Factors Associated with Shoulder Pain in Manual Wheelchair Users with Spinal Cord Injury.

Objective: To investigate the relationship between shoulder pain and various factors, including patient demographics, physical examination findings, wheelchair setup, and imaging results in manual wheelchair (MW) users with spinal cord injury (SCI).

Design: Thirty MW users with SCI participated in this cross-sectional clinical study. Hawkins - Kennedy, Neer and Speed tests were performed on both shoulders. Ultrasound shoulder pathology rating scale (USPRS) and critical shoulder angle (CSA) calculation on anteroposterior radiographs were used. Wheelchair measurements included the rear axle-to-acromion distance and the elbow angle while the patient held their hand at the top of pushrim.

Results: Wheelchair users' shoulder pain index (WUSPI) correlated with duration of MW use, USPRS total score and several subcomponent scores. WUSPI was significantly higher in patients with a CSA of 35° or higher. Patients with the recommended elbow angle and rear axle-acromion distance had significantly lower WUSPI. Clinical tests were unable to detect pathologies identified by means of ultrasound examination in 41.7% to 79.3% of cases.

Conclusion: Identifying risk factors for shoulder pain is crucial to preventing upper extremity dysfunction in SCI patients. This study supports that proper MW setup, including rear axle placement and elbow angle, reduces shoulder pain. USPRS and CSA can serve as valuable tools for early diagnosis and monitoring.