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Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study

Sara J. Mulroy, Patricia Hatchett, Valerie J. Eberly, Lisa Lighthall Haubert, Sandy Conners, Philip S. Requejo
DOI: 10.2522/ptj.20130606 Published 1 July 2015
Sara J. Mulroy
S.J. Mulroy, PT, PhD, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center, 7601 E Imperial Hwy, Bldg 800, Downey, CA 90242 (USA).
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Patricia Hatchett
P. Hatchett, DPT, NCS, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
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Valerie J. Eberly
V.J. Eberly, PT, NCS, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
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Lisa Lighthall Haubert
L. Lighthall Haubert, MPT, KEMG, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
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Sandy Conners
S. Conners, PTA, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
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Philip S. Requejo
P.S. Requejo, PhD, Pathokinesiology Laboratory, Rancho Los Amigos National Rehabilitation Center.
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Abstract

Background Shoulder joint pain is a frequent secondary complaint for people following spinal cord injury (SCI).

Objective The purpose of this study was to determine predictors of shoulder joint pain in people with paraplegia.

Methods/Design A 3-year longitudinal study was conducted. Participants were people with paraplegia who used a manual wheelchair for at least 50% of their mobility and were asymptomatic for shoulder pain at study entry. Participants were classified as having developed shoulder pain if they experienced an increase of ≥10 points on the Wheelchair User's Shoulder Pain Index in the 3-year follow-up period. Measurements of maximal isometric shoulder torques were collected at study entry (baseline), 18 months, and 3 years. Daily activity was measured using a wheelchair odometer, and self-reported daily transfer and raise frequency data were collected by telephone every 6 weeks.

Results Two hundred twenty-three participants were enrolled in the study; 39.8% developed shoulder pain over the 3-year follow-up period. Demographic variables and higher activity levels were not associated with shoulder pain onset. Baseline maximal isometric torque (normalized by body weight) in all shoulder muscle groups was 10% to 15% lower in participants who developed shoulder pain compared with those who remained pain-free. Lower shoulder adduction torque was a significant predictor of shoulder pain development (log-likelihood test=11.38), but the model explained only 7.5% of shoulder pain onset and consequently is of limited clinical utility.

Limitations Time since SCI varied widely among participants, and transfer and raise activity was measured by participant recall.

Conclusions Participants who developed shoulder pain had decreased muscle strength, particularly in the shoulder adductors, and lower levels of physical activity prior to the onset of shoulder pain. Neither factor was a strong predictor of shoulder pain onset.

Footnotes

  • Dr Mulroy and Dr Requejo provided concept/idea/research design. Dr Mulroy, Ms Hatchett, and Dr Requejo provided writing. Ms Hatchett, Ms Eberly, Ms Lighthall Haubert, Ms Conners, and Dr Requejo provided data collection. Dr Mulroy, Ms Hatchett, Dr Requejo, and Ms Conners provided data analysis. Dr Mulroy and Dr Requejo provided project management and fund procurement. Dr Requejo provided facilities/equipment. Ms Conners provided administrative support. Ms Hatchett, Ms Eberly, Ms Lighthall Haubert, and Dr Requejo provided consultation (including review of manuscript before submission). The authors acknowledge the technical support of Ramon Cervantes, Juan Garibay, Diego Rodriguez, Maneekobkunwong, Somboon, Charles Whitehead, and Carlos Williams.

  • This study was approved by the Institutional Review Board of Rancho Los Amigos National Rehabilitation Center.

  • This study was supported by a grant from the National Institutes of Health (R01 HD049774).

  • Received December 17, 2013.
  • Accepted February 17, 2015.
  • © 2015 American Physical Therapy Association
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Vol 95 Issue 7 Table of Contents
Physical Therapy: 95 (7)

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Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study
Sara J. Mulroy, Patricia Hatchett, Valerie J. Eberly, Lisa Lighthall Haubert, Sandy Conners, Philip S. Requejo
Physical Therapy Jul 2015, 95 (7) 1027-1038; DOI: 10.2522/ptj.20130606

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Shoulder Strength and Physical Activity Predictors of Shoulder Pain in People With Paraplegia From Spinal Injury: Prospective Cohort Study
Sara J. Mulroy, Patricia Hatchett, Valerie J. Eberly, Lisa Lighthall Haubert, Sandy Conners, Philip S. Requejo
Physical Therapy Jul 2015, 95 (7) 1027-1038; DOI: 10.2522/ptj.20130606
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