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Cordes CMA, Leonardis JM, Samet J, Schnorenberg AJ, England M, Mukherjee S, Vogel LC, Seitz AL, Slavens BA. Handrim kinetics and quantitative ultrasound parameters for assessment of subacromial impingement in wheelchair users with pediatric-onset spinal cord injury. Gait Posture 2024; 113:561-569. [PMID: 39182433 DOI: 10.1016/j.gaitpost.2024.08.075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 08/27/2024]
Abstract
BACKGROUND Most manual wheelchair users with pediatric-onset spinal cord injury (SCI) will experience shoulder pain or pathology at some point in their life. However, guidelines for preservation of the upper limb in children with SCI are limited. RESEARCH QUESTION What are the relationships between manual wheelchair handrim kinetics and quantitative ultrasound parameters related to subacromial impingement in individuals with pediatric-onset SCI? METHODS Subacromial impingement risk factors including supraspinatus tendon thickness (SST), acromiohumeral distance (AHD), and occupation ratio (OR; SST/AHD) were measured with ultrasound in 11 manual wheelchair users with pediatric-onset SCI. Handrim kinetics were acquired during the stroke cycle, including peak resultant force (FR), peak rate of rise of resultant force (ROR) and fractional effective force (FEF). Variability of handrim kinetics was computed using the coefficient of variation and linear regression was performed to assess correlations between handrim metrics and quantitative ultrasound parameters. RESULTS Peak resultant force significantly increased 1.4 % and variability of FEF significantly decreased 8.0 % for every 0.1 cm increase in AHD. FEF decreased 3.5 % for every 0.1 cm increase in SST. Variability of peak resultant force significantly increased 3.6 % and variability of peak ROR of resultant force significantly increased 7.3 % for every 0.1 cm increase in SST. FEF variability significantly decreased 11.6 % for every 0.1 cm increase in SST. Peak ROR significantly decreased 1.54 % with every 10 % increase in OR. FEF variability significantly decreased 1.5 % with every 10 % increase in OR. SIGNIFICANCE This is the first study to investigate relationships among handrim kinetics and shoulder structure in manual wheelchair users with pediatric-onset SCI. Associations were identified between subacromial impingement risk factors and magnitude and variability of wheelchair handrim kinetics. These results indicate the critical need to further explore the relationships among wheelchair handrim kinetics, shoulder joint dynamics, and shoulder pathology in manual wheelchair users with pediatric-onset SCI.
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Affiliation(s)
- Caleb M A Cordes
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA.
| | - Joshua M Leonardis
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Illinois Urbana-Champaign, College of Applied Health Sciences, Urbana, IL 61801, USA; University of Illinois Urbana-Champaign, Beckman Institute for Advanced Science and Technology, Urbana, IL 61801, USA
| | - Jonathan Samet
- Ann and Robert H. Lurie Children's Hospital, Department of Medical Imaging, Chicago, IL 60611, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Alyssa J Schnorenberg
- University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
| | - Mark England
- Medical College of Wisconsin, Milwaukee, WI 53226, USA
| | - Shubhra Mukherjee
- Shriners Children's Chicago, Chicago, IL 60707, USA; Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | | | - Amee L Seitz
- Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
| | - Brooke A Slavens
- University of Wisconsin-Milwaukee, Department of Rehabilitation Sciences and Technology, Milwaukee, WI 53211, USA; University of Wisconsin-Milwaukee, Department of Mechanical Engineering, Milwaukee, WI 53211, USA
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Preville-Gendreau A, Naraghi A, Dilkas S, Coros K, Moktassi A, Griffin A, White LM. Spectrum and patterns of shoulder pathology on MRI in symptomatic elite wheelchair basketball athletes. Skeletal Radiol 2024; 53:1359-1368. [PMID: 38267761 DOI: 10.1007/s00256-024-04593-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/13/2024] [Accepted: 01/14/2024] [Indexed: 01/26/2024]
Abstract
BACKGROUND Wheelchair basketball (WCB) is a popular para-sport adapted for athletes with physical disabilities. Shoulder injuries are commonly reported among WCB athletes. However, the understanding of the specific patterns and characteristics of shoulder injuries in WCB players is currently limited, and there is a lack of comprehensive literature available on this subject. OBJECTIVES To investigate the spectrum of pathologies observed in elite wheelchair basketball (WCB) athletes referred for MRI evaluation of symptomatic injuries of the shoulder. METHODS Retrospective review of consecutive elite WCB athletes referred for MRI evaluation of symptomatic shoulder injury. Demographic, clinical, and functional data including international wheelchair basketball federation (IWBF) classification of each athlete were collected. A total of 28 MRI studies were reviewed. Excluding MRI examinations of the same shoulder, 18 study cases were assessed for pathology of the rotator cuff (RC), labrum, long-head of biceps tendon, glenohumeral and acromioclavicular joints, and osseous lesions of the humerus or glenoid. Correlations between clinical-demographic features and MRI findings were statistically evaluated. RESULTS Supraspinatus tears were observed in 72.2%, infraspinatus tears in 50%, and subscapularis tears in 38.9% shoulders. Articular-sided partial tears frequently involved posterior supraspinatus (88.9%) and anterior infraspinatus (100%). Labral tears were seen in 38.9%, with involvement of the posterosuperior labrum in all tears. Hill-Sachs and osseous Bankart lesions (5.6%), and anterior-inferior labral tears (11.1%), were uncommon findings. Statistically significant correlations were observed of low IWBF point class and non-ambulatory athletes with subscapularis tendinosis (p = 0.015, p = 0.001) and tearing (p = 0.050, p = 0.013), and athletes with limited trunk control with subscapularis tendinosis (p = 0.013). CONCLUSIONS RC tears are common in elite WCB athletes with pattern of RC and labral tearing suggesting internal (superior-posterior) impingement as a contributory pathoetiologic mechanism. Non-ambulatory, low IWBF point class athletes, as well as those with limited trunk control have a statistically significant increase in subscapularis tendon pathology on MRI.
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Affiliation(s)
- Anne Preville-Gendreau
- Joint Department of Medical Imaging, Sinai Health System, Toronto, ON, Canada
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Ali Naraghi
- Joint Department of Medical Imaging, Sinai Health System, Toronto, ON, Canada
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Steven Dilkas
- West Park Healthcare Centre, Toronto, ON, Canada
- Canadian Sports Institute Ontario (CSIO), Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Kimberly Coros
- Canadian Sports Institute Ontario (CSIO), Toronto, ON, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Physical Medicine and Rehabilitation, Hennick/Bridgepoint, Sinai Health System, Toronto, ON, Canada
| | - Aiden Moktassi
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- William Osler Health System, Etobicoke General Hospital, Toronto, ON, Canada
| | - Anthony Griffin
- Orthopedic Surgery, Mount Sinai Hospital, Sinai Health, Toronto, ON, Canada
| | - Lawrence M White
- Joint Department of Medical Imaging, Sinai Health System, Toronto, ON, Canada.
- Department of Medical Imaging, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada.
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Levy O, Arealis G, Tsvieli O, Consigliere P, Lubovsky O. Reverse total shoulder replacement for patients with "weight-bearing" shoulders. Clin Shoulder Elb 2024; 27:183-195. [PMID: 38556915 PMCID: PMC11181069 DOI: 10.5397/cise.2023.00535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2023] [Revised: 11/20/2023] [Accepted: 11/23/2023] [Indexed: 04/02/2024] Open
Abstract
BACKGROUND Reverse total shoulder arthroplasty (rTSA) has gained popularity in recent years and is indicated for a wide variety of shoulder pathologies. However, use of rTSA in patients with "weight-bearing" shoulders that support wheelchair use or crutches has higher risk. The aim of this study was to assess the results of rTSA in such patients. METHODS Between 2005 and 2014, 24 patients (30 shoulders) with weight-bearing shoulders were treated with rTSA at our unit. Patients had cuff arthropathy (n=21), rheumatoid arthritis (n=3), osteoarthritis (n=1), acute fracture (n=3), or fracture sequela (n=2). Postoperatively, patients were advised not to push themselves up and out of their wheelchair for 6 weeks. This study was performed in 2016, and 21 patients (27 shoulders) were available for a mean follow-up of 5.6 years (range, 2-10 years). The mean age at surgery was 78 years (range, 54-90 years). RESULTS Constant-Murley score improved from 9.4 preoperatively to 59.8 at the final follow-up (P=0.001). Pain score improved from 2/15 to 13.8/15 (P=0.001). Patient satisfaction (Subjective Shoulder Value) improved from 0.6/10 to 8.7/10 (P=0.001). Significant improvement in mean range of motion from 46° to 130° of elevation, 14° to 35° of external rotation, and 29° to 78° internal rotation was recorded (P=0.001). Final mean Activities of Daily Living External and Internal Rotation was 32.4/36. Only three patients showed Sirveaux-Nerot grade-1 (10%) glenoid notching and three grade 2 (10%). CONCLUSIONS rTSA can be used for treatment of patients with weight-bearing shoulders. Such patients reported pain free movement, resumed daily activities, and high satisfaction rates. Level of evidence: IV.
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Affiliation(s)
- Ofer Levy
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Orthopedics, Barzilai Medical Center, Ashkelon, Israel
| | - Georgios Arealis
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
- East Kent Hospitals University NHS Foundation Trust, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| | - Oren Tsvieli
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
| | - Paolo Consigliere
- The Reading Shoulder Unit, Berkshire Independent Hospital, Reading, UK
- East Kent Hospitals University NHS Foundation Trust, Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, UK
| | - Omri Lubovsky
- Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel
- Department of Orthopedics, Barzilai Medical Center, Ashkelon, Israel
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Jones C, Schnorenberg AJ, Garlanger K, Leonardis JM, Kortes S, Riebe J, Plesnik J, Lee K, Slavens BA. Biomechanical analysis of wheelchair athletes with paraplegia during cross-training exercises. J Spinal Cord Med 2022; 45:882-897. [PMID: 34100694 PMCID: PMC9662041 DOI: 10.1080/10790268.2021.1928868] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
CONTEXT Extreme conditioning programs (ECPs), such as CrossFit®, are a relatively new method of fitness with rapid growth in individuals with paraplegia. However, it is unknown if wheelchair users are at an additional risk of musculoskeletal injury during these exercises. Biomechanical characterization is necessary to determine the safety and efficacy of ECPs as an exercise modality for wheelchair users with paraplegia. OBJECTIVE To characterize the three-dimensional (3-D) thorax and upper extremity joint kinematics of paraplegic wheelchair athletes during exercises commonly prescribed as part of ECPs. DESIGN Observational study. PARTICIPANTS Three male wheelchair athletes, average age of 37.1 ± 4.6 years, with spinal cord injury levels of T8, L2, and T10, with varying exercise experience. METHODS 3-D movement was acquired using motion capture during the performance of four exercises: battle ropes, sled pull, overhead press, and sledgehammer swing. A custom upper extremity inverse kinematics model was applied to compute 3-D joint angles. OUTCOME MEASURES 3-D peak thorax, glenohumeral, elbow, and wrist joint angles and ranges of motion (ROM), Visual Analog Scale (VAS), and Borg Scale of Perceived Exertion. RESULTS Large joint motions were required for the exercises, at times demanding extreme shoulder and/or wrist flexion and extension, abduction, and external rotation, which are concerning for injury risk in wheelchair users. Participants, however, were able to perform the exercises pain free. CONCLUSION These quantitative findings highlight that wheelchair athletes may be exposed to potentially injurious positions during common ECP exercises. These findings provide insight that may lead to improved clinical guidelines for prescription and training of exercise regimens, particularly involving ECPs, for wheelchair users.
