Shoulder magnetic resonance imaging findings in manual wheelchair users with spinal cord injury

Abstract

Objective: To investigate the prevalence of rotator cuff and long head of the biceps pathologies in manual wheelchair (MWC) users with spinal cord injury (SCI). Design: Cross-sectional study. Setting: Outpatient clinic at a tertiary medical center. Participants: Forty-four adult MWC users with SCI (36 men and 8 women) with an average age (SD) of 42 (13) years. SCI levels ranged from C6 to L1; complete and incomplete SCI. Outcome Measures: Participants’ demographic and anthropometric information, presence of shoulder pain, Wheelchair User’s Pain Index (WUSPI) scores, and magnetic resonance imaging findings of shoulder pathologies including tendinopathy, tendon tears, and muscle atrophy. Results: Fifty-nine percent of the participants reported some shoulder pain. The prevalence of any tendinopathy across the rotator cuff and the long head of biceps tendon was 98%. The prevalence of tendinopathy in the supraspinatus was 86%, infraspinatus was 91%, subscapularis was 75%, and biceps was 57%. The majority of tendinopathies had mild or moderate severity. The prevalence of any tears was 68% . The prevalence of tendon tears in the supraspinatus was 48%, infraspinatus was 36%, subscapularis was 43%, and biceps was 12%. The majority of the tears were partial-thickness tears. Participants without tendon tears were significantly younger (P < 0.001) and had been wheelchair user for a significantly shorter time (P = 0.005) than those with tendon tears. Conclusion: Mild and moderate shoulder tendinopathy and partial-thickness tendon tears were highly prevalent in MWC users with SCI. Additionally, the findings of this study suggest that strategies for monitoring shoulder pathologies in this population should not be overly reliant on patient-reported pain, but perhaps more concerned with years of wheelchair use and age.

Application and Reliability of Accelerometer-Based Arm Use Intensities in the Free-Living Environment for Manual Wheelchair Users and Able-Bodied Individuals

“…Video data were collected at 60 Hz using a handheld digital camera throughout the entire data collection. Participants were asked to complete six MWCbased activities: (1) counter height reaching (36 inches above the ground), (2) overhead reaching (54 inches above the ground), (3) 6.8 kg cross-body lifting of a backpack from the floor on the side of his/her wheelchair to a plinth on the other side, (4) level transfers between the MWC and plinth, (5) level MWC propulsion (on rollers), and (6) 5 • incline MWC propulsion (on rollers with a wooden board under the casters to create an incline). During the reaching activities, each participant retrieved and returned an aluminum (soup) can (0.45 kg) from a table (counter height) or shelf (overhead).…”

“…The majority of individuals with spinal cord injury (SCI) are non-ambulatory and require a wheelchair for their daily mobility [ 1 ]. Individuals with SCI who use a manual wheelchair (MWC users) have a high prevalence of musculoskeletal pain and injury [ 2 , 3 , 4 ] and the shoulder is the most common site of this pain and pathology [ 5 , 6 ]. Further, greater than 15% of individuals with acquired SCI reported shoulder pain as “unbearable” [ 3 ] and chronic MWC users are reported to have a four times higher prevalence of rotator cuff tears compared to age-matched able-bodied individuals [ 2 ].…”

Inertial Measurement Unit–Derived Ergonomic Metrics for Assessing Arm Use in Manual Wheelchair Users With Spinal Cord Injury: A Preliminary Report

“…Further details of the protocol can be found elsewhere. 19 The images were assessed by a board-certified, fellowship-trained, musculoskeletal radiologist with 13 years of experience (N.S.M.). 19 The radiologist was blinded to the study cohorts but not to the prior MRI examinations of each participant in order to access for subtle changes over time as is done in routine clinical care.…”

“…19 The images were assessed by a board-certified, fellowship-trained, musculoskeletal radiologist with 13 years of experience (N.S.M.). 19 The radiologist was blinded to the study cohorts but not to the prior MRI examinations of each participant in order to access for subtle changes over time as is done in routine clinical care. Tendinopathies were rated as mild, mild-moderate, moderate, moderate-severe, and severe, and tendinopathy scores of 1 to 5 were assigned respectively.…”

“…Measurement of these loads in the free-living environment for an all-day data collection remains a technological challenge and will require advances in technologies such as force sensing gloves, novel algorithms that utilize IMU data to estimate shoulder loads, or novel approaches to identify tasks with known loading profiles. 12,20 Accelerated pathology progression seen among MWC users is also driven by arm use at lower arm elevation levels due to physically demanding tasks such as propulsion and transfers 4,19,[21][22][23] ; however, a continued investigation of higher humeral elevation is warranted due to the nature of interacting with the environment from a mostly seated position. 24 Modifying arm use of MWC users to levels of able-bodied individuals is not feasible due to inherent differences in the way that daily tasks are accomplished.…”