Poor Heart Health Linked to Higher Risk of Carpal Tunnel and Rotator Cuff Pain

Having pain in your wrist, elbow, or shoulder can be the result of working a manual labor job, tackling physically demanding chores around the house, or simply getting older. However, new research suggests that these common aches and pains could also be linked to your heart health.

A recent study published in the Journal of Occupational and Environmental Medicine found that people at a higher risk for heart disease might also be more likely to develop musculoskeletal conditions like carpal tunnel syndrome, rotator cuff pain, tennis elbow, and golfer’s elbow.

Kurt Hegmann, MD, MPH, the study’s lead author, a University of Utah professor, and the director of the Rocky Mountain Center for Occupational and Environmental Health, told Verywell that these musculoskeletal disorders were “strongly linked to cardiovascular disease risk factors” and that the more of these disorders a person gets, “the more strongly they are linked to cardiovascular risks.”

Since these musculoskeletal disorders affect most people at some point in their life and can be severe enough that they have to stop taking part in sports, playing with their kids, and/or working, Hegmann said that finding a new path for prevention that will help people maintain their quality of life is crucial.

“Prioritizing cardiovascular health is key to preventing these musculoskeletal disorders, which can have a debilitating impact on people’s quality of life,” Hegmann said. “This is something other researchers and medical professionals need to be paying a lot of attention to.”

Heart, Shoulders, Elbows, and Wrists

For the study, the researchers looked at data from 1,224 workers in industries like manufacturing, healthcare, food processing, and office environments. The average age of the participants was 42 years old and more than half of them (66%) were female.

The researchers collected baseline data on all of the participants at the start of the study using interviews, physical exams, nerve conduction studies, and anthropometric measurements like height and weight.

They also looked at how many people had one or more of certain musculoskeletal disorders: rotator cuff problems, tennis elbow (lateral epicondylitis), golfer’s elbow (medial epicondylitis), and carpal tunnel syndrome. Since the participants could have these conditions on the left, right, or both sides, it was possible for them to be diagnosed with up to eight total.

The researchers also looked at the participants’ cardiovascular disease risk based on factors such as tobacco use, diabetes, and treated/untreated high blood pressure (hypertension). However, these risk scores did not include cholesterol, body mass index (BMI), or the physical strain of a participant’s job. 

Matthew Thiese, MSPH, PhD, a co-author of the study from the Rocky Mountain Center for Occupational and Environmental Health, told Verywell that the researchers followed up with the participants over nine years to see how many of them developed these disorders over time.

Who Is Most at Risk?

The researchers found that the participants with poor cardiovascular health were at a higher risk of developing musculoskeletal disorders. Specifically, people at a 15% higher risk of cardiovascular disease were:

• At four times greater risk of developing one or more musculoskeletal disorders compared to people at low risk of cardiovascular disease.
• At 17 times higher risk of developing four or more musculoskeletal disorders than people at lower risk of cardiovascular disease.

“We know that people need to engage in healthy behaviors so they don’t develop diseases that can shorten their lives. But this study shows that bad outcomes related to musculoskeletal disorders may also be waiting for people who aren’t taking care of their cardiovascular health,” said Thiese.

Why Poor Heart Health Has Whole-Body Effects

Edward Wang, MD, the Chief of Shoulder/Elbow Surgery at Stony Brook Medicine and a fellowship-trained hand surgeon, told Verywell that one reason why people with heart disease—or those who are at high risk for it—might be more likely to get musculoskeletal disorders is that they may have reduced blood flow to their muscles and joints. 

When someone’s heart is not functioning fully because they have high cholesterol or high blood pressure, the organ will struggle to pump enough oxygen and nutrients to all the parts of the body, including the muscles and joints. Over time, they’ll end up with weaker tissues and tendons, which can increase their risk for injuries or musculoskeletal disorders like tennis elbow or rotator cuff pain.

Hegmann said that other studies combined with the new findings “strongly implicate blood supply, that these cardiovascular risks (i.e. diabetes, cholesterol, etc.) reduced blood supply to the tissue.”

“[Other studies] have shown that there is a marked reduction in blood supply to the rotator cuff tendons that tear, and our results suggest that this reduction is the probable cause in these cases of rotator cuff tendinitis,” he said.

According to Wang, reduced blood flow can also affect the body’s ability to heal itself.

“When there’s not good blood flow, the body can’t keep up with the constant repair that it does when we use our body parts,” he said. “Your circulation is sort of the delivery system for bringing the nutrients in the blood vessels and that sort of thing, so it stands to reason that if blood flow is compromised then repair is also compromised.”

Other Factors Increase the Risk of Musculoskeletal Disorders, Too

Wang said there are also other factors that can increase the risk of musculoskeletal disorders. For example, the body accumulates more “wear and tear” as a person ages. At the same time, the body’s ability to repair tissues slows over time. Some conditions like distal bicep tendon ruptures, osteoarthritis, and osteoporosis are more likely to happen as a person gets older.

“Older people are more prone to rupturing things,” Wang said. “We hardly ever see somebody with a distal bicep tendon rupture in their 20s and we hardly ever see someone with tennis elbow who’s in their 20s. When people reach the age of 40 and 50, we start seeing them more.”

According to Wang, a person’s level of physical activity is another factor to consider. For example, a lack of regular exercise or a sedentary lifestyle can weaken the muscles and bones since they’re not being used, which makes them more vulnerable to injuries and health conditions.

“When someone is relatively inactive, we know from clinical practice that their bones will tend to thin out. It can lead to osteopenia or osteoporosis where your bones get lighter,” he said. “If you don’t use a bone, the body will then take the calcium away from the body, take away from that part, and put it somewhere where you are using it.”

A person’s diet also plays a role because nutrition is an important factor, especially calcium and vitamin D—two nutrients that are needed to maintain bone health and support the growth and health of the tissue.

More Research Is Needed

One of the main limitations of the study is that it was not a randomized control trial—the “gold standard” in proving a cause-and-effect link. However, Hegmann said that in the study, it was “not possible with these cardiovascular risks.”

The study also only looked at participants in certain industries. For example, Wang pointed out that jobs like construction work, which typically involve strenuous physical activity, were not included.

Diagnosing the participants with musculoskeletal disorders during physical exams was also not that specific. Wang said that how the researchers diagnosed someone was superficial. If they pushed on something and it hurt then they said it was tennis elbow or if they did a physical exam finding it hurt, then they said it was rotator cuff tendinopathy when it could have just been rotator cuff inflammation.

With these limitations in mind, Hegmann agreed that “in no way can we say that there is proof” without more research.

“The fact the relationship between cardiovascular risks was so strong, and we already know that there is a robust ability for these risks to predict the development of heart disease tells us we need to test this hypothesis, as a predictive risk for identifying who in the population needs more aggressive cardiovascular risks would be quite helpful clinically,” he said.

How to Take Care of Your Heart

Hegmann said that the importance of lowering heart disease risk goes beyond reducing the risk of heart attack and stroke.

“It affects body tissues earlier in life that cause pain and debility,” he said. “People need to get cardiovascular risk assessments at least every five years and they need to be more frequently measured and more aggressively managed when they are evaluated, especially among those who develop one or more of these disorders.”

Wang said that the information from the study may also encourage people—especially people with musculoskeletal injuries or higher heart disease risk—to get screenings and routine care.

“Everyone should go for regular checkups anyway and they could screen for cardiovascular disease. If they have cardiovascular disease, hopefully, they can take preventative measures to slow that down or reverse it, either with medication, diet, or exercise,” said Wang.