Advertisement

Ultrasonographic Measures of the Acromiohumeral Distance and Supraspinatus Tendon Thickness in Manual Wheelchair Users With Spinal Cord Injury

  • Amélie Fournier Belley
    Affiliations
    Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada
    Search for articles by this author
  • Dany H. Gagnon
    Affiliations
    Center for Interdisciplinary Research in Rehabilitation of Greater Montreal, Gingras-Lindsay Rehabilitation Institute, Montreal, Quebec, Canada

    School of Rehabilitation, University of Montreal, Montreal, Quebec, Canada
    Search for articles by this author
  • François Routhier
    Affiliations
    Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada

    Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
    Search for articles by this author
  • Jean-Sébastien Roy
    Correspondence
    Corresponding author Jean-Sébastien Roy, PT, PhD, Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, 525, Wilfrid-Hamel Boulevard, Room H-1710, Quebec City, Quebec G1M 2S8, Canada.
    Affiliations
    Center for Interdisciplinary Research in Rehabilitation and Social Integration, Quebec Rehabilitation Institute, Quebec City, Quebec, Canada

    Department of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, Quebec, Canada
    Search for articles by this author

      Abstract

      Objectives

      (1) To evaluate the reliability of ultrasonographic measures of the acromiohumeral distance (AHD) in shoulder positions linked to wheelchair propulsion in manual wheelchair users (MWUs) with spinal cord injury (SCI) and able-bodied individuals; (2) to compare ultrasonographic measures of AHD, supraspinatus tendon thickness, and occupation ratio between MWUs with SCI with and without shoulder pain (rotator cuff [RC] tendinopathy); and (3) to compare these ultrasonographic measures between MWUs with SCI and able-bodied individuals.

      Design

      Cross-sectional study.

      Setting

      Rehabilitation centers.

      Participants

      Three groups of participants (N=95; aged between 18 and 60y) were recruited within a convenience sample: objective 1: 16 MWUs with SCI (mean age, 43±9y; height, 172±13 cm, weight, 84±10 kg) and 16 able-bodied individuals (mean age, 28±9y; height, 176±11 cm, weight, 72±12 kg); objectives 2 and 3: 37 MWUs with SCI (17 with [mean age, 47±11y; height, 172±14 cm, weight, 68±11 kg] and 20 without [mean age, 45±10y; height, 172±15 cm, weight, 84±30 kg] RC tendinopathy) and 26 able-bodied individuals (mean age, 31±5y; height, 175±12 cm; weight, 89±14 kg).

      Interventions

      Not applicable.

      Main Outcome Measures

      AHD, supraspinatus tendon thickness, and occupation ratio of the supraspinatus tendon measured using ultrasound imaging systems.

      Results

      (1) Excellent intra- and interrater reliability of AHD was obtained in each arm position (intraclass correlation coefficient>.85); (2) MWUs without shoulder pain have thicker tendon than do MWUs with RC tendinopathy; and (3) a significant Group × Position interaction was found for AHD measures when comparing MWUs with SCI with able-bodied individuals (greater AHD at the end of the push phase for MWUs with SCI). A thicker tendon and a higher occupation ratio were also found in MWUs with SCI than in able-bodied individuals.

      Conclusions

      Ultrasonography is a reliable technology to evaluate AHD in MWUs in shoulder positions linked to wheelchair propulsion. Supraspinatus tendon thickness and occupation ratio of AHD adequately discriminate between MWUs with SCI and able-bodied individuals. This shows that these ultrasonographic measures can be used in future studies of populations with SCI to better understand the changes at the shoulder joint in MWUs.

      Keywords

      List of abbreviations:

      AHD (acromiohumeral distance), DASH (Disabilities of the Arm, Shoulder and Hand), ICC (intraclass correlation coefficient), MDC90 (minimal detectable change at 90%), MWU (manual wheelchair user), RC (rotator cuff), 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
      Institutional Access: Sign in to ScienceDirect

