High Prevalence Of Shoulder Pain Research Articles

Associations between aerobic exercise, muscle strength training and the prevalence of shoulder pain in manual wheelchair users with spinal cord injury

Introduction
 The primary objective of this study is to explore associations between meeting spinal cord injury (SCI)-specific exercise guidelines and the prevalence of shoulder pain in manual wheelchair users (MWU) with SCI in Switzerland. The rationale behind this investigation lies in the high prevalence of shoulder pain among MWU with SCI, impacting their daily activities, leisure- and labor participation, and overall quality of life. Understanding the association between exercise adherence and shoulder pain is crucial, not only for the well-being of the individuals but also for managing healthcare costs associated with pain treatments.
 Methods
 The study utilizes data from the SwiSCI Community Survey 2022 (Gross-Hemmi et al., 2021), focusing on a cohort of 593 manual wheelchair users (MWU) for a cross-sectional analysis, investigating the reporting of shoulder pain, and adherence to SCI-specific exercise guidelines (Martin Ginis et al., 2018). The guidelines, proposed by Martin-Ginis et al. (2018), encompass aerobic exercise and muscle-specific strength training. Logistic regression analyses were employed to assess the association of meeting these guidelines and the prevalence of shoulder pain, while considering potential confounding factors.
 Results
 High prevalence of shoulder pain was observed, affecting 40% of the MWU surveyed, which is in line with previous observations. Additionally, the study found that a significant proportion of the population did not meet the recommended guidelines for aerobic exercise (46%) and muscle strength training (64%). Logistic regression analyses showed that non-adherence to aerobic exercise guidelines was associated with 1.55 to 1.97 higher odds of reporting shoulder pain. No association of muscle strength training with the shoulder pain could be found. Therefore, meeting both aerobic and muscle strength guidelines did not yield any association with shoulder pain. Adjustments for potential confounders such as sex, age, lesion level, completeness, time since injury, and mobility scores, did not change the association between adherence to guidelines and shoulder pain.
 Discussion/Conclusion
 The prevalence of shoulder pain in the study sample is high (40%) and in line with previous publications. Compared to 75% of the Swiss general population being physical active for more than 2.5 hour a week (Bundesamt für Statistik, 2019), only 54% of the study sample is meeting the guidelines for at least the “Starter level” on aerobic exercise (cardiorespiratory, ≥ 2x 20 min/week). Those who are not meeting the aerobic exercise guidelines have 1.55 to 1.97 higher odds to have shoulder pain. Despite foreseen shoulder fitness benefit, 64% is not meeting the guidelines on muscle strength training. To further examine the relation between shoulder use, -exercise and shoulder pain, longitudinal studies on dose-effect are needed.
 References
 Gross-Hemmi, M. H., Gemperli, A., Fekete, C., Brach, M., Schwegler, U., & Stucki, G. (2021). Methodology and study population of the second Swiss national community survey of functioning after spinal cord injury. Spinal Cord, 59, 363-372. https://doi.org/10.1038/s41393-020-00584-3
 Martin Ginis, K. A., van der Scheer, J. W., Latimer-Cheung, A. E., Barrow, A., Bourne, C., Carruthers, P., Bernardi, M., Ditor, D. S., Gaudet, S., de Groot, S., Hayes, K. C., Hicks, A. L., Leicht, C. A., Lexell, J., Macaluso, S., Manns, P. J., McBride, C. B., Noonan, V. K., Pomerleau, P. … Goosey-Tolfrey, V. L. (2018). Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord, 56(4), 308-321. https://doi.org/10.1038/s41393-017-0017-3
 Bundesamt für Statistik. (Ed.). (2019). Schweizerische Gesundheitsbefragung 2017. Körperliche Aktivität und Gesundheit [Swiss Health Survey 2017: Physical activity and health]. Bundesamt für Statistik. https://www.sportobs.ch/inhalte/Downloads/213-1708.pdf

Steering-by-leaning facilitates intuitive movement control and improved efficiency in manual wheelchairs

