Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences

Cohen, Carina; Tortato, Simone; Silva, Otavio Bento Souza; Leal, Mariana Ferreira; Ejnisman, Benno; Faloppa, Flavio

doi:10.1055/s-0039-3402476

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Sumário

Artigos Originais, Ombro e Cotovelo • Rev. bras. ortop. 55 (4) • Jul-Aug 2020 • https://doi.org/10.1055/s-0039-3402476 copy

Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences^* * Work developed at Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Orthopedics and Traumatology, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil.

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

To clarify the association of thyroid disorders and primary frozen shoulder by comparing this group with controls without shoulder disease and with patients with rotator cuff tears.

Methods

We evaluated 166 patients who presented frozen shoulder with treatment in progress or already treated, which were compared with 129 patients with diagnosis of rotator cuff tears and 251 control subjects. All of the participants answered the questionnaire on the following variables: age, gender, body mass index (BMI), occupation, physical activity, presence of thyroid disorders and other comorbidities, smoking and use of alcohol.

Results

When comparing the frozen shoulder group with the control and rotator cuff groups, there is a specific association between the presence of thyroid disorders and frozen shoulder. By calculating relative risk, it is possible to state that an individual with thyropathy has 2.69 more chance of developing frozen shoulder. Also, there was an association with gender, since women with frozen shoulder exceeded significantly the risk.

Conclusions

Thyroid disorders, especially hypothyroidism and the presence of benign thyroid nodules, are risk factors significantly associated with frozen shoulder, rising the chances to 2.69 times of developing frozen shoulder.

This is the first study that uses, in addition to the control group, a second group with rotator cuff tears, so it was shown that there is a specific association of thyroid disorders and frozen shoulder, but not with shoulder disorders in general.

Keywords
frozen shoulder; adhesive capsulitis; thyroid diseases; hypothyroidism

Clinical and demographic variables	Group 1	Group 3	OR	95%	p-value
Age (median ± DI)	51 ± 11	50 ± 10	1.01	0.99-1.04	0.26
Female gender [N (%)]	100 (60%)	151 (60%)	1.00	0.67-1.50	0.99
Overweight or obesity^a a IMC > 25. [N (%)]	83 (50%)	152 (60%)	0.65	0.44-0.97	0.03
Manual profession [N (%)]	23 (14%)	126 (50%)	0.16	0.10-0.26	< 0.01^* * p < 0.02.
Physical Activity [N (%)]	92 (55%)	103 (41%)	1.79	1.20-2.70	< 0.01^* * p < 0.02.
Thyropathy [N()]	56 (34%)	35 (14%)	3.14	1.94-5.08	< 0,01^* * p < 0.02.
Thyrroidites [N()]	6 (4%)	4 (2%)	2.32	0.64-8.33	0.20
Hypothyroidism [N(%)]	29 (17%)	21 (8%)	2.32	1.27-4.23	< 0.01^* * p < 0.02.
Benign nodules [N(%)]	16 (10%)	6 (2%)	4.36	1.67-11.38	< 0.01^* * p < 0.02.
Cancer [N (%)]	5 (3%)	4 (2%)	1.92	0.51-7.25	0.34
Diabetes [N(%)]	19 (11%)	46 (18%)	0.58	0.32-1.02	0.06
Dyslipidemia [N (%)]	43 (26%)	43 (17%)	1.69	1.05-2.73	0.03
Renal lithiasis [N (%)]	22 (13%)	2 (1%)	19.02	4.41-82.07	< 0.01^* * p < 0.02.
Fibromyalgia [N (%)]	13 (8%)	2 (1%)	10.58	2.36-47.52	< 0.01^* * p < 0.02.
Hypertension [N (%)]	37 (22%)	92 (37%)	0.50	0.32-0.78	< 0.01^* * p < 0.02.
Huperurecemia [N (%)]	3 (2%)	0 (0%)	2.49	<0.01- < 0.01	0.99
Malignant neoplasia [N (%)]	16 (10%)	20 (8%)	1.23	0.62-2.45	0.55
Psychiatric diseases [N (%)]	54 (33%)	8 (3%)	14.65	6.74-31.81	< 0.01^* * p < 0.02.
Continuous use medication [N (%)]	112 (66%)	179 (71%)	0.83	0.55-1.28	0.40
Alcoholism^b b Alcoholics and ex-alcoholics. [N(%)]	9 (5%)	45 (18%)	0.26	0.13-0.55	< 0.01^* * p < 0.02.
Tobacco^c c Smokers and ex-smokers. [N(%)]	62 (37%)	98 (39%)	0.93	0.62-1.39	0.70

