Factors associated with thoracic spinal cord injury, lesion level and rotator cuff disorders

Abstract

Background:The study was concerned with the secondary functional compromise persons with long-term paraplegia contend with, that has been shown to be associated with wheelchair use. Of particular interest was the relationship between the level of thoracic spinal cord injury (SCI) and factors predisposing to rotator cu disorders (RCD), one of the most common upper extremity musculoskeletal complications linked with long-term SCI. Disorders of these peri-articular structures have previously been associated with impaired trunk postural control and abnormal muscle strength ratios in both able-bodied groups and in paraplegic athletes. Despite their neurologically intact shoulder joint musculature, high-level and low-level paraplegics have di erent degrees of trunk and pelvic stability available to them during activities of daily living (ADL). This fundamental functional anatomical di erence between high-level and low-level paraplegics had not previously been related to the diagnosis of RCD in a non-athletic long-term paraplegic population. Methods: A descriptive cross sectional study was undertaken to demonstrate the di erences in the prevalence of clinically diagnosed RCD in a high-level (n=22) and a low-level (n=20) group of persons with long-term paraplegia. Any perceived di erences were then related to the functional anatomical variations between the two groups. Inferences were made based on factors predisposing to RCD known to exist among both able-bodied and paraplegic athletes. The 42 subjects completed the Wheelchair User's Shoulder Pain Index (WUSPI) to establish the presence or absence of shoulder pain and the Musculoskeletal Function Assessment (MFA) instrument to determine di erences in functional ability and perceived degree of di culty within ®ve categories of ADL. Each participant underwent a clinical examination using validated provocative clinical tests and isometric muscle strength ratio testing. Results: There was a higher prevalence of RCD in the high-level group (P=0.009) which correlated with decreased trunk control (P=0.009). Di erences in ability to perform functional tasks were not shown to be greater in the high-level group, although there was a higher degree of perceived di culty in ADL. Muscle strength imbalances between the shoulder adductors and abductors were shown to be greater in the high-level group. Conclusions: The results of this study suggest that the functional anatomical di erences that exist within paraplegia contribute to the propensity of high-level paraplegic persons to su er from RCD. These ®ndings send a clear message to service-providers that greater acknowledgement of the di erences in trunk postural control speci®c to the level of thoracic SCI is required. This may have implications for the prescription of wheelchairs, assistive devices and instruction for alternative ADL techniques to this speci®c population.

Evaluation of the influence of different types of seats on postural control in individuals with paraplegia

“…Impairment of postural control has been associated with a greater anterior displacement of the trunk during static balance and scapular protraction during dynamic situations. 5 Koo et al 6 have demonstrated that patients with paraplegia tend to move their pelvis backward and incline their trunk forward, thus adopting a relaxed posture when sitting on foam seat, whereas wheelchair air seat (Roho cushion) seems to help in maintaining a correct posture. However, Aissaoui et al 7 noted that generic contoured foam promoted greater stability during a reaching task than flat foam and Roho cushion.…”

“…Individuals with thoracic SCI, both high (T2-T8) and low spinal cord injury (T9-T12), have difficulty in maintaining their seated position without compensation and misalignment of their skeletal structure, as the muscle group responsible for posture maintenance [2][3][4] and pelvic stability 5 is lost. Impairment of postural control has been associated with a greater anterior displacement of the trunk during static balance and scapular protraction during dynamic situations.…”

Respiratory muscle strength and aerobic performance of wheelchair basketball players

“…Indeed, WCBPs make ample use of the upper limb and trunk muscles both for wheelchair propulsion and for throwing the ball during the matches [23][24][25] . Some of these muscles involved in the stabilization, positioning, and execution of upper limb; trunk movements also act as the accessory muscles facilitating the inspiratory and expiratory processes.…”

“…The findings of the present study are in agreement with those described by Moreno 12 and could also be attributed to the previously described training of the accessory muscles during the WCB practice. Moreover, some of scapular girdle muscles act in upper limb movement and stabilization and serve as accessory muscles in the forced inspiration process [23][24][25]29 . The constant utilization of these muscles during the WCB training may have resulted in adaptations in their functions and morphologies, which culminated in a greater capacity to generate force.…”

Effectiveness of Passive Joint Mobilisation for Shoulder Dysfunction: A Review of the Literature

“…Waring & Maynard (1991) reported 23% of this group of patients still had the same or worse shoulder pain at the 6 months discharge. Regardless of the level of spinal cord injury or the result of functional movement patterns, muscle imbalances around the shoulder joint are thought to contribute to shoulder disorders in wheelchairs users (Sinnott et al, 2000).…”