BackgroundManual wheelchair propulsion is widely accepted to be biomechanically inefficient, with a high prevalence of shoulder pain and injuries among users. Directional control during wheelchair movement is a major, yet largely overlooked source of energy loss: changing direction or maintaining straightforward motion on tilted surfaces requires unilateral braking. This study evaluates the efficiency of a novel steering-by-leaning mechanism that guides wheelchair turning through upper body leaning.Methods16 full-time wheelchair users and 15 able-bodied novices each completed 12 circuits of an adapted Illinois Agility Test-course that included tilted, straight, slalom, and 180° turning sections in a prototype wheelchair at a self-selected functional speed. Trials were alternated between conventional and steering-by-leaning modes while propulsion forces were recorded via instrumented wheelchair wheels. Time to completion, travelled distance, positive/negative power, and work done, were all calculated to allow comparison of the control modes using repeated measures analysis of variance.ResultsSubstantial average energy reductions of 51% (able-bodied group) and 35% (wheelchair user group) to complete the task were observed when using the steering-by-leaning system. Simultaneously, able-bodied subjects were approximately 23% faster whereby completion times did not differ for wheelchair users. Participants in both groups wheeled some 10% further with the novel system. Differences were most pronounced during turning and on tilted surfaces where the steering-by-leaning system removed the need for braking for directional control.ConclusionsBackrest-actuated steering systems on manual wheelchairs can make a meaningful contribution towards reducing shoulder usage while contributing to independent living. Optimisation of propulsion techniques could further improve functional outcomes.

Prevalence of Shoulder Pain among Female Students Carrying Heavy Bag

Aim: To determine the prevalence of shoulder pain carrying heavy bags in female students Methodology: This was across-sectional study and data were collected through a convenient sampling technique. Data collected from theuniversity female students of sind. A visual analog scale was used to assess the intensity of pain, and To assess the burden of shoulder pain, data were collected using a self-administered questionnaire. Data was analyzed through SPSS Version 22. Results: Results indicate thatthe meanage±SDof participants were 22.8±1.99, mean height±SD were 61.10±3.7 in inches, mean weight±SD were 54.9±3.4kg. The result of this study shows that majority of students are experiencing shoulder pain by carrying uncomfortable bags in routine life. About 38.3% of messenger bags are comfortable to carry. The majority (67.5%) of the students have shoulder pain during activity, 34.2% at its worth and minority of the students are suffering from sleep disturbance due to shoulder pain. Practical implication: few studies have assessed the relationship between university students and heavy bags. Therefore, our hypothesis is that the use of overweight shoulder bags can influence the occurrence of shoulder pain. Thus, the present study aimed to determine the prevalence of shoulder pain carrying heavy bags in female students Conclusion: It is concluded that there is high prevalence of shoulder pain due to tote type of bags among university going females. The shoulder bags cause moderate to severe shoulder pain and mostly dull aching and generalized type of pain cause by shoulder bags. Keywords: Females students, Heavy bags, Prevalence, Shoulder pain

IDF21-0561 Prevalence of shoulder musculoskeletal pain and disability in individuals with Diabetes Mellitus – a preliminary study

Background: In Chile, it is estimated that 9.8% of adult population have Diabetes Mellitus (DM). Beyond the most reported complications of DM, musculoskeletal disorders are commonly found, receiving relatively little attention from health professionals. The evidences shows that musculoskeletal injuries in individuals with DM may occur due to the hyperglycemia, generating an accumulation of the non-enzymatic advanced glycation end-products (AGEs), increasing collagen crosslinking, generating abnormal collagen deposit in tendons and ligaments, turning them thicker, rigid and weaker. The shoulder joint is frequently affected, presenting limited mobility and pain. Research in this area is scarce, perhaps because other complications have been considered more life threatening. However, musculoskeletal disorders can reduce physical mobility, representing a substantial burden on morbidity and quality of life. Aim: The purpose of this study is to estimate the prevalence of shoulder pain and the shoulder pain and disability index (SPADI) in individuals with type 2 DM from Talca city (Chile). Method: This study was approved by the ethical committee (218/2020). Adults with type 2 DM participated in the study. A survey was performed to identify the presence of shoulder pain. The SPADI questionnaire was applied to the symptomatic participants, to identify their pain and disability level, with scores varying from 0–100 (the higher the score, the greater the disability). Prevalence was calculated through percentage with the 95% CI. Chi-squared test was performed to obtain information regarding the association between presence of pain and sex. Results: A total of 75 DM type 2 individuals participated in this preliminary study (♀ = 39; ♂ = 36; 57.6 ± 9.9 years old). The prevalence of shoulder pain was 52%. Of those with shoulder pain, 25.3% were female and 26.7% male. From the total sample, the prevalence of shoulder pain in female was 48.7% and male 51.3%. However, no association was found between the presence of pain and sex (p=0.64). The SPADI questionnaire presented a pain dimension scored at 65.6% ± 21.2; and a disability dimension scored at 51.5% ± 25.1.Tabled 1DM type 2 subjectsPrevalence of shoulder pain % (95% CI)Total sample (n=75)52 (0.50-0.54)Female (n=39)48.7 (0.47-0.50)Male (n=36)51.3 (0.49-0.53) Open table in a new tab Discussion: High prevalence of shoulder pain was found in the study, contrasting with a similar study which found a prevalence of 25.7% of shoulder pain in DM Scottish subjects. Studies have found that prevalence of shoulder pain in general population varies from 6.9-26%, further highlighting the high prevalence in our study. Regarding sex prevalence, the presence of pain was not associated to sex, converging with the literature that shows no difference between sex in frozen shoulder patients with DM. For SPADI scores, results are similar to those observed in the literature in patients with DM, in which the SPADI pain score was 56.7% and SPADI disability 51%. With this study, we hope to elucidate the proportion of existing cases of shoulder pain in type 2 DM individuals in Chilean population. It will enable to analyze which factors are related to the presence of pain and dysfunction, guiding in the development of specific rehabilitation protocols.

