Abstract
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain due to the use of the upper extremity for independent mobility, transfers, and other activities of daily living. Indeed, shoulder pain dramatically affects quality of life of these individuals. There is limited evidence obtained through radiographic techniques of a relationship between the forces acting on the shoulder during different propulsion conditions and shoulder pathologies. Today, ultrasound is widely accepted as a precise tool in diagnosis, displaying particularly effectiveness in screening the shoulder rotator cuff. Thus, we set out to perform an ultrasound-based study of the acute changes to the shoulder soft tissues after propelling a manual wheelchair in two workload settings. Shoulder joint kinetics was recorded from 14 manual wheelchair users with SCI while they performed high- and low-intensity wheelchair propulsion tests (constant and incremental). Shoulder joint forces and moments were obtained from inverse dynamic methods, and ultrasound screening of the shoulder was performed before and immediately after the test. Kinetic changes were more relevant after the most intensive task, showing the significance of high-intensity activity, yet no differences were found in ultrasound-related parameters before and after each propulsion task. It therefore appears that further studies will be needed to collect clinical data and correlate data regarding shoulder pain with both ultrasound images and data from shoulder kinetics.
Highlights
This mechanical stress leads to overuse syndrome, which is a possible factor influencing the development of shoulder pain in this population and commonly, injuries of the rotator cuff (Subbarao et al, 1995)
As only half of subjects suffered from shoulder pain, we considered all spinal cord injury (SCI) subjects as a single group rather that conducting a separate analysis for those who referred to shoulder pain
BIOMECHANICS The performance of the subjects in both the protocols was considered and the effective mechanical force was similar in both protocols (Table 2), the increase in the forces and moments was greater after protocol A
Summary
Manual wheelchair users with spinal cord injury (SCI) have a high prevalence of shoulder pain (Bayley et al, 1987; Sie et al, 1992; Subbarao et al, 1995; Escobedo et al, 1997; Curtis et al, 1999; Ballinger et al, 2000; Boninger et al, 2001; Mercer et al, 2006), with estimates ranging from 30% (Ballinger et al, 2000) to 73% (Pentland and Twomey, 1991). Since the upper limb is not specialized for this action, this repetitive loading may cause musculoskeletal disorders at the shoulder joint, predisposing manual wheelchair users to upper limb pathologies (Bayley et al, 1987). This mechanical stress leads to overuse syndrome, which is a possible factor influencing the development of shoulder pain in this population and commonly, injuries of the rotator cuff (Subbarao et al, 1995). Research using inverse dynamics techniques revealed that posterior and superior forces both act on the shoulder joint during the push phase of propulsion, these probably being related to coracoacromial ligament edema and compression of the rotator cuff, respectively (Koontz et al, 2002; Van Drongelen et al, 2005; Mercer et al, 2006; Collinger et al, 2008; Gil-Agudo et al, 2010a)
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