Abstract
Objective
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.
Design
Cross-sectional study, risk analysis.
Setting
Department of Orthopaedic Surgery, Trauma Surgery and Spinal Cord Injury.
Participants
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.
Interventions
None.
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.
Results
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).
Conclusions
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.
Keywords
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
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Article info
Publication history
Published online: October 19, 2014
Footnotes
Supported by the Deutsche Gesetzliche Unfallversicherung and Ministerium für Wissenschaft, Forschung und Kunst Baden-Württemberg.
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