Impact of 30 years' high-level rock climbing on the shoulder: an magnetic resonance imaging study of 31 climbers.

Rock climbers are particularly susceptible to shoulder injuries due to repetitive upper-limb movements on vertical or overhanging terrain. However, the long-term effects of prolonged climbing on the shoulder joints are still unknown. The purpose of this study was to analyze the prevalence of pain and degenerative changes in the shoulder joints after high-level rock climbing over at least 25 years. We hypothesized that specific climber-associated patterns of degeneration would be found. Thirty-one adult male high-level rock climbers were compared to an age- and sex-matched control group of 31 nonclimbers. All participants underwent a detailed interview, standardized clinical examination, and bilateral (climbers) or unilateral (nonclimbers, dominant side) magnetic resonance imaging (MRI) scans. Clinical and MRI findings of the groups were compared. The lifetime prevalence of shoulder pain in the rock climbers was 77%. The rock climbers had significantly more abnormalities in the labrum (82% vs. 52%; P = .002), long biceps tendon (53% vs. 23%; P = .006), and cartilage (28% vs. 3%; P = .005). These increased changes positively correlated with climbing intensity. There were no differences between the 2 groups with respect to rotator cuff tendon pathology (68% vs. 58%; P = .331) and acromioclavicular joint degeneration (88% vs. 90%; P = .713). Despite the increased degenerative changes in the rock climbers, their Constant score (CS) was still better than that of the nonclimbers (CS 94, interquartile range [IQR] 92-97, vs. CS 93, IQR 91-95; P = .019). Prolonged high-level rock climbing leads to a high prevalence of shoulder pain and increased degenerative changes to the labrum, long biceps tendon, and cartilage. However, it is not related to any restriction in shoulder function.

Managing shoulder pain in manual wheelchair users: a scoping review of conservative treatment interventions

Objective: To review the literature that has explored conservative treatments for the management of shoulder pain in manual wheelchair users. Methods: Five databases were systematically searched in february 2020 for terms related to shoulder pain and manual wheelchair use. Articles were screened and included if they investigated the conservative treatment of shoulder pain in wheelchair users. Participants’ physical characteristics, experimental design and primary and secondary outcome measures were extracted from studies. Studies were grouped according to treatment type to identify gaps in the literature and guide future research. Results: The initial search identified 407 articles, of which 21 studies met the inclusion criteria. Exercise-based treatment interventions were most prevalent (n = 12). A variety of exercise modalities were employed such as strengthening and stretching (n = 7), ergometer training (n = 3), Pilates classes (n = 1) and functional electrical stimulation (n = 1). Only three studies supplemented exercise with an additional treatment type. The Wheelchair Users Shoulder Pain Index was used by 18 studies as the primary measure of shoulder pain. Only seven of these included an objective measure of shoulder function. Participant characteristics varied among studies, and physical activity levels were frequently not reported. Conclusions: Despite the high prevalence of shoulder pain in manual wheelchair users, the number of studies to have explored conservative treatment types is low. Exercise is the most commonly used treatment, which is encouraging as physical inactivity can exacerbate other health conditions. Few studies have adopted interdisciplinary treatment strategies or included objective secondary measures to better understand the mechanisms of pain.