      References

        • Lundqvist C.
        • Siosteen A.
        • Blomstrand C.
        • Lind B.
        • Sullivan M.
        Spinal cord injuries: clinical, functional, and emotional status.
        Spine (Phila Pa 1976). 1991; 16: 78-83
        • Akbar M.
        • Brunner M.
        • Balean G.
        • et al.
        A cross-sectional study of demographic and morphologic features of rotator cuff disease in paraplegic patients.
        J Shoulder Elbow Surg. 2011; 20: 1108-1113
        • Gutierrez D.D.
        • Thompson L.
        • Kemp B.
        • et al.
        The relationship of shoulder pain intensity to quality of life, physical activity, and community participation in persons with paraplegia.
        J Spinal Cord Med. 2007; 30: 251-255
        • Akbar M.
        • Balean G.
        • Brunner M.
        • et al.
        Prevalence of rotator cuff tear in paraplegic patients compared with controls.
        J Bone Joint Surg. 2010; 92: 23-30
        • Hastings J.
        • Goldstein B.
        Paraplegia and the shoulder.
        Phys Med Rehabil Clin N Am. 2004; 15 (699-718): vii
        • Curtis K.A.
        • Drysdale G.A.
        • Lanza R.D.
        • Kolber M.
        • Vitolo R.S.
        • West R.
        Shoulder pain in wheelchair users with tetraplegia and paraplegia.
        Arch Phys Med Rehabil. 1999; 80: 453-457
        • Alm M.
        • Saraste H.
        • Norrbrink C.
        Shoulder pain in persons with thoracic spinal cord injury: prevalence and characteristics.
        J Rehabil Med. 2008; 40: 277-283
        • Desmeules F.
        • Minville L.
        • Riederer B.
        • Cote C.H.
        • Fremont P.
        Acromio-humeral distance variation measured by ultrasonography and its association with the outcome of rehabilitation for shoulder impingement syndrome.
        Clin J Sport Med. 2004; 14: 197-205
        • Savoie A.
        • Mercier C.
        • Desmeules F.
        • Fremont P.
        • Roy J.S.
        Effects of a movement training oriented rehabilitation program on symptoms, functional limitations and acromiohumeral distance in individuals with subacromial pain syndrome.
        Man Ther. 2015; 20: 703-708
        • Michener L.A.
        • Subasi Yesilyaprak S.S.
        • Seitz A.L.
        • Timmons M.K.
        • Walsworth M.K.
        Supraspinatus tendon and subacromial space parameters measured on ultrasonographic imaging in subacromial impingement syndrome.
        Knee Surg Sports Traumatol Arthrosc. 2015; 23: 363-369
        • Michener L.A.
        • Walsworth M.K.
        • Doukas W.C.
        • Murphy K.P.
        Reliability and diagnostic accuracy of 5 physical examination tests and combination of tests for subacromial impingement.
        Arch Phys Med Rehabil. 2009; 90: 1898-1903
        • Ngomo S.
        • Mercier C.
        • Bouyer L.J.
        • Savoie A.
        • Roy J.S.
        Alterations in central motor representation increase over time in individuals with rotator cuff tendinopathy.
        Clin Neurophysiol. 2015; 126: 365-371
        • Rice I.
        • Gagnon D.
        • Gallagher J.
        • Boninger M.
        Hand rim wheelchair propulsion training using biomechanical real-time visual feedback based on motor learning theory principles.
        J Spinal Cord Med. 2010; 33: 33-42
        • Hudak P.L.
        • Amadio P.C.
        • Bombardier C.
        • The Upper Extremity Collaborative Group (UECG)
        Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand) [corrected].
        Am J Ind Med. 1996; 29: 602-608
        • Curtis K.A.
        • Roach K.E.
        • Applegate E.B.
        • et al.
        Development of the Wheelchair User's Shoulder Pain Index (WUSPI).
        Paraplegia. 1995; 33: 290-293
        • Shah N.P.
        • Miller T.T.
        • Stock H.
        • Adler R.S.
        Sonography of supraspinatus tendon abnormalities in the neutral versus Crass and modified Crass positions: a prospective study.
        J Ultrasound Med. 2012; 31: 1203-1208
        • Portney L.G.
        • Watkins M.P.
        Statistical measures of validity.
        in: Foundations of clinical research—applications to practice. 3rd ed. Pearson-Prentice Hall, Upper Saddle River2009: 619-658
        • Schmidt W.A.
        • Schmidt H.
        • Schicke B.
        • Gromnica-Ihle E.
        Standard reference values for musculoskeletal ultrasonography.
        Ann Rheum Dis. 2004; 63: 988-994
        • Pijls B.G.
        • Kok F.P.
        • Penning L.I.
        • Guldemond N.A.
        • Arens H.J.
        Reliability study of the sonographic measurement of the acromiohumeral distance in symptomatic patients.
        J Clin Ultrasound. 2010; 38: 128-134
        • Wang H.K.
        • Lin J.J.
        • Pan S.L.
        • Wang T.G.
        Sonographic evaluations in elite college baseball athletes.
        Scand J Med Sci Sports. 2005; 15: 29-35
        • Kalra N.
        • Seitz A.L.
        • Boardman III, N.D.
        • Michener L.A.
        Effect of posture on acromiohumeral distance with arm elevation in subjects with and without rotator cuff disease using ultrasonography.
        J Orthop Sports Phys Ther. 2010; 40: 633-640
        • Maenhout A.
        • van Cingel R.
        • De Mey K.
        • Van Herzeele M.
        • Dhooge F.
        • Cools A.
        Sonographic evaluation of the acromiohumeral distance in elite and recreational female overhead athletes.
        Clin J Sport Med. 2013; 23: 178-183
        • White C.E.
        • Dedrick G.S.
        • Apte G.G.
        • Sizer P.S.
        • Brismee J.M.
        The effect of isometric shoulder internal and external rotation on the acromiohumeral distance.
        Am J Phys Med Rehabil. 2012; 91: 193-199
        • Maenhout A.
        • Dhooge F.
        • Van Herzeele M.
        • Palmans T.
        • Cools A.
        Acromiohumeral distance and 3-dimensional scapular position change after overhead muscle fatigue.
        J Athl Train. 2015; 50: 281-288
        • Skou S.T.
        • Aalkjaer J.M.
        Ultrasonographic measurement of patellar tendon thickness—a study of intra- and interobserver reliability.
        Clin Imaging. 2013; 37: 934-937
        • Drolet P.
        • Martineau A.
        • Lacroix R.
        • Roy J.S.
        Reliability of ultrasound evaluation of the long head of the biceps tendon.
        J Rehabil Med. 2016; 48: 554-558
        • Lin Y.S.
        • Boninger M.L.
        • Day K.A.
        • Koontz A.M.
        Ultrasonographic measurement of the acromiohumeral distance in spinal cord injury: reliability and effects of shoulder positioning.
        J Spinal Cord Med. 2015; 38: 700-708
        • Maenhout A.
        • Van Eessel V.
        • Van Dyck L.
        • Vanraes A.
        • Cools A.
        Quantifying acromiohumeral distance in overhead athletes with glenohumeral internal rotation loss and the influence of a stretching program.
        Am J Sports Med. 2012; 40: 2105-2112