TNF and obesity due to melanocortin 4 receptor deficiency: Obesity is also considered a risk factor for rotator cuff tear [24] because it contributes to peripheral vascular deficiencies through its associations with an increased production of adipokines (leptin; adiponectin; plasminogen activator inhibitor; tumor necrosis factor-a; angiotensinogen; interleukins 6, 8, 10, and 18).