Prevalence and factors associated with shoulder pain in the general population: a cross-sectional study

ABSTRACT Musculoskeletal pain in the shoulder is considered one of the most prevalent causes of pain and disability in adults. To verify the prevalence of shoulder pain and correlated factors in adults aged 20 years or older in cross-sectional study with 600 individuals interviewed through questionnaires: (1) participants characterization; (2) level of physical activity; (3) reported morbidities; and (4) musculoskeletal symptoms. Descriptive, bivariate, and Poisson regression analyses were performed. The prevalence of pain in the shoulder was 24% (CI 20.3%-27.5%). Being 60 years or older (PR=2.14; 1.33-2.45), female (PR=1.92; 1.29-285), using the computer more than three times a week (PR=1.55; 1.01-2.32), working in a sitting position (PR=1.64; 1.03-2.59), standing up leaning the body forward (PR=1.54; 1.00-2.37), and reporting two or more morbidities (PR=3.31; 1.97-5.57) were all indicators of shoulder pain. This study discloses a high prevalence of shoulder pain and a strong relation with women, age, those who use the computer more than three times a week, those who execute occupational activities sitting and standing up leaning the body forward, and those who report two or more diseases.

Designing instrumented walker to measure upper-extremity’s efforts: A case study

ABSTRACT The high prevalence of shoulder pain in using walkers in patients who have spinal cord injury (SCI). Also, the limited options available to economically measure grip forces in walkers, which drove the need to create one. This article describes a method to obtain upper-extremities’ forces and moments in a person with SCI by designing an appropriate instrumented walker. First, since the commercial multidirectional loadcells are too expensive, custom loadcells are fabricated. Ultimately, a complete gait analysis by means of VICON motion analysis and using inverse dynamic method has been held to measure upper-extremities’ efforts. The results for a person with SCI using a two-wheel walker in low and high heights and a basic walker show that there are higher shoulder and elbow flexion-extension moments and also higher shoulder forces in superior–inferior direction and higher elbow and wrist forces in anterior–posterior directions. The results are not much different in using two different types of walker. By using the proposed method, upper-extremities’ forces and moments were obtained and the results were compared to each other in using two different walkers.

Prevalence of Shoulder Pain Among School Teachers of Lahore, Pakistan

The shoulder joint is the most mobile joint in the body. It performs movements in different directions and can easily be injured due to any repeated movements, participation in sports or any labor work. Shoulder pain is one of the most important complaint due to which teachers apply for retirement before time. The aim of the study was to determine frequency of shoulder pain in school teachers of Lahore, Pakistan. Methods: It was an observational study in which thousand school teachers were given self-administered Performa. Schools were selected randomly. The data analysis was done by using SPSS 21 version. Results: The prevalence of shoulder pain came out to be 306 (30.6%). The number of teachers teaching from five years was 577 (57.7%) and the mean age calculated was 30.86. Conclusion: This study concluded high prevalence of shoulder pain in school teachers.

Shoulder pain in the Swiss spinal cord injury community: prevalence and associated factors

Purpose: To determine the prevalence of shoulder pain and to identify factors associated with shoulder pain in a nationwide survey of individuals living with spinal cord injury (SCI) in Switzerland.Methods: Data was collected through the 2012 community survey of the Swiss SCI Cohort Study (SwiSCI) (N = 1549; age 52.3 ± 14.8; 29% female). Sociodemographic and socioeconomic circumstances, SCI characteristics, health conditions as well as mobility independence and sporting activities were evaluated as predictor variables. Analyses were adjusted for item non-response (using multiple imputation) and unit-nonresponse (using inverse probability weighting).Results: The adjusted prevalence of shoulder pain was 35.8% (95% CI: 33.4–38.3). Multivariable regression analysis revealed higher odds of shoulder pain in females as compared to males (odds ratio: 1.89; 95% CI: 1.44–2.47), and when spasticity (1.36; 1.00–1.85) and contractures (2.47; 1.91–3.19) were apparent. Individuals with complete paraplegia (1.62; 1.13–2.32) or any tetraplegia (complete: 1.63; 1.01–2.62; incomplete: 1.82; 1.30–2.56) showed higher odds of shoulder pain compared to those with incomplete paraplegia.Conclusions: This survey revealed a high prevalence of shoulder pain. Sex, SCI severity, and specific health conditions were associated with having shoulder pain.Implications for rehabilitationIndividuals with spinal cord injury have a high prevalence of shoulder pain.Females, individuals with complete paraplegia or any tetraplegia and individuals with contractures and spasticity should receive considerable attention in rehabilitation programmes due to their increased odds of having shoulder pain.

