Shoulder Disease Patterns of the Wheelchair Athletes of Table-Tennis and Archery: A Pilot Study

Spectrum and patterns of shoulder pathology on MRI in symptomatic elite wheelchair basketball athletes

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.

Notational Analysis of Wheelchair Paralympic Table Tennis Matches

Paralympic table tennis is the third largest paralympic sport for the number of players. Performance analysis was conducted for the rally duration and interval and impact of serve, whilst none investigated the shots distribution among classes of physical impairment. Therefore, the purpose of this study was to conduct a notational analysis of international competitions in relation to the wheelchair classes. Five matches for each wheelchair class (C1-to-C5) were evaluated from 20 elite male right-handed players. Both players for each match were analyzed for the following performance indicators: strokes type, the area of ball bouncing, and the shots outcome. Backhand shots were the most used technique for all classes. The most used strokes for C1 players were backhand and forehand drive and backhand lob, while for C5 players they were backhand and forehand push and backhand topspin. Similar shots distribution was registered for C2-to-C5 players. The central and far-from-the-net zone was mainly reached by the serve for all classes. Errors shots were similar in all classes, whilst winning shots were more frequent in C1. The current notational analysis provided a meaningful performance modelling of indicators for coaches and athletes that can be used to design training programs for each class.

Shoulder biomechanics of para-table tennis: a case study of a standing class para-athlete with severe leg impairment

BACKGROUND

Both able-bodied and Class 7 para-table tennis players compete while standing, but do they use the same techniques to hit the ball? This case study examined the shoulder joint kinematics of a highly skilled para-table tennis player with severe leg impairment.

METHODS

One international level Class 7 male para-table tennis player was compared with a control group of 9 male, competitive university team players. Participants performed 15 trials of forehand and 15 trials of backhand topspin drives. Shoulder abduction/adduction angles and joint range of motion (ROM) were measured using an inertial measurement system.

RESULTS

The joint ROM of the para-player was comparable to the control group in the forehand [para-player 38°, controls 32 (15)°] and slightly larger in backhand [para-player 35°, controls 24 (16)°]. Waveform analysis revealed significant differences in the entire forehand drives (p < .001) and the preparation (p < .001) and follow-through phases (p = .014) of the backhand drives.

CONCLUSIONS

Coaches should not simply instruct para-table tennis players to replicate the characteristics of able-bodied players. Depending on the nature of the physical impairment, para-players should optimise their movement strategies for successful performance.

Shoulder pain and ultrasound findings: A comparison study of wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users

BACKGROUND

Shoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population.

OBJECTIVE

To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users.

DESIGN

Cross-sectional.

SETTING

Chicago-area adaptive sport teams/programs and musculoskeletal clinics.

PARTICIPANTS

Thirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users.

METHODS

Self-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician.

MAIN OUTCOME MEASURES

Questionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology.

RESULTS

The majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41).

CONCLUSIONS

Although wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.

A Scoping Review on Shoulder Injuries of Wheelchair Tennis Players: Potential Risk-Factors and Musculoskeletal Adaptations

Wheelchair tennis players are prone to develop shoulder injuries, due to the combination of wheelchair propulsion, overhead activities and daily wheelchair activities. A methodical literature search was conducted to identify articles on shoulder complaints in wheelchair tennis, wheelchair sports and tennis. The aims were to identify (1) type of shoulder complaints; (2) possible risk factors for the development of shoulder injuries; (3) musculoskeletal adaptations in the shoulder joint in wheelchair tennis players. Fifteen papers were included in this review, five on wheelchair tennis, three on wheelchair sports and seven on tennis. Type of shoulder complaints were acromioclavicular pathology, osteoarthritic changes, joint effusion and rotator cuff tears. Possible risk factors for the development of shoulder injuries in wheelchair tennis are overhead movements, repetitive activation of the anterior muscle chain and internal rotators, as well as a higher spinal cord injury level. Muscular imbalance with higher values for the internal rotators, increase in external range of motion, decrease in internal range of motion and reduced total arc of motion were the most common proposed musculoskeletal adaptations due to an unbalanced load. These presented risk factors and musculoskeletal adaptations might help researchers, coaches and wheelchair tennis players to prevent shoulder injuries.

