Advertisement

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:https://doi.org/10.1016/j.apmr.2017.12.015

      Abstract

      Objectives

      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.

      Design

      Cross-sectional cohort study.

      Setting

      Laboratory setting.

      Participants

      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.

      Interventions

      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.

      Results

      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.

      Conclusions

      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.

      Keywords

      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)
      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

        • National Spinal Cord Injury Statistical Center
        Facts and figures at a glance.
        University of Alabama at Birmingham, Birmingham2016
        • McCormick Z.L.
        • Lynch M.
        • Liem B.
        • et al.
        Feasibility for developing cardiovascular exercise recommendations for persons with motor-complete paraplegia based on manual wheelchair propulsion; a protocol and preliminary data.
        J Spinal Cord Med. 2016; 39: 45-49
        • Paralyzed Veterans of America Consortium for Spinal Cord Medicine
        Preservation of upper limb function following spinal cord injury: a clinical practice guideline for health-care professionals.
        J Spinal Cord Med. 2005; 28: 434-470
        • Hastings J.
        • Robins H.
        • Griffiths Y.
        • Hamilton C.
        The differences in self-esteem, function, and participation between adults with low cervical motor tetraplegia who use power or manual wheelchairs.
        Arch Phys Med Rehabil. 2011; 92: 1785-1788
        • Bayley J.C.
        • Cochran T.P.
        • Sledge C.B.
        The weight-bearing shoulder. The impingement syndrome in paraplegics.
        J Bone Joint Surg Am. 1987; 69: 676-678
        • Gellman H.
        • Sie I.
        • Waters R.L.
        Late complications of the weight-bearing upper extremity in the paraplegic patient.
        Clin Orthop Relat Res. 1988; : 132-135
        • Nichols P.J.
        • Norman P.A.
        • Ennis J.R.
        Wheelchair user's shoulder? Shoulder pain in patients with spinal cord lesions.
        Scand J Rehabil Med. 1979; 11: 29-32
        • Luime J.J.
        • Koes B.W.
        • Hendriksen I.J.
        • et al.
        Prevalence and incidence of shoulder pain in the general population; a systematic review.
        Scand J Rheumatol. 2004; 33: 73-81
        • Pentland W.E.
        • Twomey L.T.
        Upper limb function in persons with long term paraplegia and implications for independence: part II.
        Paraplegia. 1994; 32: 219-224
        • Pentland W.E.
        • Twomey L.T.
        Upper limb function in persons with long term paraplegia and implications for independence: part I.
        Paraplegia. 1994; 32: 211-218
        • Sie I.H.
        • Waters R.L.
        • Adkins R.H.
        • Gellman H.
        Upper extremity pain in the postrehabilitation spinal cord injured patient.
        Arch Phys Med Rehabil. 1992; 73: 44-48
        • Curtis K.A.
        • Black K.
        Shoulder pain in female wheelchair basketball players.
        J Orthop Sports Phys Ther. 1999; 29: 225-231
        • Dyson-Hudson T.A.
        • Kirshblum S.C.
        Shoulder pain in chronic spinal cord injury, part I: epidemiology, etiology, and pathomechanics.
        J Spinal Cord Med. 2004; 27: 4-17
        • Sawatzky B.J.
        • Slobogean G.P.
        • Reilly C.W.
        • Chambers C.T.
        • Hol A.T.
        Prevalence of shoulder pain in adult- versus childhood-onset wheelchair users: a pilot study.
        J Rehabil Res Dev. 2005; 42: 1-8
        • Stout N.L.
        • Binkley J.M.
        • Schmitz K.H.
        • et al.
        A prospective surveillance model for rehabilitation for women with breast cancer.
        Cancer. 2012; 118: 2191-2200
        • 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
        • McCasland L.D.
        • Budiman-Mak E.
        • Weaver F.M.
        • Adams E.
        • Miskevics S.
        Shoulder pain in the traumatically injured spinal cord patient: evaluation of risk factors and function.
        J Clin Rheumatol. 2006; 12: 179-186
        • van Drongelen S.
        • de Groot S.
        • Veeger H.E.
        • et al.
        Upper extremity musculoskeletal pain during and after rehabilitation in wheelchair-using persons with a spinal cord injury.
        Spinal Cord. 2006; 44: 152-159
        • Eriks-Hoogland I.E.
        • Hoekstra T.
        • de Groot S.
        • Stucki G.
        • Post M.W.
        • van der Woude L.H.
        Trajectories of musculoskeletal shoulder pain after spinal cord injury: identification and predictors.
        J Spinal Cord Med. 2014; 37: 288-298
        • Finley M.A.
        • Rodgers M.M.