Water Polo Injuries and Training Methods.

Water polo is a unique team sport combining swimming sprints and eggbeater kicking, frequent overhead movements and throwing, and regular physical contact with minimal protective equipment. Accordingly, a wide variety of training methods attempt to enhance all of these skill sets. This usually includes some combination of aerobic/anaerobic fitness (via swimming), sport-specific skills, strengthening, and nutrition. In addition, injuries in water polo are somewhat diverse. Physical contact is responsible for the majority of acute injuries, most frequently being injuries to the head and face. The high prevalence of shoulder pain in water polo is likely related to increased shoulder mobility and subsequent instability and stress on shoulder structures, yet the underlying causation is not certain. The unique aspect of shoulder injuries occurring in water polo players is that they may be due to a combination of swimming-related overuse conditions, overhead throwing, and acute trauma-related conditions. Although there is generally minimal evidence-based information available, this article attempts to highlight the current knowledge that we have in regard to water polo injuries and training methods.

Effects of chronic shoulder pain on quality of life and occupational engagement in the population with chronic spinal cord injury: preparing for the best outcomes with occupational therapy

Purpose To examine the implications of chronic shoulder pain on quality of life and occupational engagement in spinal cord injury (SCI). The Ecology of Human Performance Model and Self-Efficacy Theory will be used to further examine the interplay of shoulder pain, quality of life and engagement in this population. Method Analysis of literature. Results Persons with SCI have a high prevalence of shoulder pain and injury, affecting 37–84% of analysed studies; chronic pain limits occupational engagement and decreases quality of life. Remediation of pain provides improved occupational engagement, functional independence and quality of life in those with high self-efficacy and low depression. Conclusion Shoulder pain is a serious complication following SCI and the Ecology of Human Performance Model and Self-Efficacy Theory can be utilized in conjunction for a framework to evaluate, treat and prevent shoulder pain and its devastating effects on occupational engagement and quality of life in the spinal cord injured population. Thereafter, rehabilitation professionals will have a greater understanding of these interactions to serve as a guide for evaluation and intervention planning to promote optimal occupational engagement through limiting the experiences of occupational injustices for those with SCI and shoulder pain. Implications for RehabilitationMusculoskeletal pain at the shoulder joint and depression are common complications following spinal cord injury that limit occupational engagement and decrease quality of life.To increase engagement and quality of life in this population, treatments need to address all factors including the under-lying psychosocial instead of task and environment modification alone.The Ecology of Human Performance Model and Self-efficacy Theory are effective frameworks that can be used for evaluation, treatment planning and outcome measurement to maximize occupational engagement and quality of life.

Echographic and kinetic changes in the shoulder joint after manual wheelchair propulsion under two different workload settings.

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.

Shoulder Symptoms and Function in Geriatric Patients

Musculoskeletal problems, including shoulder pain, are common in the general population and are often cited as reasons for physician visits. Although many risk factors for shoulder pain are postulated, the effects of shoulder pain on functional level and perceived quality of life are poorly characterized in older adults. In this study, we set out to determine the prevalence and impact of shoulder symptoms and dysfunction in an older adult veteran population. A chart review, cross-sectional survey, and examination were performed. A sample of 93 individuals, aged 60 years or older, was recruited from a primary clinic outpatient waiting room at the Clement J. Zablocki VA Medical Center in Milwaukee, Wisconsin. Patients were asked about shoulder symptoms and self-assessed health and completed the Stanford Modified Health Assessment Questionnaire. A series of 3 shoulder maneuvers was used to assess shoulder mobility and pain. The presence of diabetes and statin use was documented. A more thorough chart review was performed on individuals who reported shoulder pain and disability. Severe shoulder pain was common in the study group, reported by 31% of all participants. Functional limitation measured by the Modified Health Assessment Questionnaire and answering "yes" to greater difficulty performing daily tasks was associated with reduced internal rotation, which was present in almost 36% of all participants. Symptoms were often bilateral. No statistically significant risk factors emerged in this small sample, but suggestive trends were apparent. Interestingly, few patients reported discussing these problems with their providers, and shoulder-related problems were documented in only 10% of corresponding problem lists of symptomatic patients. With an aging population, the high prevalence of shoulder pain may have considerable impact on public health. It will become increasingly important to define risk factors, delineate etiologies, and devise new management strategies for patients with symptomatic shoulder disease.

