Shoulder Pain in Wheelchair Users With Tetraplegia and Paraplegia.

Curtis KA, Drysdale GA, Lanza RD, et al (Division of Physical Therapy, Department of Orthopedics and Rehabilitation, University of Miami School of Medicine, Miami, Fla; Department of Physical Therapy, School of Health and Human Services, California State University, Fresno, Fresno, Calif), Arch Phys Med Rehabil. 1999;80:453-457.

This study compared the prevalence and intensity of shoulder pain in individuals with tetraplegia and paraplegia while performing specific functional activities.

The study was based on 195 responses out of 700 questionnaires (28%) that were sent out to people with tetraplegia or paraplegia. Data were collected regarding age, sex, marital status, duration of wheelchair use, level of spinal cord injury (SCI), frequency of wheelchair transfers per day, hours per week spent at work or school, sporting and recreational activities, history of shoulder problems, type of medical attention and treatment sought for shoulder pain, and presence of other upper-extremity pain. The subjects were 195 people with SCI (55 women, 140 men) who used manual wheelchairs for a minimum of 3 hours per week. The subjects with tetraplegia (n=92; average age= 32.9 [+ or -] 10.1 years) had used their wheelchairs for an average of 6.9 years, and 55% were employed or students. The subjects with paraplegia (n=103; average age=34.4 [+ or -] 10.7 years) had used their wheelchairs for an average of 7.2 years, and 65% were employed or students.

All respondents filled out the Wheelchair User's Shoulder Pain Index (WUSPI), which assessed pain intensity during specific activities of daily living (eg, transfers, loading a wheelchair into a car, wheeling up inclines). In order to accurately reflect the intensity of the shoulder pain instead of assuming that both groups could perform the activities at equal levels, the authors corrected WUSPI scores to reflect tasks that were done by subjects with paraplegia but could not be done by subjects with tetraplegia. These scores were labeled PC-WUSPI (Performance Corrected) scores. These corrected scores were 70% higher for subjects with tetraplegia.

Data were summarized using descriptive statistics, and differences between the subjects with tetraplegia and subjects with paraplegia were analyzed using chi-square analysis and independent t tests. Two-factor analysis of variance was used to examine the effect of age and SCI level on shoulder pain scores and the effect of duration of wheelchair use and SCI level on shoulder pain scores. Significance was determined at an alpha level of .05.

According to the results of the study, 78% of the subjects with tetraplegia and 59% of the subjects with paraplegia developed shoulder pain since becoming a wheelchair user, 59% of the subjects with tetraplegia and 42% of the subjects with paraplegia reported current shoulder pain, 47% of the subjects with tetraplegia and 34% of the subjects with paraplegia experienced bilateral shoulder pain, and 60% of the subjects with tetraplegia and 46% of the subjects with paraplegia reported pain during sleeping hours. Both groups reported the highest intensity of shoulder pain while pushing the wheelchair up an incline, pushing for longer than 10 minutes, and while sleeping. In addition, subjects with tetraplegia had significantly higher scores for pushing wheelchairs up inclines, putting on a T-shirt or pullover, and driving.

The authors concluded that shoulder pain occurred commonly in subjects with SCI and that this pain limited the ability of these subjects to perform functional activities. They likewise noted that the prevalence and intensity of shoulder pain was greater in subjects with tetraplegia versus subjects with paraplegia and that shoulder pain tended to limit functional activities to a greater extent in subjects with tetraplegia compared with those with paraplegia. Based on this information, the authors suggested that strategies should be developed to prevent or decrease shoulder pain in people with SCI, especially as these individuals age and use a wheelchair for several years.

Roslyn Sofer, PT, OCS
Touro College
Bay Shore, NY