To analyze whether frequent overhead-sports activity increases the risk for rotator cuff disease in patients with spinal cord injuries (SCIs) who are wheelchair dependent.
Cross-sectional study, risk analysis.
Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury.
Patients (N=296) with SCI requiring the full-time use of a manual wheelchair were recruited for this study. The total population was divided into 2 groups (sports vs no sports), among them 103 patients playing overhead sports on a regular basis (at least 1–2 times/wk) and 193 patients involved in overhead sports less than once a week or in no sports activity at all. The mean age of the sports group was 49.1 years. The mean duration of wheelchair dependence was 26.5 years. The mean age of the no-sports group was 48 years. The mean duration of wheelchair dependence was 25.2 years. Each individual completed a questionnaire designed to identify overhead-sports activity on a regular basis and was asked about shoulder problems. Magnetic resonance imaging scans of both shoulders were performed in each patient and analyzed in a standardized fashion.
Main Outcome Measures
Possible differences in continuous data between patients with and without rotator cuff tear were evaluated. The relative risk of suffering from a rotator cuff tear between patients playing overhead sports and those not playing overhead sports was calculated.
One hundred three patients played overhead sports regularly and 193 did not. There was no difference between groups regarding age, sex, level of SCI, and duration of wheelchair dependence. The body mass index was significantly lower in the sports group than in the no-sports group (P<.0001). A rotator cuff tear was present in 75.7% of the patients in the sports group and in 36.3% of the patients in the no-sports group (P<.0001). Rotator cuff tears were symptomatic in 92.6% of the patients. The estimated risk increase for the sports group to develop rotator cuff tears was twice as high as for the no-sports group (95% confidence interval, 1.7–2.6; P<.001). Similar results were found for the neurological level of lesion (T2–7/<T7), where the estimated risk was about 2.3 times higher in patients with a high neurological level of lesion (T2–7) than in those with a low neurological level of lesion (<T7) (95% confidence interval, 1.82–3.04; P<.001).
Overhead-sports activities have been identified as an additional risk factor, along with age and duration of wheelchair dependence, for developing rotator cuff disease in patients with paraplegia. A high frequency of sports activity shows physiological benefits as well as improves the psychological status and quality of life in patients with SCI. The dilemma is how to increase physical activity to gain physiological and psychological health benefits without further increasing overuse of the upper extremities, particularly the shoulder, in patients with paraplegia. The data from this study may be helpful in elucidating the etiology of rotator cuff tear in athletes with paraplegia and in counseling patients with SCI regarding shoulder and upper extremity activity level and provide support for developing preventive strategies.
List of abbreviations:BMI (body mass index), RCT (rotator cuff tear), SCI (spinal cord injury)
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Archives of Physical Medicine and Rehabilitation
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- [Acute and overuse injuries of the shoulder in sports] [German].Orthopade. 2014; 43: 202-208
- The disabled throwing shoulder: spectrum of pathology, part I: pathoanatomy and biomechanics.Arthroscopy. 2003; 19: 404-420
- The disabled throwing shoulder: spectrum of pathology, part II: evaluation and treatment of SLAP lesions in throwers.Arthroscopy. 2003; 19: 531-539
- The disabled throwing shoulder: spectrum of pathology, part III: the SICK scapula, scapular dyskinesis, the kinetic chain, and rehabilitation.Arthroscopy. 2003; 19: 641-661
- [Instability and impingement of the shoulder of the high performance athlete in overhead stress] [German].Sportverletz Sportschaden. 1993; 7: 115-121
- MRI findings in throwing shoulders: abnormalities in professional handball players.Clin Orthop Relat Res. 2005; 434: 130-137
- Shoulder pain in overhead throwing athlete: an evidence-based training program for treating scapula dyskinesis.Obere Extremität. 2013; 8: 164-169
- Prevalence of shoulder discomfort in paraplegic subjects.Acta Biomed. 2012; 83: 177-182
- Rotator cuff pathology in athletes.Sports Med. 1997; 24: 205-220
- Common conditions in the overhead athlete.Am Fam Physician. 2014; 89: 537-541
- Symptomatic internal impingement of the shoulder in overhead athletes.Sports Med Arthrosc. 2014; 22: 120-129