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Affiliation(s)
- Carrie Jones
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Alyssa J. Schnorenberg
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA,Correspondence to: Alyssa J. Schnorenberg, University of Wisconsin Milwaukee, Innovation Campus – Accelerator Building, Mobility Lab, Suite 131, 1225, Discovery Parkway, Wauwatosa, WI, USA; Ph: (414) 251-7746.
| | - Kristin Garlanger
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Joshua M. Leonardis
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Sam Kortes
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Justin Riebe
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
| | - Justin Plesnik
- Body by Design, Brookfield, USA,Aqua-Endurance, Milwaukee, Wisconsin, USA
| | - Kenneth Lee
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Brooke A. Slavens
- Department of Rehabilitation Sciences & Technology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin, USA
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Rouvier T, Louessard A, Simonetti E, Hybois S, Bascou J, Pontonnier C, Pillet H, Sauret C. Manual wheelchair biomechanics while overcoming various environmental barriers: A systematic review. PLoS One 2022; 17:e0269657. [PMID: 35737733 PMCID: PMC9223621 DOI: 10.1371/journal.pone.0269657] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 05/26/2022] [Indexed: 11/18/2022] Open
Abstract
During manual wheelchair (MWC) locomotion, the user's upper limbs are subject to heavy stresses and fatigue because the upper body is permanently engaged to propel the MWC. These stresses and fatigue vary according to the environmental barriers encountered outdoors along a given path. This study aimed at conducting a systematic review of the literature assessing the biomechanics of MWC users crossing various situations, which represent physical environmental barriers. Through a systematic search on PubMed, 34 articles were selected and classified according to the investigated environmental barriers: slope; cross-slope; curb; and ground type. For each barrier, biomechanical parameters were divided into four categories: spatiotemporal parameters; kinematics; kinetics; and muscle activity. All results from the different studies were gathered, including numerical data, and assessed with respect to the methodology used in each study. This review sheds light on the fact that certain situations (cross-slopes and curbs) or parameters (kinematics) have scarcely been studied, and that a wider set of situations should be studied. Five recommendations were made at the end of this review process to standardize the procedure when reporting materials, methods, and results for the study of biomechanics of any environmental barrier encountered in MWC locomotion: (i) effectively reporting barriers' lengths, grades, or heights; (ii) striving for standardization or a report of the approach conditions of the barrier, such as velocity, especially on curbs; (iii) reporting the configuration of the used MWC, and if it was fitted to the subject's morphology; (iv) reporting rotation sequences for the expression of moments and kinematics, and when used, the definition of the musculoskeletal model; lastly (v) when possible, reporting measurement uncertainties and model reconstruction errors.
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Affiliation(s)
- Théo Rouvier
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Aude Louessard
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Emeline Simonetti
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Samuel Hybois
- Complexité Innovation Activités Motrices et Sportives, Faculté des Sciences du Sport, Université Paris-Saclay, Orsay, France
| | - Joseph Bascou
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Charles Pontonnier
- Université de Rennes, Centre National de la Recherche Scientifique, Institut National de Recherche en Informatique et en Automatique, Institut de Recherche en Informatique et Systèmes Aléatoires–Unité Mixte de Recherche 6074, Rennes, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
| | - Christophe Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers Institute of Technology, Paris, France
- Centre d’Études et de Recherche sur l’Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
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Sá K, Costa e Silva A, Gorla J, Silva A, Magno e Silva M. Injuries in Wheelchair Basketball Players: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5869. [PMID: 35627406 PMCID: PMC9141608 DOI: 10.3390/ijerph19105869] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Revised: 05/06/2022] [Accepted: 05/07/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Sports injuries have physical and psychological effects that negatively affect sports performance. Although there are data available on sports injuries in wheelchair basketball, some aspects need to be clarified, such as the location, mechanisms and risk factors for injury, which are not well described due to variations and/or a lack of definition of injury. The aim of this study was to determine epidemiological information, primary injury characteristics and affected body regions in wheelchair basketball players; Methods: The PubMed, Science Direct, Scopus, Web of Science and Google Scholar databases were used; Results: eight articles were included in this review. The shoulder was the body region most affected (N = 60; 22.1%). When divided by body segments, the upper limbs were the most affected (N = 128; 47.2%), followed by the head and/or face (N = 53; 19.5%), trunk (included spine and ribs) (N = 48; 17.8%) and lower limbs (N = 42; 15.5%); Conclusions: wheelchair basketball players suffer a large number of injuries with different characteristics that are mainly linked to biomechanics and sport. These results can be used to guide coaches in structuring training to minimize recurring injuries, in addition to assisting in the organization of medical teams in competitions.
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Affiliation(s)
- Karina Sá
- Faculty of Physical Education, State University of Campinas, Campinas 13083-851, Brazil;
| | - Anselmo Costa e Silva
- Graduate Program in Human Movement Sciences, Federal University of Pará, Belém 66075-110, Brazil;
| | - José Gorla
- Faculty of Physical Education, State University of Campinas, Campinas 13083-851, Brazil;
| | - Andressa Silva
- School Physical Education, Physical Therapy and Occupational Therapy, Federal University of Minas Gerais, Belo Horizonte 31270-901, Brazil;
| | - Marília Magno e Silva
- Faculty of Physical Therapy and Occupational Therapy, Federal University of Pará, Belém 66075-110, Brazil;
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Arnet U, Boninger ML, Cools A, Bossuyt FM. Effect of Fatiguing Wheelchair Propulsion and Weight Relief Lifts on Subacromial Space in Wheelchair Users. FRONTIERS IN REHABILITATION SCIENCES 2022; 3:849629. [PMID: 36189050 PMCID: PMC9397688 DOI: 10.3389/fresc.2022.849629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/24/2022] [Indexed: 11/13/2022]
Abstract
ObjectiveThis study aimed to identify targets of intervention for reducing shoulder pain in wheelchair users with spinal cord injury (SCI) by (1) examining changes in subacromial space [acromiohumeral distance (AHD) and occupation ratio (OccRatio)] with fatiguing wheelchair propulsion, and different loading conditions [unloaded position vs. weight relief lifts (WRL)]; (2) associating these changes with wheelchair user capacity, as well as (3) identifying subject characteristics associated with subacromial space, such as sex, lesion level, time since injury, body mass index and impaired shoulder range of motion.MethodsFifty manual wheelchair users with SCI [11 females, age = 50.5 (9.7) years, time since injury = 26.2 (11.4) years] participated in this quasi-experimental one-group pretest-posttest study. Ultrasound images were used to define AHD during an unloaded position, and during personal and instructed WRL before and after fatiguing wheelchair propulsion. Furthermore, supraspinatus and biceps thickness defined from ultrasound images were used to calculate OccRatios. Wheelchair user capacity was quantified as functional strength (maximum resultant force reached during maximum isometric forward push) and anaerobic work capacity (highest power output reached during 15-m sprint test). Multilevel mixed-effects linear regression analyses controlling for between subject variability and covariables were performed to address the research questions.ResultsAHD was significantly smaller during personal WRL (p < 0.001) and instructed WRL (p = 0.009, AHD both 11.5 mm) compared to the unloaded position (11.9 mm). A higher wheelchair user capacity (higher anaerobic work capacity) reduced the impact of WRL on AHD decrease. The fatiguing wheelchair propulsion had no effect on AHD (p = 0.570) and on OccRatio of supraspinatus (p = 0.404) and biceps (p = 0.448). Subject characteristics related to a larger subacromial space were lower lesion level, shorter time since injury, impaired external rotation, a lower body mass index and a higher anaerobic work capacity.ConclusionThis study showed a significant reduction in AHD during WRL with no effect of fatiguing wheelchair propulsion on the subacromial space in wheelchair users with SCI. A higher anaerobic work capacity was beneficial in stabilizing the shoulder during WRL. Our findings may assist clinicians in designing a shoulder injury prevention program.
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Affiliation(s)
- Ursina Arnet
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- *Correspondence: Ursina Arnet
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ann Cools
- Department of Rehabilitation Sciences and Physiotherapy, University of Ghent, Ghent, Belgium
| | - Fransiska M. Bossuyt
- Shoulder Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
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Warner MB, Mason BS, Goosey-Tolfrey VL, Webborn FSEM (UK) N. Physical Activity Levels and Shoulder Pain in Wheelchair Users during COVID-19 Restrictions. Disabil Health J 2022; 15:101326. [PMID: 35568672 PMCID: PMC9001177 DOI: 10.1016/j.dhjo.2022.101326] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 01/21/2022] [Accepted: 04/01/2022] [Indexed: 11/05/2022]
Abstract
Background Manual wheelchair users are at high risk of developing shoulder pain. However, it is not known if restrictions to limit the spread of the COVID-19 virus affected physical activity, wheelchair use and shoulder pain. Objective The aim of the study is to determine whether COVID-19 related restrictions caused changes in physical activity levels and the presence of shoulder pain in persons who use a wheelchair. Methods Manual wheelchair users completed a survey about the presence and severity of shoulder pain in a cross-sectional study design. Participants completed the Leisure Time Physical Activity Questionnaire and were asked about daily wheelchair activity before and during lockdown. A logistic regression examined the relationship between increase in shoulder pain severity and change in activity levels. Results Sixty respondents were included for analysis. There was no significant change in physical activity during lockdown. There was a significant reduction in number of hours of daily wheelchair use and number of chair transfers during lockdown. Of the respondents, 67% reported having shoulder pain and 22% reported their shoulder pain becoming more severe during lockdown. No significant relationship was observed between the change in activity levels and increasing severity of shoulder pain. Conclusion Restrictions to reduce the spread of the COVID-19 virus resulted in no changes in physical activity levels in a sample of adult manual wheelchair users; however, there was a reduced time using a wheelchair each day and fewer chair transfers. The changes in wheelchair activities were not related to the worsening of shoulder pain.
