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Metabolic Factors Linked to Shoulder Pain. Metabolic syndrome is characterized by a cluster of conditions—increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels—that elevate a person’s risk of heart disease, stroke, and diabetes. A review of findings from six published studies identified an association between metabolic syndrome and an increased risk for rotator cuffrelated shoulder pain. Past research has demonstrated that a treatment plan that combines manipulative therapy with specific exercises can reduce pain and improve function in patients with rotator cuff dysfunction. BMJ Open Sport & Exercise Medicine, December 2019