        Prevalence and identification of shoulder pathology in athletic and nonathletic wheelchair users with shoulder pain: a pilot study.
        J Rehabil Res Dev. 2004; 41: 395-402
        • Escobedo E.M.
        • Hunter J.C.
        • Hollister M.C.
        • Patten R.M.
        • Goldstein B.
        MR imaging of rotator cuff tears in individuals with paraplegia.
        AJR Am J Roentgenol. 1997; 168: 919-923
        • Kivimaki J.
        • Ahoniemi E.
        Ultrasonographic findings in shoulders of able-bodied, paraplegic and tetraplegic subjects.
        Spinal Cord. 2008; 46: 50-52
        • Lal S.
        Premature degenerative shoulder changes in spinal cord injury patients.
        Spinal Cord. 1998; 36: 186-189
        • Campbell C.C.
        • Koris M.J.
        Etiologies of shoulder pain in cervical spinal cord injury.
        Clin Orthop Relat Res. 1996; : 140-145
        • Akbar M.
        • Balean G.
        • Brunner M.
        • et al.
        Prevalence of rotator cuff tear in paraplegic patients compared with controls.
        J Bone Joint Surg Am. 2010; 92: 23-30
        • 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
        • Hegedus E.J.
        • Cook C.
        • Lewis J.
        • Wright A.
        • Park J.Y.
        Combining orthopedic special tests to improve diagnosis of shoulder pathology.
        Phys Ther Sport. 2015; 16: 87-92
        • Hegedus E.J.
        • Goode A.P.
        • Cook C.E.
        • et al.
        Which physical examination tests provide clinicians with the most value when examining the shoulder? Update of a systematic review with meta-analysis of individual tests.
        Br J Sports Med. 2012; 46: 964-978
        • Saulle M.
        • Gellhorn A.C.
        Approach to the diagnosis of shoulder pain using physical exam and ultrasound: an evidence-based approach.
        Curr Phys Med Rehabil Rep. 2017; 5: 1-11
        • Boninger M.L.
        • Towers J.D.
        • Cooper R.A.
        • Dicianno B.E.
        • Munin M.C.
        Shoulder imaging abnormalities in individuals with paraplegia.
        J Rehabil Res Dev. 2001; 38: 401-408
        • Roy J.S.
        • Braen C.
        • Leblond J.
        • et al.
        Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis.
        Br J Sports Med. 2015; 49: 1316-1328
        • Brose S.W.
        • Boninger M.L.
        • Fullerton B.
        • et al.
        Shoulder ultrasound abnormalities, physical examination findings, and pain in manual wheelchair users with spinal cord injury.
        Arch Phys Med Rehabil. 2008; 89: 2086-2093
        • Hassett L.
        • Moseley A.
        • Harmer A.
        • van der Ploeg H.P.
        The reliability, validity, and feasibility of physical activity measurement in adults with traumatic brain injury: an observational study.
        J Head Trauma Rehabil. 2015; 30: E55-E61
        • Washburn R.A.
        • Zhu W.
        • McAuley E.
        • Frogley M.
        • Figoni S.F.
        The Physical Activity Scale for Individuals with Physical Disabilities: development and evaluation.
        Arch Phys Med Rehabil. 2002; 83: 193-200
        • Curtis K.A.
        • Roach K.E.
        • Applegate E.B.
        • et al.
        Reliability and validity of the Wheelchair User's Shoulder Pain Index (WUSPI).
        Paraplegia. 1995; 33: 595-601
        • 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
        • Neer II, C.S.
        Impingement lesions.
        Clin Orthop Relat Res. 1983; : 70-77
        • Hawkins R.J.
        • Kennedy J.C.
        Impingement syndrome in athletes.
        Am J Sports Med. 1980; 8: 151-158
        • Bennett W.F.
        Specificity of the Speed's test: arthroscopic technique for evaluating the biceps tendon at the level of the bicipital groove.
        Arthroscopy. 1998; 14: 789-796
        • European Society of Musculoskeletal Radiology
        Musculoskeletal ultrasound technical guidelines: I.
        Shoulder. 2010; (Available at:) (Accessed March 1, 2015)
        • Cohen J.
        Statistical power analysis for the behavioral sciences.
        32nd ed. Lawrence Erlbaum Associates, Hillsdale1988
        • Portney L.G.
        • Watkins M.P.
        Foundations of clinical research: applications to practice.
        3rd ed. Pearson/Prentice Hall, Upper Saddle River2009
        • Davis J.A.
        Elementary survey analysis.
        Prentice-Hall, Englewood Cliffs1971
        • Collinger J.L.
        • Fullerton B.
        • Impink B.G.
        • Koontz A.M.
        • Boninger M.L.
        Validation of greyscale-based quantitative ultrasound in manual wheelchair users: relationship to established clinical measures of shoulder pathology.
        Am J Phys Med Rehabil. 2010; 89: 390-400
        • Jacobson J.A.
        • Lancaster S.
        • Prasad A.
        • van Holsbeeck M.T.
        • Craig J.G.
        • Kolowich P.
        Full-thickness and partial-thickness supraspinatus tendon tears: value of US signs in diagnosis.
        Radiology. 2004; 230: 234-242