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A novel push-pull central-lever mechanism reduces peak forces and energy-cost compared to hand-rim wheelchair propulsion during a controlled lab-based experiment. J Neuroeng Rehabil 2022; 19:30. [PMID: 35300710 PMCID: PMC8932120 DOI: 10.1186/s12984-022-01007-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 03/02/2022] [Indexed: 11/21/2022] Open
Abstract
Background Hand-rim wheelchair propulsion is straining and mechanically inefficient, often leading to upper limb complaints. Previous push–pull lever propulsion mechanisms have shown to perform better or equal in efficiency and physiological strain. Propulsion biomechanics have not been evaluated thus far. A novel push–pull central-lever propulsion mechanism is compared to conventional hand-rim wheelchair propulsion, using both physiological and biomechanical outcomes under low-intensity steady-state conditions on a motor driven treadmill. Methods In this 5 day (distributed over a maximum of 21 days) between-group experiment, 30 able-bodied novices performed 60 min (5 × 3 × 4 min) of practice in either the push–pull central lever wheelchair (n = 15) or the hand-rim wheelchair (n = 15). At the first and final sessions cardiopulmonary strain, propulsion kinematics and force production were determined in both instrumented propulsion mechanisms. Repeated measures ANOVA evaluated between (propulsion mechanism type), within (over practice) and interaction effects. Results Over practice, both groups significantly improved on all outcome measures. After practice the peak forces during the push and pull phase of lever propulsion were considerably lower compared to those in the handrim push phase (42 ± 10 & 46 ± 10 vs 63 ± 21N). Concomitantly, energy expenditure was found to be lower as well (263 ± 45 vs 298 ± 59W), on the other hand gross mechanical efficiency (6.4 ± 1.5 vs 5.9 ± 1.3%), heart-rate (97 ± 10 vs 98 ± 10 bpm) and perceived exertion (9 ± 2 vs 10 ± 1) were not significantly different between modes. Conclusion The current study shows the potential benefits of the newly designed push–pull central-lever propulsion mechanism over regular hand rim wheelchair propulsion. The much lower forces and energy expenditure might help to reduce the strain on the upper extremities and thus prevent the development of overuse injury. This proof of concept in a controlled laboratory experiment warrants continued experimental research in wheelchair-users during daily life.
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Sciascia A, Kibler WB. Current Views of Scapular Dyskinesis and its Possible Clinical Relevance. Int J Sports Phys Ther 2022; 17:117-130. [PMID: 35136680 PMCID: PMC8805107 DOI: 10.26603/001c.31727] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 01/08/2022] [Indexed: 11/19/2022] Open
Abstract
Scapular dyskinesis is a condition that is frequently observed clinically but not often understood. Too often it is viewed as a diagnosis which is not accurate because it is a physical impairment. This misclassification of dyskinesis has resulted in literature that simultaneously supports and refutes scapular dyskinesis as a relevant clinical entity as it relates to arm function. These conflicting views have not provided clear recommendations for optimal evaluation and treatment methods. The authors' experience and scholarship related to scapular function and dysfunction support that scapular dyskinesis is an impairment that has causative factors, that a pathoanatomical approach should not be the primary focus but should be considered as part of a comprehensive examination, that a qualitative examination for determining the presence or absence of a scapular contribution to shoulder dysfunction is currently the best option widely available to clinicians, and that rehabilitation approaches should be reconsidered where enhancing motor control becomes the primary focus rather than increasing strength.
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Affiliation(s)
- Aaron Sciascia
- Institute of Clinical Outcomes and Research, Lexington Clinic
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Jahanian O, Schnorenberg AJ, Muqeet V, Hsiao-Wecksler ET, Slavens BA. Glenohumeral joint dynamics and shoulder muscle activity during geared manual wheelchair propulsion on carpeted floor in individuals with spinal cord injury. J Electromyogr Kinesiol 2022; 62:102318. [PMID: 31178393 PMCID: PMC6885114 DOI: 10.1016/j.jelekin.2019.05.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2018] [Revised: 05/08/2019] [Accepted: 05/30/2019] [Indexed: 02/03/2023] Open
Abstract
This study investigated the effects of using geared wheels on glenohumeral joint dynamics and shoulder muscle activity during manual wheelchair propulsion. Seven veterans with spinal cord injury propelled their wheelchairs equipped with geared wheels over a carpeted floor in low gear (1.5:1) and standard gear (1:1) conditions. Hand-rim kinetics, glenohumeral joint dynamics, and muscle activity were measured using a custom instrumented geared wheel, motion analysis, and surface electromyography. Findings indicated that the propulsion speed and stroke distance decreased significantly during the low gear condition. The peak hand-rim resultant force and propulsive moment, as well as the peak glenohumeral inferior force and flexion moment, were significantly less during the low gear condition. The peak and integrated muscle activity of the anterior deltoid and pectoralis major decreased significantly, while the normalized integrated muscle activity (muscle activity per stroke distance) was not significantly different between the two conditions. Propulsion on carpeted floor in the low gear condition was accompanied by a reduced perception of effort. The notable decrease in the peak shoulder loading and muscle activity suggests that usage of geared wheels may be beneficial for wheelchair users to enhance independent mobility in their homes and communities while decreasing their shoulder demands.
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Affiliation(s)
- Omid Jahanian
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Alyssa J Schnorenberg
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
| | - Vaishnavi Muqeet
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, WI, USA
| | | | - Brooke A. Slavens
- Department of Occupational Science and Technology, University of Wisconsin–Milwaukee, Milwaukee, WI, USA,Department of Biomedical Engineering, University of Wisconsin–Milwaukee, Milwaukee, WI, USA
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12
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Mozingo JD, Akbari-Shandiz M, Van Straaten MG, Murthy NS, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Comparison of glenohumeral joint kinematics between manual wheelchair tasks and implications on the subacromial space: A biplane fluoroscopy study. J Electromyogr Kinesiol 2022; 62:102350. [PMID: 31481296 PMCID: PMC7036020 DOI: 10.1016/j.jelekin.2019.08.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 07/12/2019] [Accepted: 08/19/2019] [Indexed: 02/03/2023] Open
Abstract
Scapula and humerus motion associated with common manual wheelchair tasks is hypothesized to reduce the subacromial space. However, previous work relied on either marker-based motion capture for kinematic measures, which is prone to skin-motion artifact; or ultrasound imaging for arthrokinematic measures, which are 2D and acquired in statically-held positions. The aim of this study was to use a fluoroscopy-based approach to accurately quantify glenohumeral kinematics during manual wheelchair use, and compare tasks for a subset of parameters theorized to be associated with mechanical impingement. Biplane images of the dominant shoulder were acquired during scapular plane elevation, propulsion, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury. A computed tomography scan of the shoulder was obtained, and model-based tracking was used to quantify six-degree-of-freedom glenohumeral kinematics. Axial rotation and superior/inferior and anterior/posterior humeral head positions were characterized for full activity cycles and compared between tasks. The change in the subacromial space was also determined for the period of each task defined by maximal change in the aforementioned parameters. Propulsion, sideways lean, and weight-relief raise, but not scapular plane elevation, were marked by mean internal rotation (8.1°, 10.8°, 14.7°, -49.2° respectively). On average, the humeral head was most superiorly positioned during the weight-relief raise (1.6 ± 0.9 mm), but not significantly different from the sideways lean (0.8 ± 1.1 mm) (p = 0.191), and much of the task was characterized by inferior translation. Scaption was the only task without a defined period of superior translation on average. Pairwise comparisons revealed no significant differences between tasks for anterior/posterior position (task means range: 0.1-1.7 mm), but each task exhibited defined periods of anterior translation. There was not a consistent trend across tasks between internal rotation, superior translation, and anterior translation with reductions in the subacromial space. Further research is warranted to determine the likelihood of mechanical impingement during these tasks based on the measured task kinematics and reductions in the subacromial space.
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Affiliation(s)
- Joseph D. Mozingo
- Biomedical Engineering and Physiology Graduate Program,
Mayo Clinic Graduate School of Biomedical Sciences, Mayo Clinic, Rochester, MN,
USA,Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
| | | | | | | | | | - David R. Holmes
- Department of Physiology and Biomedical Engineering, Mayo
Clinic, Rochester, MN, USA
| | | | - Kristin D. Zhao
- Department of Physical Medicine and Rehabilitation, Mayo
Clinic, Rochester, MN, USA
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13
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Bossuyt FM, Mason BS, Briley S, O'Brien TJ, Boninger ML, Arnet U, Goosey-Tolfrey VL. Shoulder Tendon Adaptations Following a Graded Exercise Test to Exhaustion in Highly Trained Wheelchair Rugby Athletes With Different Impairments. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:755466. [PMID: 36188798 PMCID: PMC9397820 DOI: 10.3389/fresc.2021.755466] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 12/13/2021] [Indexed: 11/13/2022]
Abstract
Objective This study aimed to identify acute changes in biceps and supraspinatus tendon characteristics before and after a graded exercise test to exhaustion (GXT) in highly trained wheelchair rugby (WR) athletes. A secondary aspect was to define chronic tendon adaptations related to the impairment of the athlete and the occupation of the tendon within the subacromial space (occupation ratio). Methods Twelve WR athletes with different impairments (age = 32 ± 6 years; body mass = 67.2 ± 11.2 kg; 9.0 ± 3.6 years competing) volunteered for this study. Performance Corrected Wheelchair Users Shoulder Pain Index was used to quantify shoulder pain. Quantitative Ultrasound Protocols (QUS) were used to define supraspinatus and biceps tendon thickness, echogenicity, and echogenicity ratio of both dominant and non-dominant shoulder before and after the GXT including 22 ± 3.1 min submaximal propulsion and 10.2 ± 1.7 min maximal propulsion on a treadmill. Furthermore, the acromio-humeral distance (AHD) defined from ultrasound (US) images was used to calculate the occupation ratios. Results A mixed-effect multilevel analysis that included shoulder as grouping variable, demonstrated a significant reduction in the echogenicity of the biceps following GXT whilst controlling for impairment [spinal cord injury (SCI) and non-SCI] and the occupation ratio (β = −9.01, SEβ = 2.72, p = 0.001, 95% CI = [−14.34; −3.68]). This points toward fluid inflow into the tendon that may be related to overload and acute inflammation. In addition, persons with a SCI (n = 8) had a thicker supraspinatus tendon in comparison to persons with non-SCI (n = 3) which may be related to chronic tendon adaptations (β = −0.53 mm, SEβ = 0.26, p = 0.038, 95% CI = [−1.04; −0.03]). Finally, a greater occupation ratio was associated with signs of tendinopathy (i.e., greater biceps and supraspinatus tendon thickness, and lower supraspinatus echogenicity and echogenicity ratio). Conclusion Acute biceps tendon adaptations in response to the GXT in highly trained WR athletes were evident with chronic adaptations in the supraspinatus tendon being related to the impairment of the athlete. Ultrasound can be used to monitor tendon adaptations in WR athletes for medical diagnosis to assist the scheduling and type of training.
