Dataset Information

Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury.

ABSTRACT:

Background

Most individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context.

Methods

Shoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression.

Findings

Periods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P?InterpretationThe occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.

SUBMITTER: Mozingo JD

PROVIDER: S-EPMC7050284 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Publications

Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury.

Mozingo Joseph D JD Akbari-Shandiz Mohsen M Murthy Naveen S NS Van Straaten Meegan G MG Schueler Beth A BA Holmes David R DR McCollough Cynthia H CH Zhao Kristin D KD

Clinical biomechanics (Bristol, Avon) 20191020

<h4>Background</h4>Most individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context.<h4>Methods</h4>Shoulder motion was imaged a ...[more]

PMID: 32035338

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Project description:To assess the association of age at pediatric-onset spinal cord injury (SCI) and years of manual wheelchair use with shoulder dynamics. Upper extremity kinematics and hand-rim kinetics were obtained during manual wheelchair propulsion. An inverse dynamics model computed three-dimensional acromioclavicular, sternoclavicular, and glenohumeral joint dynamics. Linear mixed effects models evaluated the association of age at injury onset and years of wheelchair use with shoulder dynamics. Motion laboratory within a children's hospital. Seventeen manual wheelchair users (N=17; 6 female, 11 male; mean age: 17.2 years, mean age at SCI onset: 11.5 years) with pediatric-onset SCI (levels: C4-T11) and International Standards for Neurological Classification of SCI grades: A (11), B (3), C (2), and N/A (2). Not applicable. Acromioclavicular, sternoclavicular, and glenohumeral angles and ranges of motion, and glenohumeral forces and moments. We observed a decrease in maximum acromioclavicular upward rotation (ß [95% confidence interval {CI}]=3.02 [0.15,5.89], P=.039) and an increase in acromioclavicular downward/upward rotation range of motion (ß [95% CI]=0.44 [0.08,0.80], P=.016) with increasing age at SCI onset. We found interactions between age at onset and years of use for maximum glenohumeral abduction (ß [95% CI]=0.16 [0.03,0.29], P=.017), acromioclavicular downward/upward rotation range of motion (ß [95% CI]=-0.05 [-0.09,-0.01], P=.008), minimum acromioclavicular upward rotation (ß [95% CI]=-0.34 [-0.64,-0.04], P=.026). A decrease in glenohumeral internal rotation moment (ß [95% CI]=-0.09 [-0.17,-0.009], P=.029) with increasing years of use was found. Age at injury and the years of wheelchair use are associated with shoulder complex biomechanics during wheelchair propulsion. These results are noteworthy, as both age at SCI onset and years of wheelchair use are considered important factors in the incidence of shoulder pain. These results suggest that investigations of biomechanical changes over the lifespan are critical.

Project description:ObjectiveTo test the effectiveness of a high-dose home exercise/telerehabilitation program for manual wheelchair users who have a spinal cord injury (SCI) by determining whether the intervention would reduce pain and increase function, as we hypothesized.DesignA pre-post trial with outcomes measured at 3 time points: baseline, postintervention (12wk), and follow-up (>24 wk).SettingSubjects performed an exercise program at their homes using telerehabilitation for therapist monitoring of technique and exercise advancement. Baseline and postintervention data were collected at a motion analysis laboratory in a tertiary medical center.ParticipantsA convenience sample of manual wheelchair users (N=16, 3 women; average age, 41y; average time in a wheelchair, 16y) with shoulder pain (average pain duration, 9y) and mechanical impingement signs on physical examination.InterventionsA 12-week home exercise program of rotator cuff and scapular stabilization exercises was given to each participant. The program included a high dose of 3 sets of 30 repetitions, 3 times weekly, and regular physical therapist supervision via videoconferencing.Main outcome measuresPrimary outcomes of pain and function were measured with the Wheelchair User's Shoulder Pain Index (WUSPI), Disabilities of Arm, Shoulder, and Hand (DASH) Index, and Shoulder Rating Questionnaire (SRQ). Secondary outcomes of strength were measured with isometric strength tests of scapulothoracic and glenohumeral muscles, and a static fatigue test of the lower trapezius.ResultsPain was reduced and function improved after the intervention. There was a significant main effect for pain and function between the 3 time points based on the Friedman signed-ranked test, WUSPI (χ(2)2=5.10, P=.014), DASH Index (χ(2)2=5.41, P=.012), and SRQ (χ(2)2=23.71, P≤.001). Wilcoxon signed-rank tests demonstrated that isometric strength measurements of the serratus anterior and scapular retractors increased after the exercise intervention ([t=2.42, P=.04] and [t=4.67, P=.003], respectively). Muscle impulse produced by the lower trapezius during a fatigue task also improved (t=2.2, P=.02). No differences were measured in isometric strength for the lower trapezius, glenohumeral rotators, and abductors between the baseline and 12-week time points.ConclusionsA high-dose scapular stabilizer and rotator cuff strengthening program using telerehabilitation for supervision holds promise for shoulder pain treatment in manual wheelchair users with SCI. Additional work is needed to determine the effectiveness compared with other interventions, as well as the potential for earlier intervention to prevent development of shoulder pain.