Validación de un test para valorar la cinemática de propulsión en usuarios en silla de ruedas

IntroductionWheelchair users have a high prevalence of shoulder pain due to wheelchair propulsion. The aim of this study was to develop a test to analyze wheelchair propulsion and validate it to determine whether wheelchair propulsion is related to strength and pain in the shoulder joint. Material and methodsA total of 36 wheelchair users performed the Wheelchair Users Shoulder Pain Index, the kinematic wheelchair propulsion test (T-CIDIF) and a maximum isokinetic strength test of the internal and external rotators of the shoulder. The T-CIDIF consisted of a 30-second maximum test performed on rollers in which two linear transducers recorded the movements of each arm, registering the number of propulsions and maximum and mean velocity and power. ResultsNo differences between propulsion variables were observed between the two arms. Most T-CIDIF variables were negatively correlated with the shoulder pain questionnaire (from r=−0.347 to r=−0.469, from P<.05 to P<01). All T-CIDIF variables were correlated with the peak torque, total work, mean power, and mean of the peak torques of the internal and external shoulder rotators (from r=0.390 to r=849, P<.001). ConclusionThe T-CIDIF appears to be a valid tool that is related to pain and strength in the shoulder joints of wheelchair users and could be used in the clinical setting to assess the efficacy of various therapies.

Evaluation of Pain and Ultrasonography on Shoulder in Poliomyelitis Wheelchair Basketball Players

The purpose of this study was to determine shoulder pain and shoulder ultrasonographic findings in poliomyelitis Wheelchair Basketball (WB) players. Three physicians performed physical examinations and interviewed WB players about their shoulder pain by using Wheelchair User’s Shoulder Pain Index (WUSPI), Performance-Corrected WUSPI (PC-WUSPI), and Shoulder Pain and Disability Index (SPADI). One physician performed shoulder ultrasonography on WB players. All confirmed their International Wheelchair Basketball Federation (IWBF) classifications through Korean Wheelchair Basketball Federation (KWBF). Seventeen men and 6 women players were enrolled in the study, with 46 shoulders evaluated. Nine players had unilateral lower extremity weakness and 14 players were bilateral weakness. Six players used wheelchair for daily living, and 17 players used wheelchair only when playing WB. They were 44.35±5.42 years old on average. They had played WB for 11.09±9.49 years and trained 8.69±3.83 hours a week. PC-WUSPI was significantly correlated with age (p=0.014). There were no significant differences between time spent playing WB, training time for WB, types of poliomyelitis involvement, their use of wheelchair, and WUSPI, PC-WUSPI and SPADI. Tendon tear prevalence was significantly different with training time for WB (p=0.021). Most common abnormal shoulder ultrasonographic findings were subscapularis and supraspinatus tendinopathy. Tendinopathy and tendon tear prevalence did not differ significantly with age, time spent playing WB, types of poliomyelitis, and the use of wheelchair. High prevalence of shoulder pain and rotator cuff pathology were found by physical and ultrasonographic examination in the poliomyelitis wheelchair basketball players. Rotator cuff injury prevention program are needed for prevent shoulder pain and rotator cuff pathology.

Effects of Scapula Focused Exercise Program on Shoulder Pain in Paraplegic Patients using Wheelchair

Background : Spinal Cord Injury (SCI) is a low incidence, high cost disability requiring tremendous changes in an individual lifestyle1. SCI shifts the demands of daily function and community mobility from the lower extremities to the upper extremities. As a consequence of the increased demand on the upper extremities, there is a high prevalence of shoulder pain with increased age and time since SCI. Objectives : To determine the effectiveness of scapula focused exercise program on shoulder pain in paraplegic patients using wheelchair Materials and Method : Study included 30 paraplegic subjects 20 males and 10 females who have shoulder pain and using wheelchair since 6 months. The patients were treated for a period of 8 weeks, 6 days a week, one session daily and the outcome was measured pre and post treatment by WUSPI (Wheelchair User Shoulder Pain Index). Results : Wilcoxon signed-rank test showed significant difference between pre and post WUSPI score (z=-4.785, P<O.05). And the non parametric spearman rho correlation analysis showed age and duration have positive relationship with pre and post treatment WUSPI score (P<.05). Conclusion : Scapula focused exercise program resulted in significant reductions in shoulder pain in wheelchair users with spinal injuries and shoulder pain.