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Affiliation(s)
- Fransiska Marie Bossuyt
- Shoulder, Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
- Human Performance Laboratory, Faculty of Kinesiology, University of Calgary, Calgary, AB, Canada
- *Correspondence: Fransiska Marie Bossuyt
| | - Barry S. Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Simon Briley
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Thomas J. O'Brien
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
| | - Michael L. Boninger
- Department of Physical Medicine and Rehabilitation, School of Medicine, University of Pittsburgh, Pittsburgh, PA, United States
| | - Ursina Arnet
- Shoulder, Health and Mobility Group, Swiss Paraplegic Research, Nottwil, Switzerland
| | - Victoria Louise Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
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14
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Sudah SY, Kerrigan DJ, Ruskin JB. Acromion stress fracture in an elderly cane walker with Parkinson's disease: a case report. JSES REVIEWS, REPORTS, AND TECHNIQUES 2021; 1:442-445. [PMID: 37588697 PMCID: PMC10426462 DOI: 10.1016/j.xrrt.2021.08.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/18/2023]
Affiliation(s)
- Suleiman Y. Sudah
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA
| | - Daniel J. Kerrigan
- Department of Orthopedic Surgery, Monmouth Medical Center, Long Branch, NJ, USA
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15
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Jahanian O, Van Straaten MG, Goodwin BM, Cain SM, Lennon RJ, Barlow JD, Murthy NS, Morrow MMB. Inertial Measurement Unit-Derived Ergonomic Metrics for Assessing Arm Use in Manual Wheelchair Users With Spinal Cord Injury: A Preliminary Report. Top Spinal Cord Inj Rehabil 2021; 27:12-25. [PMID: 34456543 PMCID: PMC8370702 DOI: 10.46292/sci20-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Background: Individuals with spinal cord injury (SCI) who use manual wheelchairs (MWCs) have a higher rate of rotator cuff pathology progression than able-bodied individuals. Objectives: This study aimed to test the ability of risk and recovery metrics of arm use to differentiate between (1) MWC users with SCI and matched able-bodied participants (cross-sectional matched-sample study) and (2) MWC users with rotator cuff pathology progression over 1 year from those without pathology progression (longitudinal study). Methods: Thirty-four MWC users and 34 age- and sex-matched able-bodied individuals were recruited. Upper arm risk (humeral elevation >60°) and recovery (static ≥5 seconds and humeral elevation <40°) metrics were calculated from wireless inertial measurement units (IMUs) worn on the upper arms and torso in the free-living environment. Two separate magnetic resonance imaging studies were completed and assessed for a subset of 16 MWC users approximately 1 year apart. Results: The frequency of risk events (p = .019), summated duration of recovery events (p = .025), and duration of each recovery event (p = .003) were higher for MWC users than able-bodied participants. The summated duration of risk events (p = .047), frequency of risk events (p = .027), and risk to recovery ratio (p = .02) were higher and the summated duration of recovery events (p = .036) and frequency of recovery events (p = .047) were lower for MWC users with rotator cuff pathology progression (n = 5) compared to those without progression (n = 11). Conclusion: IMU-derived metrics quantifying arm use at postures >60° and risk to recovery ratios may provide insights of potential risk factors for rotator cuff pathology progression.
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Affiliation(s)
- Omid Jahanian
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Meegan G Van Straaten
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Brianna M Goodwin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
| | - Stephen M Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, Michigan
| | - Ryan J Lennon
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, Minnesota
| | | | | | - Melissa M B Morrow
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota.,Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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16
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The longitudinal relationship between shoulder pain and altered wheelchair propulsion biomechanics of manual wheelchair users. J Biomech 2021; 126:110626. [PMID: 34329882 DOI: 10.1016/j.jbiomech.2021.110626] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 06/25/2021] [Accepted: 07/05/2021] [Indexed: 11/23/2022]
Abstract
The purpose of this study was to investigate the longitudinal association between within-subject changes in shoulder pain and alterations in wheelchair propulsion biomechanics in manual wheelchair users. Eighteen (age 33 ± 11 years) manual wheelchair users propelled their own daily living wheelchair at 1.11 m.s-1 for three minutes on a dual-roller ergometer during two laboratory visits (T1 and T2) between 4 and 6 months apart. Shoulder pain was assessed using the Performance Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI). Between visits mean PC-WUSPI scores increased by 5.4 points and varied from - 13.5 to + 20.9 points. Of the eighteen participants, nine (50%) experienced increased shoulder pain, seven (39%) no change in pain, and two (11%) decreased pain. Increasing shoulder pain severity correlated with increased contact angle (r = 0.59, P = 0.010), thorax range of motion (r = 0.60, P = 0.009) and kinetic and kinematic variability. Additionally, increasing shoulder pain was associated with reductions in peak torque (r = -0.56, P = 0.016), peak glenohumeral abduction (r = -0.69, P = 0.002), peak scapular downward rotation (r = -0.68, P = 0.002), and range of motion in glenohumeral flexion/extension and scapular angles. Group comparisons revealed that these biomechanical alterations were exhibited by individuals who experienced increased shoulder pain, whereas, propulsion biomechanics of those with no change/decreased pain remained unaltered. These findings indicate that wheelchair users exhibit a protective short-term wheelchair propulsion biomechanical response to increases in shoulder pain which may temporarily help maintain functional independence.
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17
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Goodwin BM, Cain SM, Van Straaten MG, Fortune E, Jahanian O, Morrow MMB. Humeral elevation workspace during daily life of adults with spinal cord injury who use a manual wheelchair compared to age and sex matched able-bodied controls. PLoS One 2021; 16:e0248978. [PMID: 33891602 PMCID: PMC8064589 DOI: 10.1371/journal.pone.0248978] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 03/08/2021] [Indexed: 11/18/2022] Open
Abstract
Shoulder pain and pathology are extremely common for individuals with spinal cord injuries (SCI) who use manual wheelchairs (MWC). Although risky humeral kinematics have been measured during wheelchair-based activities performed in the lab, little is known about arm kinematics in the free-living environment. The purpose of this study was to measure the humeral elevation workspace throughout a typical day for individuals with SCI who use a MWC and matched able-bodied controls. Thirty-four individuals with SCI who use a MWC (42.7±12.7 years of age, 28 males/6 females, C6-L1) and 34 age-and sex-matched controls were enrolled. Participants wore three inertial measurement units (IMU) on their upper arms and torso for one to two days. Humeral elevation angles were estimated and the percentage of time individuals spent in five elevation bins (0–30°, 30–60°, 60–90°, 90–120°, and 120–180°) were calculated. For both arms, the SCI cohort spent a significantly lower percentage of the day in 0–30° of humeral elevation (Dominant: SCI = 15.7±12.6%, Control = 32.1±15.6%, p<0.0001; Non-Dominant: SCI = 21.9±17.8%, Control = 34.3±15.5%, p = 0.001) and a significantly higher percentage of time in elevations associated with tendon compression (30–60° of humeral elevation, Dominant: SCI = 62.8±14.4%, Control = 49.9.1±13.0%, p<0.0001; Non-Dominant: SCI = 58.8±14.9%, Control = 48.3±13.6%, p = 0.003) than controls. The increased percentage of time individuals with SCI spent in elevations associated with tendon compression may contribute to increased shoulder pathology. Characterizing the humeral elevation workspace utilized throughout a typical day may help in understanding the increased prevalence of shoulder pain and pathology in individuals with SCI who use MWCs.
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Affiliation(s)
- Brianna M. Goodwin
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Stephen M. Cain
- Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI, United States of America
| | - Meegan G. Van Straaten
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, United States of America
| | - Emma Fortune
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Omid Jahanian
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
| | - Melissa M. B. Morrow
- Division of Health Care Delivery Research, Mayo Clinic, Rochester, MN, United States of America
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States of America
- * E-mail:
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18
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Changes to Biceps and Supraspinatus Tendons in Response to a Progressive Maximal Treadmill-Based Propulsion Aerobic Fitness Test in Manual Wheelchair Users: A Quantitative Musculoskeletal Ultrasound Study. Rehabil Res Pract 2021; 2021:6663575. [PMID: 33747566 PMCID: PMC7943286 DOI: 10.1155/2021/6663575] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 02/04/2021] [Accepted: 02/12/2021] [Indexed: 11/17/2022] Open
Abstract
Objective To investigate if the completion of a recently developed treadmill-based wheelchair propulsion maximal progressive workload incremental test alters the integrity of the long head of the biceps and supraspinatus tendons using musculoskeletal ultrasound imaging biomarkers. Method Fifteen manual wheelchair users completed the incremental test. Ultrasound images of the long head of the biceps and supraspinatus tendons were recorded before, immediately after, and 48 hours after the completion of the test using a standardized protocol. Geometric, composition, and texture-related ultrasound biomarkers characterized tendon integrity. Results Participants propelled during 10.2 ± 2.9 minutes with the majority (N = 13/15) having reached at least the eighth stage of the test (speed = 0.8 m/s; slope = 3.6°). All ultrasound biomarkers characterizing tendon integrity, measured in the longitudinal and transversal planes for both tendons, were similar (p = 0.063 to 1.000) across measurement times. Conclusion The performance of the motorized treadmill wheelchair propulsion test to assess aerobic fitness produced no changes to ultrasound biomarkers of the biceps or supraspinatus tendons. Hence, there was no ultrasound imaging evidence of a maladaptive response due to overstimulation in these tendons immediately after and 48 hours after the performance of the test.