Clinical and demographic variables	Group 1	Group 2	OR	95%CI	P-Value
Age (median ± DI)	51 ± 11	52 ± 8	1.00	0.97-1.03	0.99
Female gender [N (%)]	100 (60%)	76 (59%)	1.06	0.66-1.69	0.82
Overweight or obesity^a a IMC > 25. [N (%)]	83 (50%)	80 (62%)	0.61	0.38-0.98	0.04
Manual profession [N (%)]	23 (14%)	56 (43%)	0.21	0.12-0.37	< 0.01^* * p < 0.02.
Physical Activity [N (%)]	92 (55%)	45 (35%)	2.32	1.45-3.73	< 0.01^* * p < 0.02.
Thyropathy [N (%)]	56 (34%)	7 (5%)	8.87	3.88-20.29	< 0.01^* * p < 0.02.
Thyroidites [N (%)]	6 (4%)	0 (0%)	13.02	< 0.01-< 0.01	0.99
Hypothyroidism [N (%)]	29 (17%)	5 (4%)	5.25	1.97-13.98	< 0.01^* * p < 0.02.
Benign nodules [N (%)]	16 (10%)	2 (2%)	6.77	1.53-30.02	0.01^* * p < 0.02.
Cancer [N (%)]	5 (3%)	0 (0%)	12.94	< 0.01-< 0.01	0.99
Diabetes [N (%)]	19 (11%)	9 (7%)	1.72	0.75-3.95	0.20
Dyslipidemia [N (%)]	43 (26%)	27 (21%)	1.32	0.76-2.29	0.32
Renal lithiasis [N (%)]	22 (13%)	4 (3%)	4.77	1.60-14.23	< 0.01^* * p < 0.02.
Fibromyalgia [N (%)]	13 (8%)	9 (7%)	1.13	0.47-2.74	0.78
Hypertension [N (%)]	37 (22%)	67 (52%)	0.27	0.16-0.44	< 0.01^* * p < 0.02.
Hyperurecemia [N (%)]	3 (2%)	1 (1%)	2.36	0.24-22.92	0,46
Malignant neoplasms [N (%)]	16 (10%)	1 (1%)	13,65	1,79-104,38	0.01^* * p < 0.02.
Psychiatric diseases [N (%)]	54 (33%)	8 (6%)	7.29	3.32-16.00	<0.01^* * p < 0.02.
Medication use continues [N (%)]	112 (66%)	81 (63%)	1.23	0.76-1.99	0.40
Alcoholism^b b Alcoholics and ex-alcoholics. [N(%)]	9 (5%)	21 (16%)	0.30	0.13-0.67	<0.01^* * p < 0.02.
Tobacco^c c Smokers and ex-smokers. [N(%)]	62 (37%)	47 (36%)	0.99	0.61-1.60	0.97

Clinical and demographic variables	Group 2	Group 3	OR	95%CI	p-value
Age (median ± DI)	52 ± 8	50 ± 10	1.02	0.99-1.04	0.29
Female gender [N (%)]	76 (59%)	151 (60%)	0.95	0.62-1.46	0.82
Overweight or obesity^a a IMC > 25. [N (%)]	80 (62%)	152 (60%)	1.06	0.69-1.65	0.78
Manual profession [N (%)]	56 (43%)	126 (50%)	0.76	0.50-1.17	0.21
Physical Activity [N (%)]	45 (35%)	103 (41%)	0.77	0.50-1.20	0.25
Thyropathy [N (%)]	7 (5%)	35 (14%)	0.35	0.15-0.82	0.03
Thyroidites [N (%)]	0 (0%)	4 (2%)	< 0.01	< 0.01-< 0.01	0.99
Hypothyroidism [N(%)]	5 (4%)	21 (8%)	0.44	0.16-1.20	0.11
Benign nodules [N(%)]	2 (2%)	6 (2%)	0.64	0.13-3.23	0.59
Cancer [N (%)]	0 (0%)	4 (2%)	< 0.01	< 0.01-< 0.01	0.99
Diabetes [N(%)]	9 (7%)	46 (18%)	0.33	0.16-0.71	< 0.01^* * p < 0.02.
Dyslipidemia [N (%)]	27 (21%)	43 (17%)	1.28	0.75-2.19	0.37
Renal lithiasis [N (%)]	4 (3%)	2 (1%)	3.98	0.72-22.05	0.11
Fibromyalgia [N (%)]	9 (7%)	2 (1%)	9.34	1.99-43.89	< 0.01^* * p < 0.02.
Hypertension [N (%)]	67 (52%)	92 (37%)	1.87	1.21-2.87	< 0.01^* * p < 0.02.
Hyperurecemia [N (%)]	1 (1%)	0 (0%)	3.17	<0.01- < 0.01	1.00
Malignant neoplasms [N (%)]	1 (1%)	20 (8%)	0.09	0.01-0.68	0.03
Psychiatric diseases [N (%)]	8 (6%)	8 (3%)	2.01	0.74-5.48	0.17
Medication use continues [N (%)]	81 (63%)	179 (71%)	0.68	0.43-1.06	0.09
Alcoholism^b b Alcoholics and ex-alcoholics. [N (%)]	21 (16%)	45 (18%)	0.89	0.50-1.57	0.69
Tobacco^c c Smokers and ex-smokers. [N (%)]	47 (36%)	98 (39%)	0.94	0.60-1.45	0.76

Clinical and demographic variables	Thyropaths	Non-thyropaths	OR	95%CI	p-value
Age of impairment (median ± DI)	51 ± 11	51 ± 10	1.02	0.97-1.06	0.47
Female gender [N (%)]	47 (84%)	53 (48%)	5.62	2.51-12.56	< 0.01^* * p < 0.05.
Bilaterality [N (%)]	11 (20%)	23 (21%)	0.93	0.41-2.07	0.85
Time of injury in months (median ± DI)	7 ± 7	8 ± 7	0.99	0.93-1.05	0.77

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[1] Address for correspondence Carina Cohen, PhD, Departamento de Ortopedia e Traumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Centro de Traumatologia do Esporte, Rua Estado de Israel, 636, São Paulo, SP, Brazil (e-mail: cacohen18@hotmail.com).

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Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences* * Work developed at Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Orthopedics and Traumatology, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil.

Abstract

Objective

Methods

Results

Conclusions

Association between Frozen Shoulder and Thyroid Diseases: Strengthening the Evidences^* * Work developed at Universidade Federal de São Paulo, Escola Paulista de Medicina, Department of Orthopedics and Traumatology, Centro de Traumatologia do Esporte, São Paulo, SP, Brazil.