Ultrasonographic Measures of the Acromiohumeral Distance and Supraspinatus Tendon Thickness in Manual Wheelchair Users With Spinal Cord Injury

Abstract

Objectives(1) To evaluate the reliability of ultrasonographic measures of the acromiohumeral distance (AHD) in shoulder positions linked to wheelchair propulsion in manual wheelchair users (MWUs) with spinal cord injury (SCI) and able-bodied individuals; (2) to compare ultrasonographic measures of AHD, supraspinatus tendon thickness, and occupation ratio between MWUs with SCI with and without shoulder pain (rotator cuff [RC] tendinopathy); and (3) to compare these ultrasonographic measures between MWUs with SCI and able-bodied individuals. DesignCross-sectional study. SettingRehabilitation centers. ParticipantsThree groups of participants (N=95; aged between 18 and 60y) were recruited within a convenience sample: objective 1: 16 MWUs with SCI (mean age, 43±9y; height, 172±13 cm, weight, 84±10 kg) and 16 able-bodied individuals (mean age, 28±9y; height, 176±11 cm, weight, 72±12 kg); objectives 2 and 3: 37 MWUs with SCI (17 with [mean age, 47±11y; height, 172±14 cm, weight, 68±11 kg] and 20 without [mean age, 45±10y; height, 172±15 cm, weight, 84±30 kg] RC tendinopathy) and 26 able-bodied individuals (mean age, 31±5y; height, 175±12 cm; weight, 89±14 kg). InterventionsNot applicable. Main Outcome MeasuresAHD, supraspinatus tendon thickness, and occupation ratio of the supraspinatus tendon measured using ultrasound imaging systems. Results(1) Excellent intra- and interrater reliability of AHD was obtained in each arm position (intraclass correlation coefficient>.85); (2) MWUs without shoulder pain have thicker tendon than do MWUs with RC tendinopathy; and (3) a significant Group × Position interaction was found for AHD measures when comparing MWUs with SCI with able-bodied individuals (greater AHD at the end of the push phase for MWUs with SCI). A thicker tendon and a higher occupation ratio were also found in MWUs with SCI than in able-bodied individuals. ConclusionsUltrasonography is a reliable technology to evaluate AHD in MWUs in shoulder positions linked to wheelchair propulsion. Supraspinatus tendon thickness and occupation ratio of AHD adequately discriminate between MWUs with SCI and able-bodied individuals. This shows that these ultrasonographic measures can be used in future studies of populations with SCI to better understand the changes at the shoulder joint in MWUs.