- Internal impingement in the etiology of rotator cuff tendinosis revisited.Arthroscopy. 2003; 19: 810-814
- Prevalence of rotator cuff tear in paraplegic patients compared with controls.J Bone Joint Surg Am. 2010; 92: 23-30
- Shoulder joint kinetics during the push phase of wheelchair propulsion.Clin Orthop Relat Res. 1998; 354: 132-143
- Prevalence and impact of wrist and shoulder pain in patients with spinal cord injury.J Spinal Cord Med. 1995; 18: 9-13
- MR imaging of rotator cuff tears in individuals with paraplegia.AJR Am J Roentgenol. 1997; 168: 919-923
- A cross-sectional study of demographic and morphologic features of rotator cuff disease in paraplegic patients.J Shoulder Elbow Surg. 2011; 20: 1108-1113
- Ultrasonographic evaluation of the shoulder in elite wheelchair tennis players.J Sport Rehabil. 2010; 19: 161-172
- Rotator cuff injuries in professional and recreational athletes.J Surg Orthop Adv. 2013; 22: 134-142
- What is the prevalence of senior-athlete rotator cuff injuries and are they associated with pain and dysfunction?.Clin Orthop Relat Res. 2014; 472: 2427-2432
- Paraplegia and the shoulder.Phys Med Rehabil Clin N Am. 2004; 15 (vii, 699-718)
- Shoulder pain: a comparison of wheelchair athletes and nonathletic wheelchair users.Med Sci Sports Exerc. 2003; 35: 1958-1961
- Patterns of changes in wheelchair exercise capacity after spinal cord injury.Arch Phys Med Rehabil. 2013; 94: 1260-1267
- Wheelchair exercise capacity in spinal cord injury up to five years after discharge from inpatient rehabilitation.J Rehabil Med. 2013; 45: 646-652
- Longitudinal relationship between wheelchair exercise capacity and life satisfaction in patients with spinal cord injury: a cohort study in the Netherlands.J Spinal Cord Med. 2014; 37: 328-337
- People with mobility impairments: physical activity and quality of participation.Disabil Health J. 2008; 1: 7-13
- Greater daily leisure time physical activity is associated with lower chronic disease risk in adults with spinal cord injury.Appl Physiol Nutr Metab. 2009; 34: 640-647
- Increased participation in activities of daily living is associated with lower cholesterol levels in people with spinal cord injury.Arch Phys Med Rehabil. 2009; 90: 1755-1759
- Influence of sport participation on community integration and quality of life: a comparison between sport participants and non-sport participants with spinal cord injury.J Spinal Cord Med. 2009; 32: 115-124
- Physical activity and subjective well-being among people with spinal cord injury: a meta-analysis.Spinal Cord. 2010; 48: 65-72
- A systematic review of exercise as a therapeutic intervention to improve arterial function in persons living with spinal cord injury.Spinal Cord. 2011; 49: 702-714
- The effect of frequency and mode of sports activity on the psychological status in tetraplegics and paraplegics.Spinal Cord. 2000; 38: 309-314
- Measurement and description of physical activity in adult manual wheelchair users.Disabil Health J. 2008; 1: 236-244
- 2008 Physical activity guidelines for Americans.2008 (Available at:)Accessed May 10, 2014)
- Cardiovascular complications of inactivity.Rheum Dis Clin N Am. 1990; 16: 803-813
- Physical activity levels are low in free-living adults with chronic paraplegia.Obes Res. 2003; 11: 563-570
- Obesity, inactivity, and the prevalence of diabetes and diabetes-related cardiovascular comorbidities in the U.S., 2000-2002.Diabetes Care. 2005; 28: 1599-1603
- Health benefits of physical activity: the evidence.CMAJ. 2006; 174: 801-809
- Clinical significance of abnormal electrocardiographic findings in individuals aging with spinal injury and abnormal lipid profiles.J Spinal Cord Med. 2007; 30: 473-476
- The demographic and morphological features of rotator cuff disease: a comparison of asymptomatic and symptomatic shoulders.J Bone Joint Surg Am. 2006; 88: 1699-1704
- Rotator-cuff changes in asymptomatic adults: the effect of age, hand dominance and gender.J Bone Joint Surg Br. 1995; 77: 296-298
- Age-related prevalence of rotator cuff tears in asymptomatic shoulders.J Shoulder Elbow Surg. 1999; 8: 296-299
- Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs.J Bone Joint Surg Am. 2009; 91: 289-296
- Abnormal findings on magnetic resonance images of asymptomatic shoulders.J Bone Joint Surg Am. 1995; 77: 10-15
Uhthoff HK, Loehr J, Sarkar K. The pathogenesis of rotator cuff tears. In: Proceedings of the Third International Conference on Surgery of the Shoulder; October 27, 1986, Fukoura, Japan. p. 211-2.
Published online: October 19, 2014
Supported by the Deutsche Gesetzliche Unfallversicherung and Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg.
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.