Original article
Effect of Shoulder Pain on Shoulder Kinematics During Weight-Bearing Tasks in Persons With Spinal Cord Injury

https://doi.org/10.1016/j.apmr.2012.02.034Get rights and content

Abstract

Nawoczenski DA, Riek LM, Greco L, Staiti K, Ludewig PM. Effect of shoulder pain on shoulder kinematics during weight-bearing tasks in persons with spinal cord injury.

Objective

To assess 3-dimensional scapulothoracic and glenohumeral kinematics between subjects with spinal cord injury and disease (SCI/D) with and without shoulder pain during a weight-relief raise and transfer task.

Design

Case-control, repeated-measures analysis of variance.

Setting

Movement analysis laboratory.

Participants

Subjects (N=43; 23 with clinical signs of impingement and 20 without) between 21 and 65 years of age, at least 1 year after SCI/D (range, 1–43y) resulting in American Spinal Injury Association Impairment Scale T2 motor neurologic level or below, and requiring the full-time use of a manual wheelchair.

Interventions

Weight-relief raises and transfer tasks.

Main Outcome Measures

An electromagnetic tracking system acquired 3-dimensional position and orientation of the thorax, scapula, and humerus. Dependent variables included angular values for scapular upward and downward rotation, posterior and anterior tilt, and internal and external rotation relative to the thorax, and glenohumeral internal and external rotation relative to the scapula. The mean of 3 trials was collected, and angular values were compared at 3 distinct phases of the weight-relief raise and transfer activity. Comparisons were also made between transfer direction (lead vs trail arm) and across groups.

Results

Key findings include significantly increased scapular upward rotation for the pain group during transfer (P=.03). Significant group differences were found for the trailing arm at the lift pivot (phase 2) of the transfer, with the pain group having greater anterior tilt (mean difference ± SE, 5.7°±2.8°). The direction of transfer also influenced kinematics at the different phases of the activity.

Conclusions

Potentially detrimental magnitude and direction of scapular and glenohumeral kinematics during weight-bearing tasks may pose increased risk for shoulder pain or injury in persons with SCI/D. Consideration should be given to rehabilitation strategies that promote favorable scapular kinematics and glenohumeral external rotation.

Section snippets

Participants

Subjects with (n=23) and without (n=20) shoulder pain were recruited through local clinics and SCI/D support groups, resulting in a sample of convenience (table 1). Sample size was based on a power analysis to detect angular differences of 5° or more with 80% power and moderate effect size (0.6).23, 31 All subjects signed institutional-approved informed consent documents.

Inclusion criteria were as follows: 21 to 65 years of age; at least 1 year after SCI/D (complete or incomplete paraplegia, or

Results

Significant differences were found between no-pain and pain groups for the WUSPI score (P<.0003), age (P=.006), and years since injury (P=.018) and are reported in table 1. Significant covariates used in the analysis are presented in table 2.

Discussion

The primary study objective was to assess whether shoulder kinematics differed between individuals with SCI/D with and without shoulder pain. Groups were identified through clinical examination, and the WUSPI scores verified their distinction (2.5±3.7 no-pain group, 43.8±26.9 pain group; P<.0003). In addition to the differences in WUSPI scores, the pain group was older and had been injured for a longer duration than the no-pain group. Of the scapular and glenohumeral kinematics variables

Conclusions

Key findings showed greater scapular upward rotation for the pain group during transfers. Whether indicating a compensatory mechanism to avoid pain, or rotator cuff pathology is not known. The pain group also demonstrated increased scapular anterior tilt during the lift-pivot phase of the transfer in the trailing arm. Potentially detrimental scapular and glenohumeral kinematics (magnitude and direction) found in both groups during the lift and hold phases of the transfer and weight-relief raise

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  • Cited by (0)

    Supported by the National Institutes of Health (grant no. R15HD41379-01) and the Spinal Cord Research Foundation (grant no. 2251-01).

    No commercial party having a direct financial interest in the results of the research supporting this article has or will confer a benefit on the authors or on any organization with which the authors are associated.

    In-press corrected proof published online on Jun 15, 2012, at www.archives-pmr.org.

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