Project description:Objective: To investigate the progression of rotator cuff tendon pathology across one year in manual wheelchair (MWC) users with spinal cord injury (SCI) and matched able-bodied individuals, and to explore the association between pain, age, and duration of wheelchair use with the progression of rotator cuff pathology.Design: Longitudinal cohort study, 1-year follow-up.Setting: Outpatient clinic at a tertiary medical center.Participants: Twenty-four adult MWC users with SCI (20 men) with an average age (SD) of 37(12) years and 24 age and sex-matched able-bodied individuals.Interventions: Not applicable.Main outcome measure(s): Presence of shoulder pain was collected. Magnetic resonance imaging (MRI) abnormalities of rotator cuff tendons including tendinopathy and tendon tears at baseline and 1-year follow-up visits were graded by a board-certified musculoskeletal radiologist, and three categories of tendon pathology scores including individual tendon scores, unilateral cuff scores, and bilateral cuff scores were calculated for each participant.Results: Fifty-four percent of the MWC users reported shoulder pain at both time points which was significantly higher than able-bodied cohort at baseline (17%, P = 0.012) and year 1 (21%, P = 0.021). Rotator cuff tendon pathology was detected as mainly mild tendinopathies and low-grade partial-thickness tears in both cohorts at both time points but was more common in MWC users. The results for the bilateral cuff scores indicated a significant (P < 0.008) progression of rotator cuff tendon pathology in the MWC users over one year. MRI findings did not change significantly for the able-bodied cohort across time. There was no association of pain, age, or duration of MWC use with progression of rotator cuff pathology in MWC user cohort.Conclusion: MWC users had a higher prevalence of pain than matched able-bodied cohort, but pain was minimal and not function-limiting. Bilateral cuff TOTAL scores showed pathology progression in MWC users, but MRI findings remained stable in the able-bodied cohort. MWC users were 3.4 times more likely to experience pathology progression than the able-bodied cohort.

Project description:Study designCohort study.ObjectivesShoulder pain prevalence is high in those with spinal cord injury (SCI) and is associated with decreased function, participation restrictions and decreased quality of life. Limited evidence exists regarding physical impairments of newly acquired SCI. The current study compared musculoskeletal factors at rehabilitation initiation in individuals with newly acquired SCI to uninjured individuals. We hypothesized no impairment differences of shoulder pain, strength, mobility, muscle extensibility, or rotator cuff integrity would exist between groups.SettingMulti-site laboratory setting.MethodsThirty-five individuals with newly acquired SCI and age and gender-matched controls without SCI (n = 34) participated. Musculoskeletal Pain Survey, shoulder range of motion (ROM), strength, pectoralis minor muscle extensibility (PM) and tissue integrity [Ultrasound Pathology Rating Scale (USPRS)] were obtained.ResultsHigher pain was reported by individuals experiencing new SCI along with lower strength across all bilateral measures, reduced elevation, external rotation, and horizontal adduction ROM, with large effect sizes. PM bilateral extensibility was reduced compared to controls, with moderate between group effect size; however, no USPRS score difference existed.ConclusionsThis study provided the first comprehensive clinical description for individuals with newly acquired SCI. In comparison to matched uninjured controls, participants with new SCI reported greater shoulder pain with impairments in mobility, strength, and extensibility. The identified early clinical impairments aligned with progressive impairment including further pain development and persistence. Awareness and modification of these early clinical impairments may lead to improved long-term outcomes, improving the overall health and well-being of individuals with newly acquired SCI.SponsorshipSpinal Cord Injury Research Program Investigator-Initiated Research Award under Award No. W81XWH-17-1-0476.

Dataset Information

Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury.

Background

Methods

Findings

Publications

Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury.

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