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19
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Briley SJ, Vegter RJ, Goosey-Tolfrey VL, Mason BS. Scapular kinematic variability during wheelchair propulsion is associated with shoulder pain in wheelchair users. J Biomech 2020; 113:110099. [DOI: 10.1016/j.jbiomech.2020.110099] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 09/07/2020] [Accepted: 10/17/2020] [Indexed: 10/23/2022]
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20
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Briley SJ, Vegter RJ, Tolfrey VL, Mason BS. Propulsion biomechanics do not differ between athletic and nonathletic manual wheelchair users in their daily wheelchairs. J Biomech 2020; 104:109725. [DOI: 10.1016/j.jbiomech.2020.109725] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 02/25/2020] [Accepted: 02/25/2020] [Indexed: 11/25/2022]
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21
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Comparing supraspinatus to acromion proximity and kinematics of the shoulder and thorax between manual wheelchair propulsion styles: A pilot study. Clin Biomech (Bristol, Avon) 2020; 74:42-50. [PMID: 32120286 DOI: 10.1016/j.clinbiomech.2020.01.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 12/27/2019] [Accepted: 01/18/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Repetitive glenohumeral joint movement during manual wheelchair propulsion has been associated with shoulder pain in individuals with spinal cord injury. Clinical guidelines for shoulder health maintenance encourage semi-circular over arc propulsion to reduce loading frequency. This study aimed to determine the difference in estimated supraspinatus to acromion compression risk, and shoulder, thorax kinematics between (1) arc and semi-circular propulsion; and (2) self-selected and coached strategies. METHODS Shoulder and thorax kinematics were captured during wheelchair propulsion, noting individually self-selected styles. Participants were then coached to perform the other style(s) of interest, arc and/or semi-circular. CT bone models of the humerus and scapula were animated using glenohumeral kinematics to estimate the minimum distance between the supraspinatus humeral attachment and the acromion. Compression risk was defined as the proportion of each propulsion phase where the minimum distance fell below 5 mm. Comparisons were made between conditions evaluating compression risk, minimum distances and kinematics at events throughout propulsion. FINDINGS Ten individuals with spinal cord injury (9 male) participated. Arc and semi-circular propulsion did not significantly differ in compression risk or minimum distance across propulsion phases. Self-selected styles yielded lower compression risk and larger proximity values compared to coached styles. Glenohumeral horizontal abduction and thorax flexion differed between arc and semi-circular propulsion. Multiple glenohumeral and humerothoracic differences emerged between self-selected and coached conditions. INTERPRETATION Supraspinatus compression was observed during both arc and semi-circular propulsion, suggesting risk may be unavoidable in this task. Self-selected styles yield less risk, likely related to coached style unfamiliarity.
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22
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Mozingo JD, Akbari-Shandiz M, Murthy NS, Van Straaten MG, Schueler BA, Holmes DR, McCollough CH, Zhao KD. Shoulder mechanical impingement risk associated with manual wheelchair tasks in individuals with spinal cord injury. Clin Biomech (Bristol, Avon) 2020; 71:221-229. [PMID: 32035338 PMCID: PMC7050284 DOI: 10.1016/j.clinbiomech.2019.10.017] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 10/11/2019] [Accepted: 10/17/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Most individuals with spinal cord injury who use manual wheelchairs experience shoulder pain related to wheelchair use, potentially in part from mechanical impingement of soft tissue structures within the subacromial space. There is evidence suggesting that scapula and humerus motion during certain wheelchair tasks occurs in directions that may reduce the subacromial space, but it hasn't been thoroughly characterized in this context. METHODS Shoulder motion was imaged and quantified during scapular plane elevation with/without handheld load, propulsion with/without added resistance, sideways lean, and weight-relief raise in ten manual wheelchair users with spinal cord injury using biplane fluoroscopy and computed tomography. For each position, minimum distance between rotator cuff tendon insertions (infraspinatus, subscapularis, supraspinatus) and the coracoacromial arch was determined. Tendon thickness was measured with ultrasound, and impingement risk scores were defined for each task based on frequency and amount of tendon compression. FINDINGS Periods of impingement were identified during scapular plane elevation and propulsion but not during pressure reliefs in most participants. There was a significant effect of activity on impingement risk scores (P < 0.0001), with greatest impingement risk during scapular plane elevation followed by propulsion. Impingement risk scores were not significantly different between scapular plane elevation loading conditions (P = 0.202) or propulsion resistances (P = 0.223). The infraspinatus and supraspinatus tendons were both susceptible to impingement during scapular plane elevation (by acromion), whereas the supraspinatus was most susceptible during propulsion (by acromion and coracoacromial ligament). INTERPRETATION The occurrence of mechanical impingement during certain manual wheelchair tasks, even without increased load/resistance, demonstrates the importance of kinematics inherent to a task as a determinant of impingement. Frequency of and technique used to complete daily tasks should be carefully considered to reduce impingement risk, which may help preserve shoulder health long-term.
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Affiliation(s)
- Joseph D Mozingo
- Biomedical Engineering and Physiology Graduate Program, Mayo Clinic Graduate School of Biomedical Sciences, USA; Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - David R Holmes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, MN, USA
| | | | - Kristin D Zhao
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN, USA.
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23
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Changes in supraspinatus and biceps tendon thickness: influence of fatiguing propulsion in wheelchair users with spinal cord injury. Spinal Cord 2019; 58:324-333. [PMID: 31745246 PMCID: PMC7065940 DOI: 10.1038/s41393-019-0376-z] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 09/02/2019] [Accepted: 10/05/2019] [Indexed: 11/16/2022]
Abstract
Study design: Quasi-experimental, pretest-posttest design. Objectives: To identify acute changes in the supraspinatus and biceps tendon following fatiguing wheelchair propulsion and to associate tendon changes with risk factors associated with shoulder pain in persons with spinal cord injury (SCI). Setting: Biomechanical laboratory Swiss Paraplegic Research. Methods: A population-based sample of 50 wheelchair users with SCI at lesion level T2 or below participated. Fatigue was measured using the rate of perceived exertion and heart rate. Linear regression techniques were used to assess the association between the dependent and independent variables. Dependent variables included absolute differences in supraspinatus and biceps tendon thickness, contrast and echogenicity ratio assessed with ultrasound before and after a fatiguing wheelchair propulsion intervention. Independent variables included: susceptibility to fatigue (Yes/No), the acromio-humeral distance, sex, time since injury, activity levels and body weight. Results: A reduction in supraspinatus tendon thickness after fatiguing wheelchair propulsion (−1.39 mm; 95% CI: −2.28; −0.51) was identified after controlling for all potential confounders. Females who fatigued (n=4) displayed a greater reduction in supraspinatus tendon thickness as compared to those who did not fatigue (n=7). In contrast, higher body weight was associated with an increase in supraspinatus tendon thickness and a greater acromio-humeral distance before the intervention was associated with an increase in biceps tendon thickness. Conclusions: Acute changes in the supraspinatus and biceps tendon after fatiguing wheelchair propulsion may explain the high prevalence of tendon injuries in this population. Future research should determine the consequences of tendon changes and its relationship to tendinopathy.
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Slavens BA, Jahanian O, Schnorenberg AJ, Hsiao-Wecksler ET. A comparison of glenohumeral joint kinematics and muscle activation during standard and geared manual wheelchair mobility. Med Eng Phys 2019; 70:1-8. [PMID: 31285137 DOI: 10.1016/j.medengphy.2019.06.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2018] [Revised: 06/17/2019] [Accepted: 06/21/2019] [Indexed: 10/26/2022]
Abstract
The high prevalence of upper extremity joint injuries among manual wheelchair users is largely attributed to the high repetitive loading during propulsion. The purpose of this study was to evaluate the effects of using geared wheels for manual wheelchair mobility on shoulder joint biomechanics. Fourteen able-bodied participants performed overground propulsion and ramp ascension using standard and geared manual wheelchair wheels. Spatial temporal parameters, glenohumeral joint kinematics, and shoulder muscle activity were quantified. Findings indicated that regardless of the level of slope, the propulsion speed and stroke distance decreased significantly (p ≪ 0.001), and the stroke frequency increased significantly (p ≤ 0.025) during geared manual wheelchair propulsion. The glenohumeral joint ranges of motion in the coronal plane (p ≤ 0.005) and peak joint angles in the coronal (p ≤ 0.023) and transverse (p ≤ 0.012) planes were significantly different between standard and geared wheels usage. Shoulder muscle activity was substantially less using the geared wheels with significant findings in the pectoralis major (level floor, p ≤ 0.008) and infraspinatus (p ≤ 0.014) peak muscle activity, and the anterior deltoid (p ≤ 0.014) and pectoralis major (p ≤ 0.015) integrated muscle activity. However, the shoulder flexor normalized integrated muscle activity (muscle activity per stroke distance) was not different between the wheels.
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Affiliation(s)
- Brooke A Slavens
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA.
| | - Omid Jahanian
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Alyssa J Schnorenberg
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, WI, USA
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Hybois S, Puchaud P, Bourgain M, Lombart A, Bascou J, Lavaste F, Fodé P, Pillet H, Sauret C. Comparison of shoulder kinematic chain models and their influence on kinematics and kinetics in the study of manual wheelchair propulsion. Med Eng Phys 2019; 69:153-160. [PMID: 31221514 DOI: 10.1016/j.medengphy.2019.06.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Revised: 04/03/2019] [Accepted: 06/06/2019] [Indexed: 11/30/2022]
Abstract
Several kinematic chains of the upper limbs have been designed in musculoskeletal models to investigate various upper extremity activities, including manual wheelchair propulsion. The aim of our study was to compare the effect of an ellipsoid mobilizer formulation to describe the motion of the scapulothoracic joint with respect to regression-based models on shoulder kinematics, shoulder kinetics and computational time, during manual wheelchair propulsion activities. Ten subjects, familiar with manual wheelchair propulsion, were equipped with reflective markers and performed start-up and propulsion cycles with an instrumented field wheelchair. Kinematic data obtained from the optoelectronic system and kinetic data measured by the sensors on the wheelchair were processed using the OpenSim software with three shoulder joint modeling versions (ellipsoid mobilizer, regression equations or fixed scapula) of an upper-limb musculoskeletal model. As expected, the results obtained with the three versions of the model varied, for both segment kinematics and shoulder kinetics. With respect to the model based on regression equations, the model describing the scapulothoracic joint as an ellipsoid could capture the kinematics of the upper limbs with higher fidelity. In addition, the mobilizer formulation allowed to compute consistent shoulder moments at a low computer processing cost. Further developments should be made to allow a subject-specific definition of the kinematic chain.
