Original research| Volume 99, ISSUE 4, P615-622, April 2018

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Agreement of Musculoskeletal Ultrasound and Clinical Assessment of Shoulder Impairment in Manual Wheelchair Users With Various Duration of Spinal Cord Injury

Published:January 12, 2018DOI:



      To determine (1) agreement of musculoskeletal ultrasound (MSK-US) findings of shoulder pathology and related shoulder special test results in individuals with varied durations of manual wheelchair (MWC) use after spinal cord injury (SCI); and (2) whether shoulder musculoskeletal impairments, per MSK-US and clinical examination, differed in individuals with SCI and varying durations of MWC use.


      Cross-sectional cohort study.


      Laboratory setting.


      Adult volunteers (N=23) with SCI who used an MWC for community mobility. Individuals were stratified into 3 groups based on duration of MWC use: <5 years, 5 to 15 years, and >15 years.


      Not applicable.

      Main Outcome Measures

      Special tests for shoulder impingement and bicipital tendonitis were performed. Bilateral shoulder MSK-US was performed, with the Ultrasound Shoulder Pathology Rating Scale (USPRS) quantifying biceps tendon, supraspinatus tendon, and greater tuberosity cortical surface impairments.


      No agreement was found between MSK-US and related special tests. Special tests failed to identify impairment in 33.3% to 100% of those identified on MSK-US. The total USPRS score was highest in those with >15 years' MWC use. A higher proportion of dynamic impingement (supraspinatus and biceps) was found in those with >15 years' MWC use, with other MSK-US items having moderate effect sizes among duration-use groups.


      MSK-US identified shoulder impairments more frequently than commonly used special tests. A significant increase in the presence of MSK-US shoulder impairments was identified in the longest-duration group. This was not the case for special tests or pain. MSK-US is an easily administered, low-cost, noninvasive method for determining shoulder impairments and should be used in routine screening of individuals who use an MWC after SCI.


      List of abbreviations:

      BMI (body mass index), MSK-US (musculoskeletal ultrasound), MWC (manual wheelchair), PASIPD (Physical Activity Scale for Individuals with Physical Disabilities), SCI (spinal cord injury), UE (upper extremity), USPRS (Ultrasound Shoulder Pathology Rating Scale), WUSPI (Wheelchair Users Shoulder Pain Index)
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