The incidence of rotator cuff disease in smoking and non-smoking patients: a cadaveric study

The etiology of rotator cuff disease is multifactorial. One theory behind the high incidence of rotator cuff tears in the shoulder is that the supraspinatus/infraspinatus tendon contains a zone of relative avascularity in the area proximal to its insertion at the greater tuberosity. Tobacco smoking is known to contribute to microvascular disease, and it can be hypothesized that smoking tobacco further compromises the vascular supply to the supraspinatus/infraspinatus tendon, thus increasing the incidence of tendinous pathology in the rotator cuff. This article evaluates the rotator cuffs of 72 shoulders in 36 cadavers and compares the incidence of macroscopic and microscopic disease within the rotator cuff tendon. Microscopic evaluation of the accompanying lung tissue from the respective cadaver also was performed. As a result, we were able to determine the presence or absence of a smoking history or emphysema from each cadaver as it related to rotator cuff disease in the shoulder. Of the 36 shoulders that exhibited macroscopic rotator cuff tears, 23 were from cadavers with a history of smoking compared to only 13 from cadavers with no history of smoking. Furthermore, the presence of advanced microscopic rotator cuff pathology (Grade 3 or 4 fibrous degeneration) was more than twice as likely in the cadavers with a history of smoking (22/32) compared to only 10 of 32 shoulders from cadavers with no history of smoking. While none of this data was statistically significant due to the insufficient number of subject cadavers, strong trends were noted in these findings.