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Affiliation(s)
- Samuel Hybois
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France.
| | - Pierre Puchaud
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Centre d'Études et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Maxime Bourgain
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Antoine Lombart
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Centre d'Études et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Joseph Bascou
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Centre d'Études et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - François Lavaste
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France; Centre d'Études et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Pascale Fodé
- Centre d'Études et de Recherche sur l'Appareillage des Handicapés, Institution Nationale des Invalides, Créteil, France
| | - Hélène Pillet
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
| | - Christophe Sauret
- Institut de Biomécanique Humaine Georges Charpak, Arts et Métiers ParisTech, Paris, France
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Lin JH, Xu X. Occupational cranking operations: The scapula perspective. APPLIED ERGONOMICS 2019; 75:129-133. [PMID: 30509517 DOI: 10.1016/j.apergo.2018.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 07/27/2018] [Accepted: 09/23/2018] [Indexed: 06/09/2023]
Abstract
Cranking the landing gear is a common task performed by truck drivers to raise or lower trailers. This task poses a risk to the shoulder joint due to the required forceful exertion and the posture constrained to the hand-handle interface. As a potential occupational risk, there has been no definitive guideline for best practices among truck drivers. An operator can crank perpendicular (frontal) or parallel (sagittal) to the crank rotation. In this laboratory study, the effects of cranking method and resistance on scapular range of motion and shoulder muscle activity were observed in 12 participants. Scapular posture was measured using an optical motion tracking system. EMG was monitored on 16 muscles contributing to shoulder movement. The results show that during frontal cranking, the scapular range of protraction was 28 ± 11.6°, which was more than the sagittal cranking (23 ± 10.4°), indicating a decreased subacromial space and elevated shoulder impingement risk. Seven muscles (all three deltoid muscles, middle trapezius, supraspinatus, infraspinatus, and teres minor) demonstrated that when the crank resistance was low, the front cranking method resulted in lower activity than the side cranking. When the crank resistance was 20 Nm, the muscle activity on these seven muscles was greater when cranking from the front than from the side. Based on these observations, we suggest that when the resistance is low (lowering the trailer) the driver should stand facing the trailer. On the contrary, it is advantageous to stand parallel to the trailer and crank while raising the trailer to apply the full body strength to reduce the shoulder load.
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Affiliation(s)
- Jia-Hua Lin
- Safety and Health Assessment and Research for Prevention (SHARP), Washington State Department of Labor and Industries, Olympia, WA, USA.
| | - Xu Xu
- Edward P. Fitts Department of Industrial and Systems Engineering, North Carolina State University, Raleigh, NC, USA
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Abstract
Context:Previous literature has theorized that alterations in shoulder physical characteristics are present in wheelchair athletes and contribute to shoulder pain and injury. Limited empirical evidence is present that evaluates the effectiveness of a shoulder injury prevention program focusing on improving these altered characteristics.Objective:To evaluate the effectiveness of a 6-week intervention program at improving characteristics that increases the risk of developing pain or shoulder injury.Design:Pretest and posttest.Setting:Home-based and controlled laboratory.Participants:Seven college wheelchair athletes.Interventions:Shoulder range of motion (ROM) and scapular muscle strength were assessed, and a 5-minute injury prevention program was taught to participants. Participants completed the intervention 3 times per week for 6 weeks. Following completion of the program, a postintervention screening was performed.Main OutcomeMeasures:Internal rotation (IR)/external rotation (ER) ROM, retraction strength, and IR/ER strength.Results:Participants experienced a significant improvement in dominant limb shoulder IR ROM (t6 = 3.56,P = .01) with an average increase of 11.4° of IR ROM and a significant improvement in dominant limb shoulder ER ROM (t6 = 2.79,P = .03) with an average increase of 8.0° of ER ROM. There were no significant increases in shoulder IR or ER strength and scapular retraction strength (P > .05).Conclusions:Improvements in ROM have previously been linked to decreases in shoulder pain and injury in other upper-extremity dominant sports by improving scapular kinematics. These results provide evidence that a 6-week strengthening and stretching intervention program may decrease risk factors for shoulder injury in wheelchair basketball athletes.
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Mason BS, Vegter RJK, Paulson TAW, Morrissey D, van der Scheer JW, Goosey-Tolfrey VL. Bilateral scapular kinematics, asymmetries and shoulder pain in wheelchair athletes. Gait Posture 2018; 65:151-156. [PMID: 30558924 DOI: 10.1016/j.gaitpost.2018.07.170] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 07/09/2018] [Accepted: 07/19/2018] [Indexed: 02/02/2023]
Abstract
BACKGROUND Shoulder pain is the most common complaint for wheelchair athletes. Scapular orientation and dyskinesia are thought to be associated with shoulder pathology, yet no previous studies have examined the bilateral scapula kinematics of wheelchair athletes during propulsion. RESEARCH QUESTION To examine bilateral scapular kinematics of highly trained wheelchair rugby (WR) players and any associations with self-reported shoulder pain during everyday wheelchair propulsion. METHODS Ten WR players (5 with shoulder pain, 5 without) performed 2 × 3-minute bouts of exercise in their everyday wheelchair on a wheelchair ergometer at two sub-maximal speeds (3 and 6 km h-1). During the final minute, 3D kinematic data were collected at 100 Hz to describe scapulothoracic motion relative to each propulsion cycle. Instantaneous asymmetries in scapular orientation between dominant and non-dominant sides were also reported. Differences in scapular kinematics and propulsion asymmetries were compared across shoulders symptomatic and asymptomatic of pain. RESULTS An internally rotated, upwardly rotated and anteriorly tilted scapula was common during wheelchair propulsion and asymmetries ≤14° did exist, yet minimal changes were observed across speeds. Participants with bilateral shoulder pain displayed a less upwardly rotated scapula during propulsion, however large inter-individual variability in scapular kinematics was noted. SIGNIFICANCE Scapular asymmetries are exhibited by wheelchair athletes during wheelchair propulsion, yet these were not exacerbated by increased speed and had limited associations to shoulder pain. This suggests that propulsion kinematics of highly trained athletes may not be the primary cause of pain experienced by this population.
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Affiliation(s)
- Barry S Mason
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1).
| | - Riemer J K Vegter
- Faculty of Medical Sciences, University of Groningen, The Netherlands
| | - Thomas A W Paulson
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
| | - Dylan Morrissey
- Sport and Exercise Medicine, Queen Mary University of London, UK; Barts Health NHS Trust, London, UK
| | - Jan W van der Scheer
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
| | - Victoria L Goosey-Tolfrey
- Peter Harrison Centre for Disability Sport, School of Sport, Exercise & Health Sciences, Loughborough University, UK(1)
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Kentar Y, Brunner M, Bruckner T, Hug A, Raiss P, Zeifang F, Loew M, Almansour H, Akbar M. Impact of spine alignment on the rotator cuff in long-term wheelchair users. J Shoulder Elbow Surg 2018; 27:1004-1011. [PMID: 29428293 DOI: 10.1016/j.jse.2017.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2017] [Revised: 12/01/2017] [Accepted: 12/03/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND We investigated the impact of poor seated posture on the prevalence of rotator cuff tears (RCTs) among wheelchair-dependent individuals with long-standing paraplegia. METHODS The study included 319 patients. Lateral radiographs of the spine were collected from a database and analyzed to assess the global spinopelvic alignment (SPA). Magnetic resonance images of both shoulders were obtained to detect the presence of cuff tears. Patients were divided into 2 groups: Group RCT-I included all patients with cuff tears (right, left, or bilateral), whereas group RCT-II consisted exclusively of patients with bilateral cuff tears. We used the classification systems developed by Kendall et al and Roussouly et al to assess the sagittal spine alignment and SPA, respectively. Univariate and multivariate analyses were performed. To fit both models (groups RCT-I and RCT-II) to the data, the 4 spine curves according to Roussouly et al were subdivided into 2 groups: Group SPA-I included both type 1 and type 2, whereas group SPA-II included both type 3 and type 4. RESULTS Magnetic resonance images showed a cuff tear in 192 patients (60.19%) (group RCT-I). Among those, 37 patients (11.60%) had tears in both shoulders (group RCT-II). In group RCT-I, 70.31% of the patients had a kyphotic-lordotic posture. The kyphotic-lordotic posture, a longer duration, and a more rostral neurologic level of injury were highly associated with cuff tear prevalence. In group RCT-II, the multivariate analysis showed that only the duration of spinal cord injury was significantly associated with RCTs. CONCLUSION Thoracic hyperkyphosis was associated with a markedly high rate of RCTs. The data from this study may provide support for developing preventive strategies.
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Affiliation(s)
- Yasser Kentar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Manuela Brunner
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Thomas Bruckner
- Institute of Medical Biometry and Informatics, University of Heidelberg, Heidelberg, Germany
| | - Andreas Hug
- Spinal Cord Injury Center, University of Heidelberg, Heidelberg, Germany
| | - Patric Raiss
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Felix Zeifang
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | | | - Haidara Almansour
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany
| | - Michael Akbar
- Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury, University of Heidelberg, Heidelberg, Germany.
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Warner MB, Wilson D, Heller MO, Wood D, Worsley P, Mottram S, Webborn N, Veeger D, Batt M. Scapular kinematics in professional wheelchair tennis players. Clin Biomech (Bristol, Avon) 2018; 53:7-13. [PMID: 29407353 DOI: 10.1016/j.clinbiomech.2018.01.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Participating in wheelchair tennis increases the demands placed on the shoulder and could increase the risk of developing shoulder pain and injury that might be associated with differences in scapular kinematics. The aim of the study was to examine the presence of shoulder pain and scapular kinematics in professional wheelchair tennis players. METHOD Scapular kinematics were obtained in 11 professional wheelchair tennis players, 16 people with shoulder impingement and 16 people without shoulder impingement during humeral elevation and lowering. Clinical examination of the wheelchair tennis players was undertaken using the Wheelchair Users Shoulder Disability Index (WUSPI) and clinical signs of shoulder impingement. FINDINGS The WUSPI questionnaire (mean = 28 SD 13.8) demonstrated wheelchair tennis participants experienced little shoulder pain and clinical examination revealed negative impingement tests. Wheelchair tennis players had greater scapular posterior tilt during humeral elevation (3.9° SE 1.71; P = 0.048) and lowering (4.3° SE 1.8; P = 0.04) on the dominant compared to non-dominant side. The dominant scapulae of wheelchair tennis players were significantly (P = 0.014) more upwardly rotated (21° SD 6.7) than the scapulae of people with shoulder impingement (14.1° SD 7.0) during scapular plane humeral elevation. INTERPRETATION This first study of scapular kinematics in professional wheelchair tennis athletes demonstrated bilateral asymmetries and differences to able-bodied participants with shoulder impingement. Understanding the role of sport participation on shoulder function in wheelchair users would assist in the development of preventative and treatment exercise programmes for wheelchair users at risk of shoulder injury and pain.