Variability of peak shoulder force during wheelchair propulsion in manual wheelchair users with and without shoulder pain

BackgroundManual wheelchair users report a high prevalence of shoulder pain. Growing evidence shows that variability in forces applied to biological tissue is related to musculoskeletal pain. The purpose of this study was to examine the variability of forces acting on the shoulder during wheelchair propulsion as a function of shoulder pain. MethodsTwenty-four manual wheelchair users (13 with pain, 11 without pain) participated in the investigation. Kinetic and kinematic data of wheelchair propulsion were recorded for 3min maintaining a constant speed at three distinct propulsion speeds (fast speed of 1.1m/s, a self-selected speed, and a slow speed of 0.7m/s). Peak resultant shoulder forces in the push phase were calculated using inverse dynamics. Within individual variability was quantified as the coefficient of variation of cycle to cycle peak resultant forces. FindingsThere was no difference in mean peak shoulder resultant force between groups. The pain group had significantly smaller variability of peak resultant force than the no pain group (P<0.01, η2=0.18). InterpretationThe observations raise the possibility that propulsion variability could be a novel marker of upper limb pain in manual wheelchair users.

Increased interleukin 1β levels in the subacromial fluid in diabetic patients with rotator cuff lesions compared with nondiabetic patients

Diabetic patients have a high prevalence of shoulder pain and stiffness. Interleukin (IL) 1β was reportedly correlated with shoulder stiffness and decreased shoulder function. We retrospectively compared the expression of IL-1β in the subacromial synovial fluid between diabetic and nondiabetic patients with rotator cuff tearing. We enrolled 68 patients with rotator cuff tearing (23 diabetic patients and 45 nondiabetic patients). The preoperative sum of range-of-motion deficit (SROMD), Constant score, and visual analog scale (VAS) score were obtained. Intraoperatively, subacromial synovial fluid was collected for the IL-1β level measurement. Comparisons of IL-1β levels, Constant scores, SROMD, and VAS scores between diabetic and nondiabetic patients were analyzed with the Mann-Whitney U test. Diabetic patients with rotator cuff tearing had significantly increased subacromial IL-1β levels (P= .048), SROMD (P < .001) and VAS scores (P = .022) and lower Constant scores (P < .001) than nondiabetic patients. The IL-1β levels in the subacromial fluid were significantly correlated with the Constant score (r = -0.477, P < .001), VAS score (r = 0.698, P < .001), and SROMD (r = 0.293, P= .015) in all patients. The elevated IL-1β levels in the subacromial fluid of patients with diabetes may explain the likelihood of pain and shoulder stiffness developing in these patients. We suggest more aggressive treatment for rotator cuff lesions in diabetic patients.

High prevalence of shoulder pain among elite Norwegian female handball players

Clinical experience indicates that a substantial number of handball players may suffer from shoulder pain, but they continue to play despite having shoulder pain problems. The aim of this study was to evaluate the prevalence and consequences of shoulder pain problems among Norwegian female elite handball players. In the preseason of the 2007-2008 season, 179 players from all 12 teams of the Norwegian elite league went through the following tests: internal and external shoulder range of motion, apprehension, relocation test, and shooting velocity. All players completed the Fahlström questionnaire and, for players with current pain, the Western Ontario shoulder instability index questionnaire. Sixty-five (36%) players reported shoulder pain on the test day, and 40 (22%) players reported previous shoulder pain. Two thirds of the players with pain reported a gradual onset. For players with current or previous pain, 22 (36%) and 14 (36%) had missed match play, and 43 (68%) and 28 (76%) reported changing their training habits. A positive apprehension and relocation test was found among 51 (29%) of the players. In conclusion, a high proportion of female elite handball players experience shoulder pain and problems and have an unstable shoulder.