Our findings align with those of Cole and Rechardt, demonstrating a significant relationship between BMI and USS scores.5,30 Obesity is known to promote the release of pro-inflammatory cytokines such as IL-1, IL-6, and TNF-α,30 which have also been implicated in the pathophysiology of shoulder disorders. The gene discussed is TNF; the disease is obesity due to melanocortin 4 receptor deficiency.