Shoulder pain is a common and persistent problem among individuals with spinal cord injury (SCI), reported to range between 30 and 50% in subjects with paraplegia. The high prevalence of shoulder pain and impingement problems may be related to increased loading and the repetitive use of the upper limbs during functional tasks of daily living. Mechanisms of impingement have been linked to alterations in scapulothoracic and glenohumeral kinematics resulting in a reduction in the available subacromial space and subsequent soft tissue injury. Although faulty motion patterns have been identified in subjects with impingement syndrome without SCI, these kinematics have not been assessed during functional tasks in subjects with SCI. Further, quantitative evidence documenting specific patterns of abnormal scapular or humeral motion in directions that negatively impact the subacromial space in persons with SCI is not available.
The specific aims of the current research study are to identify if detrimental three-dimensional scapulothoracic and glenohumeral kinematic patterns distinguish subjects with SCI and shoulder pain from those without shoulder pain during a weight relief raise and transfer activity. Forty subjects between the ages of 18 and 65 with a SCI resulting in paraplegia below the T2 neurological level will be recruited for the study. One half of these subjects will have a diagnosed history of shoulder pain and test positive for shoulder impingement on clinical examination. The comparison group will have no history or current symptoms of shoulder pain. Three-dimensional kinematics will be recorded using electromagnetic tracking sensors while subjects complete the weight relief raise and transfer tasks. Comparisons will be made between the groups for different phases of each task using an ANOVA model and follow-up testing. If altered scapular kinematic patterns can be identified, then interventions can be designed to modify, and more importantly, prevent further progression of these detrimental movement patterns through selective stretching and strengthening exercises ? ?
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|Nawoczenski, Deborah A; Ritter-Soronen, Jordan M; Wilson, Christine M et al. (2006) Clinical trial of exercise for shoulder pain in chronic spinal injury. Phys Ther 86:1604-18|