Abstract
This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P < 0.01) occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P = 0.008). Increased shoulder pain was associated with AHD percentage narrowing after ER (P ≤ 0.007). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.
Highlights
Subacromial impingement syndrome (SIS) is a common shoulder dysfunction in manual wheelchair users (MWUs)
The results of this study suggest that MWUs should limit weight-relief raise (WR) for pressure relief, as placing the shoulder in a WR position led to a significant reduction in the subacromial space
The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs
Summary
Subacromial impingement syndrome (SIS) is a common shoulder dysfunction in manual wheelchair users (MWUs). During a WR, MWUs need to lift and support the weight of the body to reduce pressure on the buttocks This activity results in excessive shoulder joint loading and requires rotator cuff muscles to maintain glenohumeral joint stability [4,5,6]. Van Drongelen et al simulated shoulder joint reaction forces during the WR using musculoskeletal modeling techniques They found that large weight-bearing forces (1288 N) acted to drive the humerus into the glenohumeral joint during the WR [6].
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