The weight-bearing shoulder. The impingement syndrome in paraplegics.

Bayley, James C.; Cochran, Thomas; Sledge, Clement B.

doi:10.2106/00004623-198769050-00006

Cited by 333 publications

(191 citation statements)

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“…Other degenerative changes reported in the literature, spur formation in 39% (Figure 4), osteonecrosis ( Figure 3) 34% (Barber et al 1996) 6 and impingement ( Figure 4) 29% (Bayley et al 1987), 3 were also documented in the shoulder X-rays of subjects of this study. The radiological changes appeared to occur at an early stage than reported in the literature 4 ± 5 years versus 10 years or longer.…”

Section: Discussionsupporting

confidence: 72%

“…Literature review revealed some 22 retrospective reports with radiological changes in symptomatic patients with upper extremity pain. 3,5,6 But others reported radiological changes in inactive rather than active individuals, 7 rejecting the overuse theory proposed by Wing et al 8 All published reports indicate the need for further research.…”

Section: Introductionmentioning

confidence: 99%

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Premature degenerative shoulder changes in spinal cord injury patients

Lal

1998

Spinal Cord

117

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Shoulder pain and the resultant dysfunction is an expected problem in individuals with spinal cord injury. But there is a remarkable lack of information about the natural history, diagnosis, prevention and long term outcomes. Degenerative changes may develop prematurely in their shoulders, due to overuse and altered mechanical stresses, with or without symptoms was the hypothesis of this prospective study. Information from this study is expected to assist in identi®cation of high risk SCI individuals, and ultimately in development of preventive strategies.The shoulders of 53 spinal cord injury patients from the onset of injury until 15 years duration were subjected to clinical and radiological examination at the Rehabilitation Institute of Chicago. Thirty-eight out of 53 (72%) patients demonstrated radiological evidence of degenerative changes, but only six (11%) complained of pain in the shoulders.This study demonstrated a correlation between individuals with higher level of wheelchair activity (72%), higher age (92% above and 8% less than 30 years) and female gender (89% females versus 65% males) more prone to develop degenerative changes in the shoulders. Acromioclavicular joint was predominantly a ected.Detailed radiological ®ndings, etiopathological factors and long term recommendations are discussed. The need for further studies and consistent management strategies are stressed.

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Section: Discussionsupporting

confidence: 72%

Section: Introductionmentioning

confidence: 99%

Premature degenerative shoulder changes in spinal cord injury patients

Lal

1998

Spinal Cord

117

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“…Bayley et al found rotator cu tears in 65% of individuals with paraplegia and shoulder pain. 5 Wylie found radiographic shoulder abnormalities in 32% of the MWUs 20 years post injury. 6 While the shoulder is the most commonly sited area of pain a high prevalence of elbow pain is also seen.…”

Section: Introductionmentioning

confidence: 98%

Shoulder and elbow motion during two speeds of wheelchair propulsion: a description using a local coordinate system

et al. 1998

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Individuals who propel wheelchairs have a high prevalence of upper extremity injuries. To better understand the mechanism behind these injuries this study investigates the motion of the shoulder and elbow during wheelchair propulsion. The objectives of this study are: (1) To describe the motion occurring at the shoulder and elbow in anatomical terms during wheelchair propulsion; (2) to obtain variables that characterize shoulder and elbow motion and are statistically stable; (3) to determine how these variables change with speed. The participants in the study were a convenience sample of Paralympic athletes who use manual wheelchairs for mobility and have unimpaired arm function. Each subject propelled an ultralight wheelchair on a dynamometer at 1.3 and 2.2 meters per second (m/s). Biomechanical data was obtained using a force and moment sensing pushrim and a motion analysis system. The main outcome measures investigated were: maximum and minimum angles while in contact with the pushrim, range of motion during the entire stroke and peak accelerations. All of the measures were found to be stable at both speeds (Cronbach's alpha 40.8). The following measures were found to di er with speed (data format: measure at 1.3 m/s+SD; measure at 2.2 m/s+SD): minimum shoulder abduction angle during propulsion (24.58+6.7, 21.68+7.2), range of motion during the entire stroke in elbow¯exion/extension (54.08+9.9, 58.18+10.4) and shoulder sagittal¯exion/extension (74.88+9.4, 82.68+8.5), and peak acceleration in shoulder sagittal¯exion/extension (40448/s 2 +946, 71468/s 2 +1705), abduction/adduction (26788/s 2 +767, 49288/s 2 +1311), and elbow¯exion/extension (93558/s 2 +4120, 128898/s 2 +5572). This study described the motion occurring at the shoulder and elbow using a local coordinate system. Stable parameters that characterize the propulsive stroke and di ered with speed were found. In the future these same parameters may provide insight into the cause and prevention of shoulder and elbow injuries in manual wheelchair.

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“…Wheelchair users rely largely on the upper extremities for mobility and transfers1,3,4 which eventually results in degenerative structural or physiological joint changes. 5 Researchers have reported that wheelchair users demonstrate chronic degenerative injuries to soft tissues, including impingement syndromes, rotator cuff tears, sprains, strains and avascular necrosis, as well as evidence of radiological degenerative changes in the shoulder joint. [5][6][7][8][9] The independence of wheelchair users depends on the integrity of their upper limbs.2,4 Several studies have shown that shoulder pain is a limiting factor in the daily activities of individuals with paraplegia, especially during transfers, wheelchair propulsion, reaching, lift ing, driving and loading the wheelchair into the caL2, 4,5 Many indices are available to measure generalized pain or functional impairment in individuals with chronic disabilities.…”

Section: Introductionmentioning

confidence: 99%

Development of the Wheelchair User's Shoulder Pain Index (WUSPI)

et al. 1995

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Chronic shoulder pain is a frequently reported phenomenon in individuals who use wheelchairs as their primary means of mobility. No indices are currently available which detect difficulties in performing daily activities due to shoulder discomfort in a largely independent population of wheelchair users. The Wheelchair User's Shoulder Pain Index (WUSPI) was designed to measure shoulder pain in individuals who use wheelchairs. A pilot index was created to measure shoulder pain and related difficulty during basic and instrumental activities of daily living. The instrument was administered to 64 wheelchair users at an athletic event. Analyses of internal consistency and interitem correlations were used to revise and refine the original instrument. Individual item analysis revealed that th.e subjects in this study experienced the most shoulder pain when wheeling up an inclir.c or on outdoor surfaces, when lifting an object from an overhead shelf, when trying to sleep, when transferring from tub to wheelchair and when washing their backs. The final 15-item index shows high internal consistency. This instrument is useful for both clinical and research purposes to detect and monitor shoulder pain and accompanying loss of function by wheelchair users.

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The weight-bearing shoulder. The impingement syndrome in paraplegics.

Cited by 333 publications

References 0 publications

Premature degenerative shoulder changes in spinal cord injury patients

Premature degenerative shoulder changes in spinal cord injury patients

Shoulder and elbow motion during two speeds of wheelchair propulsion: a description using a local coordinate system

Development of the Wheelchair User's Shoulder Pain Index (WUSPI)

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