonstrated by scanning electron microscopy. J Electron Microsc (Tokyo). 2012;61: 327–334.

32. Chaudhur S, Dines JS, Delos D, Warren RF, Voigt C, Rodeo SA. 2012. Role of fatty infiltration in the pathophysiology and outcomes of rotator cuff tears. Arthritis Care Res (Hoboken). 2012;64: 76–82.

33. Tsouli SG, Kiortsis DN, Argyropoulou MI, Mikhailidis DP, Elisaf MS. Pathogenesis, detection and treatment of Achilles tendon xanthomas. Eur. J. Clin. Invest. 2005;35: 236–244. doi: 10.1111/j.1365-2362.2005.01484.x 15816992

Článek vyšel v časopise


2019 Číslo 11