Study design: Prospective cohort study. Objectives: To study upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using subjects with a spinal cord injury (SCI) and its relation with lesion characteristics, muscle strength and functional outcome. Setting: Eight rehabilitation centers with an SCI unit in the Netherlands. Methods: Using a questionnaire, number, frequency and seriousness of musculoskeletal pain complaints of the upper extremity were measured. A pain score for the wrist, elbow and shoulder joints was calculated by multiplying the seriousness by the frequency of pain complaints. An overall score was obtained by adding the scores of the three joints of both upper extremities. Muscle strength was determined by manual muscle testing. The motor score of the functional independence measure provided a functional outcome. All outcomes were obtained at four test occasions during and 1 year after rehabilitation. Results: Upper extremity pain and shoulder pain decreased over time (30%) during the latter part of in-patient rehabilitation (Po0.001). Subjects with tetraplegia (TP) showed more musculoskeletal pain than subjects with paraplegia (PP) (Po0.001). Upper extremity pain and shoulder pain were significantly inversely related to functional outcome (Po0.001). Muscle strength was significantly inversely related to shoulder pain (Po0.001). Musculoskeletal pain at the beginning of rehabilitation and BMI were strong predictors for pain 1 year after in-patient rehabilitation (Po0.001). Conclusions: Subjects with TP are at a higher risk for upper extremity musculoskeletal pain and for shoulder pain than subjects with PP. Higher muscle strength and higher functional outcome are related to fewer upper extremity complaints.Spinal Cord (2006) 44, 152-159.

ABSTRACT. van Drongelen S, van der Woude LH, Janssen TW, Angenot EL, Chadwick EK, Veeger DH. Mechanical load on the upper extremity during wheelchair activities. Arch Phys Med Rehabil 2005;86:1214-20.Objective: To determine the net moments on the glenohumeral joint and elbow joint during wheelchair activities.Design: Kinematics and external forces were measured during wheelchair activities of daily living (level propulsion, riding on a slope, weight-relief lifting, reaching, negotiating a curb) and processed in an inverse dynamics biomechanic model.Setting: Biomechanics laboratory. Participants: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia.Interventions: Not applicable. Main Outcome Measure: Net moments on the glenohumeral joint and elbow joint.Results: Peak shoulder and elbow moments were significantly higher for negotiating a curb and weight-relief lifting than for reaching, level propulsion, and riding on a slope. Overall, the elbow extension moments were significantly lower for subjects with tetraplegia than for those with paraplegia.Conclusions: The net moments during weight-relief lifting and negotiating a curb were high when compared with wheelchair propulsion tasks. Taking the effect of frequency and duration into account, these loads might imply a considerable risk for joint damage in the long term.Key Words: Activities of daily living; Biomechanics; Elbow; Rehabilitation; Shoulder; Wheelchairs. © 2005 by American Congress of Rehabilitation Medicine and the American Academy of Physical Medicine and RehabilitationI N HANDRIM WHEELCHAIR USERS, the upper extremities are at serious risk of overuse injuries. Wheelchair use requires continuous use of the upper extremities, not only for mobility but also for transfers, weight-relief lifts, and reaching activities. Studies 1,2 have shown that shoulder pain and impingement frequently occur among people with a spinal cord injury (SCI). Pain is experienced during wheelchair-related activities of daily living (ADLs), such as wheelchair propulsion and performing transfers. Because these activities are essential for functional independence, quality of life, and even the life expectancy of people after an SCI, 3 evaluating the mechanical load on the shoulder is important to an understanding of the mechanisms that may cause upper-extremity joint degeneration. Factors that have been mentioned as contributors to the development of shoulder complaints are the relatively high load and high frequency of this load on the shoulder during wheelchair propulsion. 4 In addition, and possibly even more important, the load on the shoulder during other wheelchairrelated tasks, such as transfers and weight-relief lifts, has been mentioned. [5][6][7] In our study, we used net moments around the elbow and the glenohumeral joint (GHJ) to quantify the mechanical load on those joints. Net joint moments are generally used to analyze (working) conditions and to classify these conditions. 8 To show the high loading at the shoulder, studies 9-12 have ...

Due to continuous force application in hand-cycling, shoulder load was lower compared with wheelchair propulsion. Furthermore, muscles that are prone to overuse injuries were less stressed during handcycling. Therefore, handcycling may be a good alternative for outdoor mobility and may help prevent overuse injuries of the shoulder complex.

ABSTRACT. van Drongelen S, van der Woude LH, Janssen TW, Angenot EL, Chadwick EK, Veeger DH. Glenohumeral contact forces and muscle forces evaluated in wheelchair-related activities of daily living in able-bodied subjects versus subjects with paraplegia and tetraplegia. Arch Phys Med Rehabil 2005;86: 1434-40.Objective: To estimate the differences in glenohumeral contact forces and shoulder muscle forces between able-bodied subjects and subjects with paraplegia and tetraplegia during wheelchair-related activities of daily living (ADLs).Design: Kinematics and external forces were measured during wheelchair ADLs (level propulsion, weight-relief lifting, reaching) and processed by using an inverse dynamics 3-dimensional biomechanical model.Setting: Biomechanics laboratory. Participants: Five able-bodied subjects, 8 subjects with paraplegia, and 4 subjects with tetraplegia (Nϭ17).Interventions: Not applicable. Main Outcome Measures: Glenohumeral contact forces and shoulder muscle forces.Results: Peak contact forces were significantly higher for weight-relief lifting compared with reaching and level propulsion (PϽ.001). High relative muscle force of the rotator cuff was seen, apparently needed to stabilize the joint. For weight-relief lifting, total relative muscle force was significantly higher for the tetraplegia group than for the able-bodied group (Pϭ.022).Conclusions: Glenohumeral contact forces were significantly higher for weight-relief lifting and highest over the 3 tasks for the tetraplegia group. Without taking paralysis into account, more muscle force was estimated for the subjects with tetraplegia during weight-relief lifting.

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A total hip replacement (THR) is a common and routine procedure to reduce pain and restore normal activity. Gait analysis can provide insights into functional characteristics and dynamic joint loading situation not identifiable by clinical examination or static radiographic measures. The present prospective longitudinal study tested whether 2 years after surgery a THR would restore dynamic loading of the knee and hip joints in the frontal plane to normal. Instrumented gait analysis was performed shortly before surgery and approximately 2 years after THR on 15 unilateral hip osteoarthritis (OA) patients. 15 asymptomatic matched individuals were recruited as healthy controls. Results showed that abnormal joint loading persisted 2 years after THR. The 2nd external knee adduction moment in terminal stance in the affected (-34%, p = 0.002, d = 1.22) and non-affected limb (-25%, p = 0.035, d = 0.81) was lower compared to controls and thus indicated a shift in the knee joint load distribution from medial to lateral. A correlation analysis revealed that a smaller hip range of motion explained 46% of 2nd knee adduction moment alterations. In contrast, the 2nd external hip adduction moment in terminal stance was postoperatively higher in the affected (+22%, p = 0.007, d = 1.04) and non-affected limb (+22%, p = 0.005, d = 1.05). Here, 51% of 2nd hip adduction moment alterations can be explained with a greater hip adduction angle. Patients with a THR may therefore be at higher risk for abnormal joint loading and thus for the development of OA in other joints of the lower extremities. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

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