Shoulder Impingement Testing

113 Pages·2015·2.17 MB·English

Shoulder Evaluation for
Wheelchair Users: An Evidence
Based Approach for Clinicians

Martin J. Kilbane, PT, OCS
31st International Seating Symposium
February 27, 2015
Nashville, TN
Learning Objectives
Upon completion of this lecture participants will be able to:

1. List two pathologies of the glenohumeral joint and scapulo-
thoracic joint common to individuals with spinal cord injury

2. List three available research and current evidenced based
practice sources on examination techniques for the shoulder
complex.

3. List three basic shoulder examination techniques to
appropriately identify structural pathology and assist in
determining appropriate wheelchair selection.
Overall Goal of Presentation
Are we utilizing the best available evidence
for examination of the shoulder complex
when prescribing wheelchairs?

Evidence doesn’t tell us everything, but it certainly tells us a lot!
Why the big fuss?
Incidence in SCI
• According to the Consortium for Spinal Cord Injuries Clinical
Practice Guidelines 2005 (Surveys and Cross Sectional Studies)
it is estimated to be up to 60%.

• Shoulder pain is a problem in up to 86% of
persons with spinal cord injury.
• Eriks-Hoogland IE, Hoekstra T, de Groot S, Stucki G, Post MW, van der Woude
LH. Trajectories of musculoskeletal shoulder pain after spinal cord injury:
Identification and predictors. J Spinal Cord Med. 2014 May;37(3):288-98.

• General Population:
– 30% of people experiencing shoulder pain at some stage of their
lives up to 50% of the population experiencing at least one episode
of shoulder pain annually.
• Lewis JS. Rotator cuff tendinopathy/subacromial impingement syndrome: is it time
for a new method of assessment? Br J Sports Med. 2009 Apr;43(4):259-64.
Why do we need to revolutionize care?
• Only 2% of this population undergoes shoulder
surgery treatment for rotator cuff tear and
shoulder disability
(out of 60% who reported pain).
• Pellegrini A, Pegreffi F, Paladini P, Verdano MA, Ceccarelli F, Porcellini G.
Prevalence of shoulder discomfort in paraplegic subjects. Acta Biomed. 2012
Dec;83(3):177-82.

• Reduction in shoulder pain were related to
significant increases and social participation
and improvements in quality of life in people
with long term paraplegia.
• Kemp BJ, Bateham AL, Mulroy SJ, Thompson L, Adkins RH, Kahan JS.
Effects of reduction in shoulder pain on quality of life and community
activities among people living long-term with SCI paraplegia: a randomized
control trial. J Spinal Cord Med. 2011;34(3):278-84.
Risk Factors in SCI
• Duration of injury
• Older age
• Higher BMI
• Use of manual wheelchair
• Poor seated Posture
• Decreased Flexibility
• Muscle imbalances of the rotator cuff and scapula stabilizers
• With a better understanding of the epidemiology, etiology, and
basic patho-mechanics of shoulder pain in SCI, clinicians are in
a better position to evaluate, treat, and prevent these
disorders.

Dyson-Hudson TA, Kirshblum SC. Shoulder pain in chronic spinal cord injury,
Part I: Epidemiology, etiology, and pathomechanics. J Spinal Cord Med.
2004;27(1):4-17.
SCIRE Project summary
www.scireproject.com
• The shoulder is the most common joint above the level of injury where pain complaints
are reported with persons with paralysis (tetraplegia or paraplegia) (Apple 2001).
• The shoulder is not well designed to handle the higher
intra-articular pressures required for both weight
bearing and mobility (Apple 2001).
• Partial innervation and impaired balance of shoulder, scapular and thoracolumbar
muscles place individuals with tetraplegia at a higher risk for developing shoulder pain
especially during weight-bearing upper limb activities such as wheelchair propulsion,
transfers, and pressure reliefs.
• Due to differences in trunk postural control, differences may also occur between
individuals with high paraplegia (T2-T7) and low paraplegia (T8-T12).
• Individuals with C1-C4 motor levels of injury are also at risk for shoulder pain
• SCI severity also may be associated with shoulder pain (Dyson-Hudson & Kirshblum
2004).
• Lack of use of immobilization of the shoulder girdle muscles can limit their active
joint movement and lead to muscle shortening and shoulder capsule tightness.
SCIRE Project summary
www.scireproject.com
• The development of pain is associated with decreased shoulder ROM
• Weakness and paralysis in these muscles can lead to increased reliance on the
trapezius, which can result in overuse and pain in this muscle.
• Shoulder pain can occur from nerve root injury or radicular pain with
dysesthesias or phantom sensations
• People of certain age groups, those with higher cervical lesions and those with
shorter lengths of bed rest may be at a greater risk
• Gender may be associated with shoulder pain in individuals with SCI (Pentland &
Twomey 1991).
• Body mass index (BMI) also may play a role in shoulder injuries in manual
wheelchair using individuals with SCI because it directly relates to the amount
of physical strain experienced during ADLs in these individuals (Bonninger et al.
2001; Jensen et al. 1996).
• Shoulder pain is more common in individuals with tetraplegia and complete
injuries and in women and duration of injury, older age, and higher BMI all may
be risk factors for developing shoulder pain and/or abnormalities in persons with
SCI (Dyson-Hudson & Kirshblum 2004).
Clinicians

vs.
Technicians