Risk Factors for the Development of Shoulder Pain in Elite Sled Hockey Players

BACKGROUND

Shoulder pain is one of the most common injuries in adaptive athletes. There are minimal prior studies that investigate shoulder pain prevalence and associated risk factors in sled hockey players.

OBJECTIVE

To characterize the prevalence of shoulder pain in elite-level adaptive sled hockey athletes and identify associated risk factors.

DESIGN

Cross-sectional observational study.

SETTING

2019 USA Sled Hockey Classic in Chicago, IL from 7 February 2019 to 10 February 2019.

PARTICIPANTS

Eighty-two elite sled hockey athletes who participated in a nationally sanctioned sports event.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome of the study was to describe the experience of shoulder pain using player-reported outcomes of pain including: binary (yes/no) pain reporting in the last month, Performance-Corrected Wheelchair User's Shoulder Pain Index (PC-WUSPI) reporting pain in the last week, and Visual Analog Scale (VAS) reporting pain in the last month. Associations were assessed between the measurements of pain and characteristics of participants.

RESULTS

Of all participants, 70.5% endorsed shoulder pain in the last month. The average VAS for the past month was 2.13 and average PC-WUSPI for the past week was 15.46. Statistically significant associations were found between endorsement of pain in the last month and specific correlative factors including increased weight (P value .008; odds ratio [OR] 1.04, 95% confidence interval [CI] 1.01-1.07) and increased duration of manual wheelchair use (P-value .002; OR 1.13, 95% CI 1.04-1.22).

CONCLUSION

Elite-level sled hockey athletes commonly report experiencing shoulder pain. There is evidence that an elite-level sled hockey player's weight and longer duration of manual wheelchair use are both associated with a greater likelihood for self-reporting shoulder pain rather than number of years of playing the sport.

Shoulder Pain and the Weight-bearing Shoulder in the Wheelchair Athlete

Shoulder pain is one of the most common complaints amongst wheelchair athletes. There are many debated potential risk factors for shoulder pain in this population including inherent anatomy, increased loading forces, overuse, age, wheelchair use duration, trunk control, and sport played. Proper identification of etiology of shoulder pain with a thorough history and physical examination is important for management purposes. Treatment can be challenging as complete rest from exacerbating activities is often difficult as upper extremity use is necessary for everyday life activities such as mobility and transfers. Addition of shoulder maintenance strengthening program focusing on strengthening adductors, external rotators, and scapular retractors is important to keep shoulder muscles well-balanced to prevent injury.

Method of complex development of psychomotor qualities in precisely-targeted sports

The purpose of the study: the determination of the effect of special precision-target exercises on the level and structure of psychophysiological indicators, physical and technical preparedness of players at the initial stage of training. Material and methods. The study was attended by 22 young footballers 10-12 years old. The subjects were divided into two groups (control and experimental) for 11 people in each. The control and experimental group trained the same amount of time for the same progips, but in the experimental group, in the main part of the class, used the technique of complex development of precision-target movements. Measured the level of physical and technical preparedness, as well as the level of psychophysiological functions of athletes. Results. It is shown that the experimental group experienced significant improvements in the techniques of football due to the development of precision-oriented skills. Really improved results of physical and technical preparedness of athletes of the experimental group were revealed. The control group is also characterized by a significant improvement in testing results by level of technical and physical fitness, but not reliable or at a lower level of significance. The positive influence of the method of complex development of precision-target movements on the psychophysiological indices of athletes is shown. It was shown that after the experiment, the number of reliable interrelationships between the indicators of psychophysiological functions and the indicators of technical and physical fitness in the experimental group increased, and in the control remained unchanged. Conclusions. The application of the experimental methodology for the development of precision-target movements positively influenced the level of technical and physical preparedness, psycho-physiological indicators, as well as the structure of the complex preparedness of athletes.