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Affiliation(s)
- Martin B Warner
- Faculty of Health Sciences, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK.
| | - David Wilson
- Faculty of Health Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Markus O Heller
- Faculty of Engineering and the Environment, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Dan Wood
- English Institute of Sport, Bisham Abbey, Bisham, UK
| | - Peter Worsley
- Faculty of Health Sciences, University of Southampton, Southampton, UK; Institute for Life Sciences, University of Southampton, Southampton, UK
| | - Sarah Mottram
- Faculty of Health Sciences, University of Southampton, Southampton, UK; Movement Performance Solutions, Bristol, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - Nick Webborn
- The Sussex Centre for Sport and Exercise Medicine, University of Brighton, Eastbourne, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
| | - DirkJan Veeger
- Department of Human Movement Sciences, Vrije Universiteit, Amsterdam, Netherlands
| | - Mark Batt
- Nottingham University Hospitals, Nottingham, UK; Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, UK
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Abstract
The shoulder achieves a wide spectrum of motion, and in a subset of patients, including those who use manual wheelchairs and upper extremity walking aids, the shoulder also serves as the primary weight-bearing joint. Because the weight-bearing shoulder is subject to considerable joint reaction forces and overuse, a broad spectrum of pathology can affect the joint. The combination of muscle imbalance and repetitive trauma presents most commonly as subacromial impingement syndrome but can progress to other pathology. Patients with high-level spinal cord injury, leading to quadriplegia and motor deficits, have an increased incidence of shoulder pain. Understanding the needs of patients who use manual wheelchairs or walking aids can help the physician to better comprehend the pathology of and better manage the weight-bearing shoulder.
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Hallbeck MS, Lowndes BR, McCrory B, Morrow MM, Kaufman KR, LaGrange CA. Kinematic and ergonomic assessment of laparoendoscopic single-site surgical instruments during simulator training tasks. APPLIED ERGONOMICS 2017; 62:118-130. [PMID: 28411722 DOI: 10.1016/j.apergo.2017.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Revised: 12/22/2016] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
While laparoendoscopic single-site surgery (LESS) appears to be feasible and safe, instrument triangulation, tissue handling, and other bimanual tasks are difficult even for experienced surgeons. Novel technologies emerged to overcome LESS' procedural and ergonomic difficulties of "tunnel vision" and "instrument clashing." Surgeon kinematics, self-reported workload and upper body discomfort were used to compare straight, bent and two articulating instruments while performing two basic surgical tasks in a LESS simulator. All instruments resulted in bilateral elevation and rotation of the shoulders, excessive forearm motion and flexion and ulnar deviation of wrists. Surgeons' adopted non-neutral upper extremity postures and performed excessive joint excursions to compensate for reduced freedom of movement at the single insertion site and to operate the instrument mechanisms. LESS' cosmetic benefits continue to impact laparoscopic surgery and by enabling performance through improved instruments, ergonomic improvement for LESS can reduce negative impact on surgeon well-being and patient safety.
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Affiliation(s)
- M Susan Hallbeck
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Surgery, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA.
| | - Bethany R Lowndes
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA; Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA
| | - Bernadette McCrory
- Department of Mechanical and Materials Engineering, College of Engineering, University of Nebraska, Lincoln, NE 68588, USA; Department of Biostatistics, College of Public Health, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Melissa M Morrow
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Mayo Clinic, Rochester, MN 55905, USA; Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN 55905, USA
| | - Kenton R Kaufman
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Chad A LaGrange
- Department of Surgery, Division of Urology, University of Nebraska Medical Center, Omaha, NE 68198, USA
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Abstract
The purpose of this study was to validate a commercially available inertial measurement unit (IMU) system against a standard lab-based motion capture system for the measurement of shoulder elevation, elbow flexion, trunk flexion/extension, and neck flexion/extension kinematics. The validation analyses were applied to 6 surgical faculty members performing a standard, simulated surgical training task that mimics minimally invasive surgery. Three-dimensional joint kinematics were simultaneously recorded by an optical motion capture system and an IMU system with 6 sensors placed on the head, chest, and bilateral upper and lower arms. The sensor-to-segment axes alignment was accomplished manually. The IMU neck and trunk IMU flexion/extension angles were accurate to within 2.9 ± 0.9 degrees and 1.6 ± 1.1°, respectively. The IMU shoulder elevation measure was accurate to within 6.8 ± 2.7° and the elbow flexion measure was accurate to within 8.2 ± 2.8°. In the Bland-Altman analyses, there were no significant systematic errors present; however, there was a significant inversely proportional error across all joints. As the gold standard measurement increased, the IMU underestimated the magnitude of the joint angle. This study reports acceptable accuracy of a commercially available IMU system; however, results should be interpreted as protocol specific.
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Zhao KD, Van Straaten MG, Cloud BA, Morrow MM, An KN, Ludewig PM. Scapulothoracic and Glenohumeral Kinematics During Daily Tasks in Users of Manual Wheelchairs. Front Bioeng Biotechnol 2015; 3:183. [PMID: 26636073 PMCID: PMC4653754 DOI: 10.3389/fbioe.2015.00183] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2015] [Accepted: 10/26/2015] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND Rates of shoulder pain in individuals who use manual wheelchairs (MWCs) as their primary means of mobility have been reported to be as high as 70% during activities of daily living. Current prevailing thought is that mechanical impingement of the soft tissues that reside within the subacromial space between the humeral head and coracoacromial arch is a major contributor to the shoulder pain in users of MWCs. The subacromial space size is directly related to the kinematics at the shoulder joint. Yet to be answered are questions about which common daily tasks are characterized by the most potentially detrimental kinematics. OBJECTIVE The purpose of this analysis was to quantify and compare potentially detrimental kinematics in three common tasks performed by individuals with spinal cord injury and shoulder pain. These data will add to the body of knowledge and test common assumptions about relative risk of tasks. DESIGN A cross-sectional study of 15 MWC users with shoulder pain. METHODS Electromagnetic surface sensor measures of mean and peak scapulothoracic (ST) internal and downward rotation, anterior tilt, and glenohumeral (GH) internal rotation were compared across propulsion, weight relief, and scapular plane abduction tasks using one-way repeated-measure ANOVA. RESULTS Statistical differences were observed between the tasks for all rotations. Mean ST anterior tilt was greater in weight relief and propulsion than during scapular plane abduction (24°, 23°, and 13° of anterior tilt, respectively). Mean GH axial rotation during weight relief was more internally rotated than during propulsion and scapular plane abduction (9°, 26°, and 51° of external rotation, respectively). LIMITATIONS Surface-based measures of kinematics are subject to skin motion artifact, especially in translation which was not addressed in this study. CONCLUSION Each task presented with specific variables that might contribute to risk of developing shoulder "impingement" and pain. These data may assist therapists in their assessment of movement contributions to shoulder pain in this population, as well as in subsequent treatment planning.
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Affiliation(s)
- Kristin D Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN , USA
| | - Meegan G Van Straaten
- Motion Analysis Laboratory, Division of Orthopedic Research, Mayo Clinic , Rochester, MN , USA
| | - Beth A Cloud
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic , Rochester, MN , USA
| | - Melissa M Morrow
- Department of Health Sciences Research, Mayo Clinic , Rochester, MN , USA
| | - Kai-Nan An
- Biomechanics Laboratory, Division of Orthopedic Research, Mayo Clinic , Rochester, MN , USA
| | - Paula M Ludewig
- Program in Rehabilitation Science, Department of Physical Medicine and Rehabilitation, University of Minnesota , Minneapolis, MN , USA
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Lin YS, Boninger ML, Day KA, Koontz AM. Ultrasonographic measurement of the acromiohumeral distance in spinal cord injury: Reliability and effects of shoulder positioning. J Spinal Cord Med 2015; 38:700-8. [PMID: 24968117 PMCID: PMC4725804 DOI: 10.1179/2045772314y.0000000205] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVE To investigate the reliability of ultrasonographic measurement of acromiohumeral distance (AHD) and the effects of shoulder positioning on AHD among manual wheelchair users (MWUs) with spinal cord injury (SCI) and an able-bodied control group. METHODS Ten MWUs with SCI and 10 able-bodied subjects participated in this study. The ultrasonographic measurements of AHD from each subject were obtained by two raters during passive and active scapular plane arm elevation in neutral, 45°, 90° with and without resistance and in a weight relief raise position. The measurements were recorded again by each rater using the same procedures after a 30-minute time interval. All raters were blinded to each other's measurements. SETTING University Laboratories and Veteran Affairs Healthcare System. RESULTS Intra-rater (intraclass correlation coefficient, ICC > 0.83) and inter-rater (ICC > 0.78) reliability was excellent for both the MWUs with SCI and able-bodied groups across all arm positions except for the 45° position in the control group for one of the raters (intra-rater: ICC < 0.40 and inter-rater: ICC < 0.60). AHD significantly reduced when the shoulder was in the 90° arm elevated positions with or without resistance. CONCLUSION Findings from our study demonstrated that ultrasonography is a reliable means to evaluate AHD in both able bodied and individuals with SCI, who are known to have significant shoulder pathology. This technique could be used to develop reference measures and to identify changes in AHD caused by interventions.
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Affiliation(s)
| | | | | | - Alicia M. Koontz
- Correspondence to: Alicia Koontz, Human Engineering Research Laboratories, VA Pittsburgh Healthcare System & University of Pittsburgh, 6425 Penn Ave. Suite 400, Pittsburgh, PA 15206, USA.
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36
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Russell IM, Raina S, Requejo PS, Wilcox RR, Mulroy S, McNitt-Gray JL. Modifications in Wheelchair Propulsion Technique with Speed. Front Bioeng Biotechnol 2015; 3:171. [PMID: 26579513 PMCID: PMC4620433 DOI: 10.3389/fbioe.2015.00171] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 10/12/2015] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Repetitive loading of the upper limb joints during manual wheelchair (WC) propulsion (WCP) has been identified as a factor that contributes to shoulder pain, leading to loss of independence and decreased quality of life. The purpose of this study was to determine how individual manual WC users with paraplegia modify propulsion mechanics to accommodate expected increases in reaction forces (RFs) generated at the pushrim with self-selected increases in WCP speed. METHODS Upper extremity kinematics and pushrim RFs were measured for 40 experienced manual WC users with paraplegia while propelling on a stationary ergometer at self-selected free and fast propulsion speeds. Upper extremity kinematics and kinetics were compared within subject between propulsion speeds. Between group and within-subject differences were determined (α = 0.05). RESULTS Increased propulsion speed was accompanied by increases in RF magnitude (22 of 40, >10 N) and shoulder net joint moment (NJM, 15 of 40, >10 Nm) and decreases in pushrim contact duration. Within-subject comparison indicated that 27% of participants modified their WCP mechanics with increases in speed by regulating RF orientation relative to the upper extremity segments. CONCLUSIONS Reorientation of the RF relative to the upper extremity segments can be used as an effective strategy for mitigating rotational demands (NJM) imposed on the shoulder at increased propulsion speeds. Identification of propulsion strategies that individuals can use to effectively accommodate for increases in RFs is an important step toward preserving musculoskeletal health of the shoulder and improving health-related quality of life.
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Affiliation(s)
- Ian M. Russell
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Shashank Raina
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
| | - Philip S. Requejo
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Rand R. Wilcox
- Department of Psychology, University of Southern California, Los Angeles, CA, USA
| | - Sara Mulroy
- Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, Downey, CA, USA
| | - Jill L. McNitt-Gray
- Department of Biomedical Engineering, University of Southern California, Los Angeles, CA, USA
- Department of Biological Sciences, University of Southern California, Los Angeles, CA, USA
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Quadrupedal Locomotion-Respiration Entrainment and Metabolic Economy in Cross-Country Skiers. J Appl Biomech 2015; 32:1-6. [PMID: 26252735 DOI: 10.1123/jab.2014-0243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A 1:1 locomotion-respiration entrainment is observed in galloping quadrupeds, and is thought to improve running economy. However, this has not been tested directly in animals, as animals cannot voluntarily disrupt this entrainment. The purpose of this study was to evaluate metabolic economy in a human gait involving all four limbs, cross-country skiing, in natural entrainment and forced nonentrainment. Nine elite cross-country skiers roller skied at constant speed using the 2-skate technique. In the first and last conditions, athletes used the natural entrained breathing pattern: inhaling with arm recovery and exhaling with arm propulsion, and in the second condition, the athletes disentrained their breathing pattern. The rate of oxygen uptake (VO2) and metabolic rate (MR) were measured via expired gas analysis. Propulsive forces were measured with instrumented skis and poles. VO2 and MR increased by 4% and 5% respectively when skiers used the disentrained compared with the entrained breathing pattern. There were no differences in ski or pole forces or in timing of the gait cycle between conditions. We conclude that breathing entrainment reduces metabolic cost of cross-country skiing by approximately 4%. Further, this reduction is likely a result of the entrainment rather than alterations in gait mechanics.
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Schnorenberg AJ, Slavens BA, Graf A, Krzak J, Vogel L, Harris GF. Upper extremity biomechanics of children with spinal cord injury during wheelchair mobility. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2015; 2014:4338-41. [PMID: 25570952 DOI: 10.1109/embc.2014.6944584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
While much work is being done evaluating the upper extremity joint dynamics of adult manual wheelchair propulsion, limited work has examined the pediatric population of manual wheelchair users. Our group used a custom pediatric biomechanical model to characterize the upper extremity joint dynamics of 12 children and adolescents with spinal cord injury (SCI) during wheelchair propulsion. Results show that loading appears to agree with that of adult manual wheelchair users, with the highest loading primarily seen at the glenohumeral joint. This is concerning due to the increased time of wheelchair use in the pediatric population and the impact of this loading during developmental years. This research may assist clinicians with improved mobility assessment methods, wheelchair prescription, training, and long-term care of children with orthopaedic disabilities.
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Morrow MMB, Van Straaten MG, Murthy NS, Braman JP, Zanella E, Zhao KD. Detailed shoulder MRI findings in manual wheelchair users with shoulder pain. BIOMED RESEARCH INTERNATIONAL 2014; 2014:769649. [PMID: 25180192 PMCID: PMC4142383 DOI: 10.1155/2014/769649] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/10/2014] [Accepted: 07/21/2014] [Indexed: 11/17/2022]
Abstract
Shoulder pain and pathology are common in manual wheelchair (MWC) users with paraplegia, and the biomechanical mechanism of injury is largely unknown. Establishing patterns of MRI characteristics in MWC users would help advance understanding of the mechanical etiology of rotator cuff disease, thus improving the logic for prescribed interventions. The purpose of this study was to report detailed shoulder MRI findings in a sample of 10 MWC users with anterolateral shoulder pain. The imaging assessments were performed using our standardized MRI Assessment of the Shoulder (MAS) guide. The tendon most commonly torn was the supraspinatus at the insertion site in the anterior portion in either the intrasubstance or articular region. Additionally, widespread tendinopathy, CA ligament thickening, subacromial bursitis, labral tears, and AC joint degenerative arthrosis and edema were common. Further reporting of detailed shoulder imaging findings is needed to confirm patterns of tears in MWC users regarding probable tendon tear zone, region, and portion. This investigation was a small sample observational study and did not yield data that can define patterns of pathology. However, synthesis of detailed findings from multiple studies could define patterns of pathological MRI findings allowing for associations of imaging findings to risk factors including specific activities.
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Affiliation(s)
- Melissa M. B. Morrow
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Meegan G. Van Straaten
- Division of Orthopedic Research, Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN 55905, USA
| | - Naveen S. Murthy
- Division of Musculoskeletal Radiology, Department of Radiology, Mayo Clinic, Rochester, MN 55905, USA
| | - Jonathan P. Braman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, MN 55455, USA
| | - Elia Zanella
- Department of Biomedical Engineering, University of Minnesota, Minneapolis, MN 55455, USA
| | - Kristin D. Zhao
- Rehabilitation Medicine Research Center, Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, MN 55905, USA
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Effects of repetitive shoulder activity on the subacromial space in manual wheelchair users. BIOMED RESEARCH INTERNATIONAL 2014; 2014:583951. [PMID: 25215283 PMCID: PMC4158143 DOI: 10.1155/2014/583951] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/15/2014] [Revised: 06/10/2014] [Accepted: 06/17/2014] [Indexed: 11/18/2022]
Abstract
This study investigated (1) the effect of repetitive weight-relief raises (WR) and shoulder external rotation (ER) on the acromiohumeral distance (AHD) among manual wheelchair users (MWUs) and (2) the relationship between shoulder pain, subject characteristics, and AHD changes. Twenty-three MWUs underwent ultrasound imaging of the nondominant shoulder in an unloaded baseline position and while holding a WR position before and after the WR/ER tasks. Paired t-tests and Spearman correlational analysis were used to assess differences in the AHD before and after each task and the relationships between pain, subject characteristics, and the AHD measures. A significant reduction in the subacromial space (P<0.01) occurred when subjects performed a WR position compared to baseline. Individuals with increased years of disability had greater AHD percentage narrowing after WR (P=0.008). Increased shoulder pain was associated with AHD percentage narrowing after ER (P≤0.007). The results support clinical practice guidelines that recommend MWUs limit WR to preserve shoulder function. The isolated repetitive shoulder activity did not contribute to the changes of subacromial space in MWUs. The ultrasonographic measurement of the AHD may be a target for identifying future interventions that prevent pain.
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Troy KL, Munce TA, Longworth JA. An exercise trial targeting posterior shoulder strength in manual wheelchair users: pilot results and lessons learned. Disabil Rehabil Assist Technol 2014; 10:415-20. [DOI: 10.3109/17483107.2014.905644] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Ratcliffe E, Pickering S, McLean S, Lewis J. Is there a relationship between subacromial impingement syndrome and scapular orientation? A systematic review. Br J Sports Med 2013; 48:1251-6. [DOI: 10.1136/bjsports-2013-092389] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Dellabiancia F, Porcellini G, Merolla G. Instruments and techniques for the analysis of wheelchair propulsion and upper extremity involvement in patients with spinal cord injuries: current concept review. Muscles Ligaments Tendons J 2013; 3:150-156. [PMID: 24367774 PMCID: PMC3838323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
The correct functionality of the upper limbs is an essential condition for the autonomy of people with disabilities, especially for those in wheelchair. In this review we focused on the biomechanics of wheelchair propulsion and we described the instrumental analysis of techniques for the acquisition of wheelchair propulsion.
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Affiliation(s)
- Fabio Dellabiancia
- Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giuseppe Porcellini
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
| | - Giovanni Merolla
- Biomechanics Laboratory “Marco Simoncelli”, D. Cervesi Hospital, Cattolica, Rimini, Italy
- Unit of Shoulder and Elbow Surgery, D. Cervesi Hospital, Cattolica, Rimini, Italy
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Kibler WB, Ludewig PM, McClure PW, Michener LA, Bak K, Sciascia AD. Clinical implications of scapular dyskinesis in shoulder injury: the 2013 consensus statement from the 'Scapular Summit'. Br J Sports Med 2013; 47:877-85. [PMID: 23580420 DOI: 10.1136/bjsports-2013-092425] [Citation(s) in RCA: 361] [Impact Index Per Article: 32.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The second international consensus conference on the scapula was held in Lexington Kentucky. The purpose of the conference was to update, present and discuss the accumulated knowledge regarding scapular involvement in various shoulder injuries and highlight the clinical implications for the evaluation and treatment of shoulder injuries. The areas covered included the scapula and shoulder injury, the scapula and sports participation, clinical evaluation and interventions and known outcomes. Major conclusions were (1) scapular dyskinesis is present in a high percentage of most shoulder injuries; (2) the exact role of the dyskinesis in creating or exacerbating shoulder dysfunction is not clearly defined; (3) shoulder impingement symptoms are particularly affected by scapular dyskinesis; (4) scapular dyskinesis is most aptly viewed as a potential impairment to shoulder function; (5) treatment strategies for shoulder injury can be more effectively implemented by evaluation of the dyskinesis; (6) a reliable observational clinical evaluation method for dyskinesis is available and (7) rehabilitation programmes to restore scapular position and motion can be effective within a more comprehensive shoulder rehabilitation programme.
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Affiliation(s)
- W Ben Kibler
- Shoulder Center of Kentucky, Lexington, KY 40504, USA
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Effect of Shoulder Pain on Shoulder Kinematics During Weight-Bearing Tasks in Persons With Spinal Cord Injury. Arch Phys Med Rehabil 2012; 93:1421-30. [DOI: 10.1016/j.apmr.2012.02.034] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Revised: 02/23/2012] [Accepted: 02/27/2012] [Indexed: 11/20/2022]
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